THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com


S U M M A R Y


DIARY: September 25, 2015 03:36 AM Friday; Rod Welch

VA meetings recover injury hiking Half Dome release from hospital.

1...Summary/Objective
....Youtube video on changing Hydrofera Blue dressing...
....HYDROFERA BLUE BACTERIOSTATIC DRESSINGS
....INSTRUCTIONS FOR USE


..............
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CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0403 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0403 -    ..
0404 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040501 - Follow up ref SDS 11 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040503 - Very productive day, with high quality care.  Wound dressing changed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040504 - early AM, then walked through the hospital to aid recovery - about 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040505 - mile.  Organized tables to facilitate working today. ref SDS 0 XO5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040506 - About 4 hours later, met with surgery team for examination.  Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040507 - explained new work plan to change dressing once-a-day to be performed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040508 - by Home Care nurse. ref SDS 0 PPUR  Surgery team changed dressing and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040509 - packed wound with greater density. ref SDS 0 R16G  Surgery team                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040510 - returned 30 minutes later and changed the dressing again using greater                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040511 - packing density that expanded undermining with significant pain.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040512 - ref SDS 0 YN5M  Cardiology scheduled meeting with Doctor Simpson to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040513 - schedule testing for response to treatment regressing atherosclerosis.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040514 - ref SDS 0 GK9I  Went to ROI and received lab results for this morning,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040515 - that shows rising WBC 10.8 at top of range. ref SDS 0 BY6M  Later                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040516 - wound dressing came loose and fell to the ankle, so Ericka did the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040517 - dressing again. ref SDS 0 PQYU  Discharge manager visited and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040518 - explained arrangements coordinated yesterday by Alona, for a nurse to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040519 - change the wound dressing each day at home. ref SDS 0 M54Q  Christy                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040520 - Burns provided expert wound care, changing the protocol for the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040521 - dressing system. ref SDS 0 DP4K  This was the 4th or 5th wound                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040522 - dressing change since the Surgery Team.  Christy also changed from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040523 - daily to changing dressing every 3 days, and this will be done in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040524 - hospital by Svetlana, beginning next Monday, thus eliminating                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040525 - requirements for home care nursing. ref SDS 0 NS5J  Christy reported                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040526 - the wound looks infected, which aligns with elevated WBC in lab                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040527 - earlier this morning. ref SDS 0 QX3Q  The nurse Ericka coordinated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040528 - with Discharge Manager medications for the patient to take home.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040529 - ref SDS 0 5G5O  Lena in the Pharmacy was very helpful aligning                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040530 - Omeprazole prescription with patient requirements. ref SDS 0 5G8T                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040531 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040532 -            [On 150928 0900 Lana in VA Wound Outpatient Clinic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040533 -            changed Hydrofera Blue Tunnel dressing, and switched to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040534 -            Enluxtra wound dressing for covering the Hydrofera Blue                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040535 -            tunnel packing dressing. ref SDS 14 XI5J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040536 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040537 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040538 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040539 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040541 -  ..
0406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0408 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040901 - Earlier this morning, about 0130 - 0230, Nancy changed the strip gauze                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040902 - dressing and bandage on the debridement surgery wound.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040904 -  ..
040905 - Struggled to get out of bed and through initial 5 - 10 minute pain                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040906 - cycle that then enables walking normally.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040908 -  ..
040909 - Walked through the hospital on 2nd floor, and then did 4 - 5 laps                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040910 - around the ward, totalling about 1 mile.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040912 -  ..
040913 - Saw Doctor Jason Yoo and said good morning, as he entered the ward to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040914 - begin his shift.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040916 -  ..
040917 - Back in the room, cleaned things up and changed organization of tables                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040918 - to make work more efficient configuring the computer in relation to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040919 - medical paraphernalia.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040920 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040921 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040922 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040923 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040924 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040925 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040926 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040928 -  ..
0410 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0411 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0412 - 0514                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0413 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041301 - Nurse came in for blood draw.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041302 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041303 - Continued working on the record for past few days.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041304 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041306 -  ..
0414 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0415 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0416 - 0657                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0417 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041701 - Meeting with surgical team for wound recovery left leg injury.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041702 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041703 -        Doctor Lucy Kornblith                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041704 -        Doctor Jason Yoo                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041705 -        Brandon Siminatore, student                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041706 -        Catherine Burke, student                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041707 -        Onur Yenigun, student                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041709 -  ..
041710 - Doctor Kornblith examined the wound.   She seemed to indicate the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041711 - condition today shows progress toward recovery, compared to yesterday.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041712 - The doctor further indicated that the wound should be re-bandaged                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041713 - today and packed with strip gauze in greater density than the nurse                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041714 - did last night, per above. ref SDS 0 XO5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041716 -  ..
041717 - Doctor Kornblith confirmed planning yesterday by Alona.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041718 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041719 -        1.  Discharge today                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041720 -        2.  Wound packing once a day                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041721 -        3.  VA nurse home care change wound dressing with strip packing gauze.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041723 -  ..
041724 - Doctor Kornblith explained that changing and packing the wound 3 times                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041725 - per day, as prescribed yesterday on 150924 0330, ref SDS 12 LF7I, is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041726 - the optimal line of care to recover from this large hematoma on lower                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041727 - left leg treated with surgical debridement by Jessica on 150923 1530.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041728 - ref SDS 11 QD5K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041730 -  ..
041731 - The doctor then approved changing the protocl from 3 times to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041732 - once-a-day, because the location of the wound on the lower left leg                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041733 - makes this work changing the dressing (including strip gauze packing)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041734 - complicated and delicate with high risk of compounding injury.  This                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041735 - work requires professional, experienced, medical expertise.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041737 -  ..
041738 - Doctor Kornblith's decision that the work be performed by experienced,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041739 - medical professionals reflects difficulty VA medical staff encountered                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041740 - performing the doctor's order for "dense" gauze packing. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041741 - DR9G  So far, everyone has done it differently.  Accordingly, there is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041742 - no reasonable expectation that patients with no medical training nor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041743 - experience can gain sufficient skill in 1 or 2 days to achieve optimal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041744 - or even satisfactory results.  Since Home Care professionals typically                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041745 - can only attend patients once-a-day, the prescription was approved to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041746 - change wound dressing with strip gauze packing to once per day.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041748 -  ..
041749 - The doctor advised that the discharge team will make arrangements for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041750 - Home Care nurse to come once per day.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041752 -  ..
041753 - Doctor Kornblith removed the bandage and strip gauze packing placed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041754 - earlier this morning by Nancy, per above. ref SDS 0 XO5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041755 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041756 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041758 -  ..
041759 - The doctor used patient cell phone to record improving condition of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041760 - the wound...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041761 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041762 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041764 -  ..
041765 - The doctor commented there is evident healing progress with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041766 - debridgement wound already beginning to close.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041768 -  ..
041769 - Doctor Kornblith presented following work plan to heal from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041770 - debridement surgery yesterday...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041771 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041772 -        1.  Home Care nurse beginning tomorrow will remove dressing and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041773 -            perform wound strip gauze packing and gauze bandaging, as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041774 -            done last night in ER...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041775 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041776 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041778 -             ..
041779 -        2.  Patient follow up examination in Wound Clinic on 150928.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041780 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041781 -                           United States Department Veteran's Affairs                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041782 -                           Medical Center                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041783 -                           Building 200 Room GA-157                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041784 -                           4150 Clement Street                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041785 -                           San Francisco, CA  94121                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041786 -                           415 221 4810  ext 4772                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041787 -                           Cell 415 260 3456                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041789 -             ..
041790 -        3.  Avoid standing still.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041792 -             ..
041793 -        4.  Avoid sitting normally on a chair with feet touching the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041794 -            ground - whenever possible left foot should be elevated to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041795 -            heart level with pillows, shown in photograph of patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041796 -            care in hospital gurney...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041797 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041798 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041799 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041800 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041802 -             ..
041803 -        5.  When sitting, elevate left leg to avoid blood pooling in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041804 -            the wound that increases pressure on damaged tissue,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041805 -            causing infection and pain.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041807 -             ..
041808 -        6.  Avoid long hikes (over 3 miles) until approved by doctor -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041809 -            estimate 1 - 2 weeks.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041810 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041811 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041812 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041813 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041814 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041815 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041816 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041818 -  ..
0419 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0420 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0421 - 0723                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0422 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
042201 - Doctor Kornblith.  Doctor Jason Yoo, and Brandon Siminatore, student,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
042202 - left the room to continue checking other patients.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
042204 -  ..
042205 - Catherine Burke and Onur Yenigun remained.  They dressed the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
042206 - debridgement wound again with strip gauze packing, implementing Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
042207 - Kornblith's guidance, per above, ref SDS 0 DR9G, shown in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
042208 - photographs...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
042209 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042210 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
042211 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042212 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
042214 -  ..
042215 - After Onur completed this work, he and Catherine left the room.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042216 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042217 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042219 -  ..
0423 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0424 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0425 - 0807                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0426 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
042601 - Catherine Burke and Onur Yenigun returned.  They advised that Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042602 - Kornblith decided to use a diffferent bandage procedure, because the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042603 - packing gauze will only be changed once per day.  Accordingly, they                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
042604 - removed the gauze packing and bandaging just placed, per above.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042605 - ref SDS 0 R16G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
042607 -  ..
042608 - This 2nd packing procedure took longer, and was much more painful than                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
042609 - previous wound packing by Jessica post debridement surgery in the ER,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
042610 - and then by Nancy in Med Surg, ref SDS 0 XO5I, and by Onur 30 minutes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
042611 - ago, per above. ref SDS 0 R16G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
042613 -  ..
042614 - Seemed like more packing strip gauze was forced beneath the skin,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
042615 - which expanded undermining on this procedure, possibly indicated by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
042616 - photograph...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
042617 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042618 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
042620 -  ..
042621 - Thanked Catherine and Onur for good work...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
042622 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042623 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
042624 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042625 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042627 -  ..
0427 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0428 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0429 - 0835                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0430 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043001 - After surgical team completed dressing the leg wound, and left the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043002 - room, walked down the hall to Karen's office in cardiology.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043004 -  ..
043005 - She was very nice asking about injuries on noticing attire signalling                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043006 - admission to the hospital as a patient.  Explained the fall 10 days                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043007 - ago on 150916 hiking Half Dome in Yosemite.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043009 -  ..
043010 - Karen recalled recommending request consult with Doctor Paul Simpson                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043011 - in Cardiology on ordering CCTA, reported on 150526 1148. ref SDS 5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
043012 - PB70  This followed up initial discussions with Karen and Doctor Shunk                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043013 - considering non-invasive procedures for testing response to treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043014 - that regresses atherosclerosis on 131121 0930. ref SDS 1 MZ5K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043016 -  ..
043017 - Explained that Doctor Rao made referral to Doctor Simpson, about 2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043018 - months ago on 150731 1610, ref SDS 10 FO9I, but have not received                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
043019 - notice of meeting.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043021 -  ..
043022 - Karen indicated that VA failure to schedule a meeting indicates the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043023 - notice has been side tracked.  Walked with Karen back down the hall,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043024 - to a small office next door to Karen.  She introduced, Joe, the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043025 - schedule clerk.  Karen asked him to schedule a meeting with Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043026 - Paul Sampson.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043028 -  ..
043029 - Joe said the VA computer is down.  He took the name and last 4 of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043030 - social security, and will schedule a meeting with Doctor Sampson when                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043031 - the computer system comes back online.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043032 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043033 -            [On 151001 1200 meeting with Joe again; he scheduled                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043034 -            meeting with Doctor Simpson on 151014 0900. ref SDS 16 JH8I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043036 -             ..
043037 -            [On 151005 1102 chance meeting with Doctor Wineski, Chief                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
043038 -            of Cardiology, in hallway, reviewed issues to discuss with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043039 -            Doctor Simpson on ordering CCTA to assess reducing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043040 -            treatments with statins based on finding no evidence of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043041 -            atherosclerotic plaques, and in order to reduce side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043042 -            effects of increased urination that causes dehydration,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043043 -            which then causes blistering, peeling, cracking, bleeding                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043044 -            feet that prevents hiking, and further to possibly increase                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043045 -            PPI (Omeprazole) in order to prevent ulceration of LESV                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043046 -            following failure of Dor fundoplication. ref SDS 19 5H5N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
043048 -             ..
043049 -            [On 151014 0900 meeting with Doctor Simpson scheduled CCTA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
043050 -            with calcium score on 151019 0930. ref SDS 21 OG3N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043052 -             ..
043053 -            [On 151019 0930 CCTA with calcium score performed; meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
043054 -            with doctor in Radiology Department reviewed requirements                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043055 -            for calcium score to evaluate response to treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043056 -            recovering from atherosclorosis. ref SDS 22 GR4K  At the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
043057 -            end of the meeting, the doctor agreed to perform calcium                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043058 -            score for comprehensive CCTA test. ref SDS 22 LQ5F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043060 -             ..
043061 -            [On 151029 2257 submitted letter to Doctor Stewart                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043062 -            presenting request to assist interpreting CCTA on 151019,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043063 -            for developing calcium score that was omitted in analyst's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043064 -            report. ref SDS 23 4X5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
043066 -             ..
043067 -            [On 151104 1114 discussion with Doctor Stewart planning to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
043068 -            submit medical articles on using CCTA to evaluate response                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043069 -            to treatment for atherosclerosis, and on adverse side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043070 -            effects of statin drugs. ref SDS 24 O66N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
043072 -             ..
043073 -            [On 151119 2141 received letter from Doctor Stewart                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043074 -            submitting 6 medical articles on using CCTA to evaluate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043075 -            response to treatment for atherosclerosis, and on adverse                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043076 -            side effects of statin drugs. ref SDS 25 4X5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043077 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043078 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043079 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043080 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043082 -  ..
0431 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0432 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0433 - 0852                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0434 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043401 - Visited ROI on 1st flooor.  Received lab results on blood draw earlier                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043402 - today, per abpve. ref SDS 0 PPTP                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043404 -  ..
043405 - WBC increased from 9.8 to 10.8, which is the top of the range.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043407 -  ..
043408 - Ordered all medical records for period...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
043409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043410 -                150923 - 150925                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043411 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043412 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043414 -  ..
0435 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0436 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0437 - 0911                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0438 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043801 - Nancy stopped in the room.  Her shift has ended.  She said goodbye                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043802 - and offered good wishes for recovery.  Nancy said it was fun being                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043803 - the nurse, because the patient was very helpful.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043804 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043805 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043807 -  ..
0439 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0440 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0441 - 0916                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0442 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
044201 - Ericka here for antibiotic pill treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
044202 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044203 - She crushed the pills to aid swallowing.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
044204 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044206 -  ..
0443 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0444 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0445 - 1012                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0446 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
044601 - Improvement - can sit up on edge of bed and place feet on the ground                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044602 - without immedate pain in left leg.  Pain then rises instantly to level                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044603 - "12" as blood floods wound in lower left leg.   In 2 minutes or so                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
044604 - pain falls to level 10 which enables standing up.  Few more minutes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044605 - can transfer pressure gradually to left foot.  Pain gradually drops                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044606 - to level 8, enabling left leg and foot to support full weight.  After                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
044607 - few more minutes can barely walk.  Pain then subsides to level 4 and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044608 - can walk normally.  Then drops to 1 - 2, barely noticable.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
044609 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044610 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044612 -  ..
0447 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0448 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0449 - 1027                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0450 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
045001 - Kathy called on cell phone from meeting with GI Clinic at VA Medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
045002 - Center in Sacramento.  She explained asking the staff about                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
045003 - implementing notice from the VA received last week to schedule next                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
045004 - EGD dilation procedure.  The earliest the clinic can schedule meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
045005 - with Doctor Lee for next EGD dilation is on 151204 0800.  This will be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
045006 - 8 months since prior procedure on 150421, ref SDS 4 K37G, and so                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
045007 - conflicts with work plan to meet in 6 months prescribed in Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
045008 - Notes. ref SDS 4 LG9L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
045009 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045010 -            [On 151201 2111 letter submits agenda for meeting to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
045011 -            perform next EGD dilation on 151204. ref SDS 28 DF5J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
045013 -             ..
045014 -            [On 151001 1200 called and left message asking Doctor Lee                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
045015 -            to update refills for Omeprazole PPI so there is enough                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
045016 -            supply to last until next meeting on 151204. ref SDS 17                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
045017 -            PQ3F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045019 -             ..
045020 -            [On 151002 1820 Doctor Lee returned call; will order                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
045021 -            Omeprazole 20 mg prescription sufficient until next EGD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
045022 -            Dilation procedure on 151204, and complimenting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
045023 -            prescription entered on 150925 for only 1 month.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
045024 -            ref SDS 18 NV5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
045026 -             ..
045027 -            [On 151012 1151 VA Internet Pharmacy indicates Doctor Lee                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
045028 -            updated Omeprazole 20 mg prescription so there is enough                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
045029 -            medication to last until next meeting on 151204.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
045030 -            ref SDS 20 0C5H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
045032 -             ..
045033 -            [On 151201 2111 letter submits agenda for meeting to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
045034 -            perform next EGD dilation on 151204. ref SDS 28 DF5J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
045036 -  ..
045037 - Evidently, did not received notice from the VA in time to coordinate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
045038 - schedules.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
045040 -  ..
045041 - Asked Kathy to accept meeting 151204 0800, since this works best for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
045042 - timely operations arriving early enough to complete the work in time                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
045043 - to avoid risks of heavy traffic returning home.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045045 -  ..
045046 - Further asked to schedule the follow up meeting with Doctor Lee to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
045047 - review findings and consider adjusting work plans.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
045049 -  ..
045050 - Kathy said Doctor Lee can meet the following Friday, on 151210 0800.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
045052 -  ..
045053 - Accepted this schedule.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
045054 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045055 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045056 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045057 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045058 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045059 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045061 -  ..
0451 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0452 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0453 - 1101                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0454 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
045401 - Doctor Rao, PCP, called and left message on home phone, so did not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
045402 - actually take this call.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
045404 -  ..
045405 - The doctor reported she reviewed patient history showing admission to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
045406 - VA Medical Center hospital and treatment with debridgement on 150923.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
045407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045408 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045410 -  ..
0455 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0456 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0457 - 1102                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0458 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
045801 - Pain medication provided by Ericka.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
045802 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045803 - Got up and walked around the ward for exercise.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045805 -  ..
045806 - Right wrist seems a bit stiffer today for some reason.  Left wrist                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
045807 - still getting better.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
045808 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045809 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045810 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045812 -  ..
0459 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0460 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0461 - 1106                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0462 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
046201 - Elastic bandage on left leg wound, came loose, and fell to ankle.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
046202 - Walked to Ericka's work station, and showed her the problem.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
046204 -  ..
046205 - She said to return to the room, and she will get supplies to changed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
046206 - the dressing on the wound.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
046207 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
046209 -  ..
0463 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0464 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0465 - 1123                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0466 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
046601 - Ericka arrived.  She removed the gauze wrap and set a new bandage.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
046603 -  ..
046604 - The problem may have been that Onur used a horizontal tape to hold it                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
046605 - in place.  Last night, and Ericka again today have been using vertical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
046606 - tape that extends to the native skin above and below the gauze wrap,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
046607 - which seems to hold the vertical position of the dressing in place.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
046608 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
046609 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
046610 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
046612 -  ..
0467 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0468 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0469 - 1143                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0470 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
047001 - Amalia Garcia visited.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
047002 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047003 - She is with VA Project Red, case coordinator.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
047004 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047005 -                    415 221 4810 ext 2756 also 22756                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
047007 -  ..
047008 - Amalia has ordered Home Health Care to perform gauze bandaging of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
047009 - hematoma surgical wound, ordered by Doctor Korneblith, per above.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
047010 - ref SDS 0 UI6L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
047011 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047012 -            Home Health Agency...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
047013 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047014 -            Happy Hands @ Home                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
047015 -            650 286 9000                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
047016 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047018 -  ..
047019 - She explained the home care nurse will have papers to sign.  This                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
047020 - will not obligate payment by customer of any kind.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
047022 -  ..
047023 - Amalia said the VA will provide home care supplies for the nurse to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
047024 - use.  There is no charge to the customer any supplies.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
047026 -  ..
047027 - The nurse may call later today, or in the morning to schedule a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047028 - convenient time for providing home care.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
047029 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047030 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047032 -  ..
0471 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0472 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0473 - 1312                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0474 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
047401 - Ericka came by.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047402 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047403 - She has paged the Patient Discharge Department for advice on when to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047404 - prepare patient for discharge.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
047405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047408 -  ..
0475 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0476 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0477 - 1413                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0478 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
047801 - Christy Burns visited.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
047802 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047803 - She is with VA Medical Center Wound Care Department...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
047805 -                            ..
047806 -                           Christy Burns, RN, BSN, WCC, CWCN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
047807 -                           United States Department Veteran's Affairs                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047808 -                           Medical Center                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
047809 -                           Building 200 Room GA-157                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
047810 -                           4150 Clement Street                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
047811 -                           San Francisco, CA  94121                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
047812 -                           415 221 4810  ext 4772                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
047813 -                           Cell 415 260 3456                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
047814 -                           christy.burns2@va.gov                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047816 -  ..
047817 - Christy explained that she provides care for wounds on patients in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
047818 - hospital.  Her colleague Svetlana Nakamura (Lana) sees out-patients.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047819 - Lana will see me next Monday, 150928 0900 at...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047820 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047821 -                           Svetlana Nakamura, RN, WCC, OMSN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
047822 -                           United States Department Veteran's Affairs                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047823 -                           Medical Center                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
047824 -                           Nursing Service                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
047825 -                           Building 200 Room GA-157                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
047826 -                           4150 Clement Street                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
047827 -                           San Francisco, CA  94121                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
047828 -                           415 221 4810  ext 4772                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
047829 -                           Cell 415 260 3456                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
047830 -                           christy.burns2@va.gov                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047832 -  ..
047833 - Christy completely removed the strip gause packing performed this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
047834 - morning by Onur, per above. ref SDS 0 DS33  The packing gauze removed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047835 - by Christy seemed over 2' long - it kept coming and coming from the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
047836 - wound.  May explain why packing procedure hurt much more than prior                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
047837 - bandaging earlier today, and yesterday.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
047839 -  ..
047840 - Christy advised that she will use a different type of packing.  It can                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
047841 - stay in place for a week, and at least until the follow up meeting in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047842 - 3 days with Lana on Monday in Module 2 for Would Care Clinic.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
047844 -  ..
047845 - Materials used for bandaging the wound by Christy...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047846 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047847 -        1.  Hydrofera Blue                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
047848 -            Bacterostatic Tunnel Dressing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
047849 -            Part Number:  HBT0906                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
047850 -            Size:  9 MM diameter (1.2 grams)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
047851 -            HCPCS:  A6215                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
047852 -            Quantity:  1 pair                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
047853 -            Single Use Only                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
047855 -  ..
047856 - After the meeting, research on the Internet found...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047857 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047858 -    Youtube video on changing Hydrofera Blue dressing...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
047859 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047860 -              https://www.youtube.com/watch?v=oVxlgPzgck8                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
047861 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047862 -    This video was posted in 2011, and so may be outdated.  However,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
047863 -    seems likely, if the product has more current guidance, there                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
047864 -    would be notice of it for marketing purposes.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
047866 -     ..
047867 -    About 33% through the video there are instructions that say...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
047868 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047869 -               1.  24 hour dressing change instructions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
047870 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047871 -                   Color Change on Dressing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
047872 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047873 -                      Replace dressing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047874 -                      Continue to inspect every 24 hours                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
047875 -                      Until no color change                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
047877 -                    ..
047878 -               2.  No Color Change on Dressing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
047879 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047880 -                   Replace Dressing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
047881 -                   Keep in Place for 72 Hours                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
047882 -                   Unless Strike Through Occurs                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
047884 -  ..
047885 - Another source on changing Hydrofera Blue Dressing...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047886 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047887 -    HYDROFERA BLUE BACTERIOSTATIC DRESSINGS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
047888 -    INSTRUCTIONS FOR USE                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
047889 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047890 -              http://www.hollisterwoundcare.com/files/pdfs/ifus/HydroferaBlueIFU.pdf                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
047891 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047892 -    DRESSING CHANGE AND REMOVAL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
047893 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047894 -    1.  The first dressing change should occur at 24 hours.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
047896 -         ..
047897 -    2.  Examine the area of the dressing in contact with the wound bed:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
047898 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047899 -        a. If the dressing has turned white or lightened in color, the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047900 -           dressing should be changed again at 24 hours until the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
047901 -           dressing retains its color.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047903 -            ..
047904 -        b. If the dressing has retained its color where it is in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047905 -           contact with the wound, a new dressing can be applied and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
047906 -           left in place for up to 72 hours.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
047907 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047908 -              [On 150928 0900 Lana in VA Wound Outpatient Clinic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
047909 -              changed Hydrofera Blue Tunnel dressing, and switched to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047910 -              Enluxtra wound dressing for covering the Hydrofera Blue                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047911 -              tunnel packing dressing. ref SDS 14 XI5J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
047913 -         ..
047914 -    3.  Do not allow the dressing to completely dry out. The dressing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047915 -        should be rehydrated as needed.  If a Hydrofera BlueŽ Dressing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047916 -        is allowed to dry out, rehydration with sterile saline or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
047917 -        sterile water is recommended prior to removal.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047919 -         ..
047920 -    4.  The dressing should be changed if it turns white or upon                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047921 -        strikethrough drainage.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
047923 -  ..
047924 - These two separate sources seem to support leaving Hydrofera Blue                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
047925 - wound dressing in place for up to 72 hours or 3 days.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047926 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047927 -            [On 151201 0848 research found Hydrofera Blue dressing is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
047928 -            recommended to change in 3 days; letter to Lana asksa bout                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047929 -            adjusting schedule. ref SDS 27 UT54                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047931 -             ..
047932 -            [On 151201 0848 at 1027 letter from Lana proposing visit to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
047933 -            VA Medical Center in San Francisco to change wound dressing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
047934 -            on Thursday 151203 0900. ref SDS 27 RS5K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
047936 -             ..
047937 -            [On 151201 0848 at 1033 letter to Lana at VA Medical Center                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
047938 -            in San Francisco, notifies will visit the hospital Wound                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
047939 -            Clinic on Thursday, 151203 0900, to change wound dressing.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047940 -            ref SDS 27 5T7A                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
047942 -             ..
047943 -            [On 151203 0900 Lana related experience in Wound Care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047944 -            Clinic at the VA Medical Center in San Francisco finding                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
047945 -            that, despite product specifications calling for 3 day                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
047946 -            dressing changes, presented in research on 150925 0336,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
047947 -            ref SDS 13 HL6O, favorable results extending changes for 7                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
047948 -            days, ref SDS 29 L43F, using Hydrofera Blue Bacterostatic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
047949 -            wound dressing, as prescribed during the meeting on 151130                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047950 -            0800. ref SDS 26  Lana further changed the protocol in this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
047951 -            case back to changing wound dressing in 3 days to implement                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
047952 -            product specifications on preventing dressing from drying                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047953 -            out with rehydration, also reported on 150925 0336.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
047954 -            ref SDS 13 SQ76, she decided to check the dressing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
047955 -            personally on 3-4 day intervals to ensure appropriate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
047956 -            action is taken for timely recovery. ref SDS 29 NS4F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047958 -  ..
047959 - This supports Christy's work plan today for Lana to change the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
047960 - dressing at the VA on Monday, 150928.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047962 -  ..
047963 - Wound dressing materials applied today continue...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
047964 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047965 -        2.  Mepilex Border with Safety Technology                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
047966 -            15 x 15 CM                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047967 -            Molnlycke Health Care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
047969 -             ..
047970 -        3.  Tube elastic bandage                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047971 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047973 -  ..
047974 - Christy said the packing used today has anticeptic that will prevent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047975 - infection, and treat any infection that may have occurred up until                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
047976 - now.  Christy said the wound today looks very infected.  This may                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
047977 - explain why WBC elevated this morning since the lab yesterday.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
047978 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047979 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
047980 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047981 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
047983 -  ..
047984 - Christy expects the specialized packing and bandaging materials have                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047985 - treatment that will resolve infection until Lana examins the wound on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047986 - Monday.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
047988 -  ..
047989 - Asked about getting written approval from the attending physician,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
047990 - Doctor Lucy Kornblith, per above, ref SDS 0 DR9G, to change wound                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
047991 - treatment protocol she approved earlier this morning, per above?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
047992 - ref SDS 0 DR9G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
047994 -  ..
047995 - Christy said she will enter in her Progress Notes that applied                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
047996 - bandaging for the leg wound in accordance with Wound Department                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047997 - standard of care, per above. ref SDS 0 XN5L  Christy further advised                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047998 - that the Wound Department has better materials and equipment for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
047999 - treating serious wounds than are commonly available to the surgical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
048000 - department here at the Medical Center.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
048002 -  ..
048003 - Christy will notify Amelia to use upgraded procedures implemented by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
048004 - Christy today, rather than gauze strip packing with gauze bandage                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
048005 - roll, used the past 2 days.  This means home care nursing will not be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
048006 - needed tomorrow and Sunday.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
048008 -  ..
048009 - Christy said that normally for a large, severe hematoma on the lower                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
048010 - leg, only 1 length of bacteriostatic tunnel dressing is required to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
048011 - "pack" the wound.  She decided to use 2 lengths for this wound,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048012 - because it has been enlarged by prior packing of seemingly over 2'                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
048013 - long strip of gauze, this morning, reported just above. ref SDS 0 NS59                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
048015 -  ..
048016 - Christy used a wound cover with adhesive to hold the 2 packing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
048017 - lengths in place.  Shen wrote on the Mepilex Border covering the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
048018 - bacteriostatic tunnel dressing...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
048019 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048020 -        2 pieces of hydrofera blue packing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
048021 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048022 -        9/25... representing the date today 150925                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
048024 -         ..
048025 -        CAB... representing her name, "Christy A Burns"                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
048026 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048027 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
048029 -  ..
048030 - Christy advised that the patient will receive supplies at discharge                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
048031 - today for changing only the Mepilex Border with Safety Technology once                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
048032 - a day, using gauze bandaging to hold everything in place, as Christy                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
048033 - has done today.  Her colleague, Lanna, will change both packing with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
048034 - Hydrofera Blue Bacterostatic Tunnel Dressing, and the gauze bandaging                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
048035 - during the meeting next Monday in the Wound Care Department at 0900.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
048036 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048037 -            [On 150928 0900 Lana in VA Wound Outpatient Clinic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
048038 -            changed Hydrofera Blue Tunnel dressing, and switched to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
048039 -            Enluxtra wound dressing for covering the Hydrofera Blue                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
048040 -            tunnel packing dressing. ref SDS 14 XI5J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
048042 -             ..
048043 -            [On 151001 1200 Lana changed Hydrofera Blue Tunnel dressing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
048044 -            and the Enluxtra cover pad, ref SDS 16 LY79; she found                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
048045 -            infected tissue along the edges of the wound, and so used a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
048046 -            surgeon's scaple to cut this tissue so that healing will                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
048047 -            not be impeded; this caused considerable pain. ref SDS 16                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
048048 -            NC9G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048049 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048050 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048051 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048053 -  ..
0481 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0482 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0483 - 1448                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0484 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
048401 - After Christy left, Ericka came into the room.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
048402 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048403 - She is ordering supplies for patient home care to be delivered later                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
048404 - today when the patient is discharged.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
048406 -  ..
048407 - Discussed getting Omeprazole 20 mg to reduce side effects taking 40                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
048408 - mg tablets.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
048410 -  ..
048411 - Ericka will request this from the Pharmacy who is preparing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
048412 - medications for home care.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
048413 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048414 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048416 -  ..
0485 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0486 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0487 - 1457                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0488 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
048801 - Amelia Called.  She has talked to Christy, and concurs a Home Care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
048802 - nurse will not be needed on Saturday and Sunday.  After the meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
048803 - with Lana on Monday, a new work plan will be developed on Home Care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
048804 - support.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
048806 -  ..
048807 - Amelia will call Happy Hands @ Home and notify to standby for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
048808 - providing home care services after Monday, next week on 150928.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048809 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048810 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048811 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048812 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
048814 -  ..
0489 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0490 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0491 - 1507                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0492 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
049201 - Lena with VA Pharmacy called.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
049202 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
049203 - She explained that since Doctor Lee in GI Clinic VA Medical Center in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
049204 - Sacramento has prescribed Omeprazole 40 mg twice a day, and was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
049205 - previously delivered by the VA Pharmacy in Martinez, only the doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
049206 - can change the prescription.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
049208 -  ..
049209 - We reviewed the record showing Doctor Lee changed the prescription                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
049210 - from Omerpazole 20 mg twice per day, in effect the past several years                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
049211 - to the higher dose of 40 mg twice per day on 150624 0924, ref SDS 8                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
049212 - PWQW, in response to notice from the patient to try higher dose                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
049213 - protocol for preventing ulceration of LESV caused by failed Dor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
049214 - Fundoplication, also reported on 150624 0924, ref SDS 8 L861,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
049215 - presented during a meeting with Doctor Lee several months earlier on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
049216 - 150319 0800. ref SDS 3 N46G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
049218 -  ..
049219 - During a meeting with Doctor Stewart, Chief of General Surgery, here                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
049220 - at the VA Medical Center in San Francisco, the doctor explained risks                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
049221 - performing corrective surgery to correct failed Dor fundoplication,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
049222 - reported on 150526 1300. ref SDS 6 L44F  As a result, during a follow                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
049223 - up meeting with Doctor Stewart on 150623, there was discussion to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
049224 - increase Omeprazole in order to reduce ulceration of LESV, and thus                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
049225 - avoid high risk surgery to repair Dor Fundoplication. ref SDS 7 WW5K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
049226 - Doctor Lee was notified in a letter the next day on 150624, of Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
049227 - Stewart's work plan. ref SDS 8 OP91  The doctor called later the same                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
049228 - day on 150624, and ordered the increase in Omeprazole from 20 mg twice                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
049229 - per day to 40 mg twice per day. 150624 0924, ref SDS 8 L861                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
049231 -  ..
049232 - This was tried for several weeks, but turned out to cause severe side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
049233 - effects taking Omeprazole 40 mg, reported on 150819, shown in case                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
049234 - study patient medication, diet, exercise and vitals on 140101 0600.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
049235 - ref SDS 2 4Q5F  As a result, we need to return to Omeprazole 20 mg                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
049236 - twice per day.  To reduce side effects of severe dehydration from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
049237 - frequent urination, will take Omeprazole 20 mg only once per day or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
049238 - as needed based on immediate symptoms.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
049240 -  ..
049241 - Lena said she will enter a new prescription for Omeprazole 20 mg twice                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
049242 - per day and provide 1 month supply for the patient to take home on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
049243 - discharge later today.  Patient can coordinate with Doctor Lee on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
049244 - finalizing line of care during next EGD dilation procedure coming up                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
049245 - next month.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
049247 -  ..
049248 - Thanked Lena for timely consideration.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
049249 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
049250 -            [On 151001 1200 at 1342 called and left message for Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
049251 -            Lee to enter new prescription for Omeprazole 20 mg to last                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
049252 -            at least until next EGD Dilation meeting on 151204.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
049253 -            ref SDS 16 PQ3F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
049255 -             ..
049256 -            [On 151002 1820 Doctor Lee returned call; will order                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
049257 -            Omeprazole 20 mg prescription sufficient until next EGD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
049258 -            Dilation procedure on 151204, and complimenting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
049259 -            prescription entered on 150925 for only 1 month.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
049260 -            ref SDS 18 NV5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
049261 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
049262 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
049263 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
049265 -  ..
0493 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0494 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0495 - 1521                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0496 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
049601 - Met with Onur Yenigun.  He was in the doctors "on-call" office, which                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
049602 - is just around the corner from the room.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
049604 -  ..
049605 - Onur did the 2 packing care episodes, earlier morning, per above.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
049606 - ref SDS 0 DS33                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
049608 -  ..
049609 - Explained that left knee now feels "thicker" and so swollen.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
049611 -  ..
049612 - Walked back to the patient room.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
049614 -  ..
049615 - Onur made clinical examination.  He tested the area between the knee                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
049616 - and the hematoma care wound by feeling the skin with his hand.  Onur                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
049617 - seemed to indicate there is slight increased temperature to the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
049618 - touch, and compared with the right knee.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
049620 -  ..
049621 - Onur cited inflammation coloration above the wound                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
049622 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
049623 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
049625 -  ..
0497 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0498 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0499 - 1533                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0500 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
050001 - Ericka removed the IV getting ready to go home.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050002 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050003 - She read through discharge instructions.  These have been superseeded                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050004 - by Christy's instructions an hour or so ago.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050006 -  ..
050007 - Erica submitted a large bag full of...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050008 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050009 -        1.  Kerlix Bandage Rolls                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050010 -            100% cotton 6 ply large - 4.5" x 4 yards long                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
050011 -            Product specification:  15G253162X                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
050013 -  ..
050014 - Another bag contained about 6 each...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050015 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050016 -        2.  Hydrofera Blue                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
050017 -            Bacterostatic Tunnel Dressing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
050018 -            Part Number:  HBT0906                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050019 -            Size:  9 MM diameter (1.2 grams)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
050020 -            HCPCS:  A6215                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
050021 -            Quantity:  1 pair                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050022 -            Single Use Only                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
050024 -             ..
050025 -        3.  Mepilex Border with Safety Technology                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050026 -            15 x 15 CM                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050027 -            Molnlycke Health Care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050029 -             ..
050030 -        4.  Tube elastic bandage                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050032 -  ..
050033 - These are for changing the wound dressing  every day at home, as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050034 - explained by Christy earlier today, per above.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
050036 -  ..
050037 - Erica submitted 3 medications and explained instructions for home                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
050038 - care...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
050039 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050040 -        1.  Omeprazole 20 mg capsules RX 6101616                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050041 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050042 -            Take 1 capsule twice a day.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050044 -  ..
050045 - This implements planning the call with Lena in the Pharmacy earlier                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050046 - today, per above. ref SDS 0 5G8T                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050048 -             ..
050049 -        2.  Clindamycin HLC 150 MG RX 6101596                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050050 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050051 -            Take 2 pills every 6 hours for next 7 days to control                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050052 -            infection.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050054 -             ..
050055 -            Doctor Yoo                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050056 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050057 -               [On 151001 1200 at 1315 received from Pharmacy VA MCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
050058 -               another order for Clindamycin HLC 150 MG RX 6101596                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
050059 -               quantity 28 to complete prescription for 7 days                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
050060 -               medication. ref SDS 16 477B                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050062 -             ..
050063 -        3.  Hydrocodone 5 MG with Acetaminophen 325 MG RX 90421826                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
050064 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050065 -            Take up to 2 pills every 6 hours to control pan as needed.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050067 -             ..
050068 -            Doctor Yoo                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050070 -  ..
050071 - Discussed protocol for resolving breakthrough pain.  The past 2 days,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050072 - Nancy on the night shift, and Ericka on days have been giving Percocet                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050073 - for breakthrough pain between 6 hour treatment intervals.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
050075 -  ..
050076 - Ericka left the room to investigate treatment for breakthrough pain                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050077 - during home care.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
050078 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050079 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050081 -  ..
0501 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0503 - 1542                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
050401 - After Ericka left, got dressed and assembled c16 in case for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050402 - traveling.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
050404 -  ..
050405 - Walked into the hallway, and saw Doctor Stewart in conversation with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050406 - another provider.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
050408 -  ..
050409 - Doctor Stewart took a moment to discuss CCTA, previously considered                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050410 - with her in the meeting on 150623 1300. ref SDS 7 1Y5L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050412 -  ..
050413 - Reviewed meeting with Doctor Rao in Primary Care, indicating on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050414 - 150729, that CCTA should be ordered by Cardiology, 150729 0800.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050415 - ref SDS 9 TA91                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050417 -  ..
050418 - Doctor Stewart smiled and said that she can order CCTA herself.  She                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050419 - requested email address for submitting articles on debilitating side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050420 - effects from taking statin drugs.  After the patient responds, she                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050421 - will consider ordering CCTA to assess need for taking statin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050422 - medications.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050423 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050424 -            [On 151005 1102 discussion with Doctor Wisneski in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
050425 -            Cardiology; she opposes CCTA, ref SDS 19 VZ4L, she proposed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050426 -            reducing dose of statins and taking treatment every other                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050427 -            day, to reduce adverse side effects. ref SDS 19 GL7G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050429 -             ..
050430 -            [On 151014 0900 meeting with Doctor Simpson scheduled CCTA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
050431 -            with calcium score on 151019 0930. ref SDS 21 OG3N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050433 -             ..
050434 -            [On 151019 0930 CCTA with calcium score performed; meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
050435 -            with doctor in Radiology Department reviewed requirements                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050436 -            for calcium score to evaluate response to treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
050437 -            recovering from atherosclorosis. ref SDS 22 GR4K  At the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
050438 -            end of the meeting, the doctor agreed to perform calcium                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050439 -            score for comprehensive CCTA test. ref SDS 22 LQ5F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050441 -             ..
050442 -            [On 151029 2257 submitted letter to Doctor Stewart                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
050443 -            presenting request to assist interpreting CCTA on 151019,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050444 -            for developing calcium score that was omitted in analyst's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050445 -            report. ref SDS 23 4X5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
050447 -             ..
050448 -            [On 151104 1114 discussion with Doctor Stewart planning to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
050449 -            submit medical articles on using CCTA to evaluate response                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050450 -            to treatment for atherosclerosis, and on adverse side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050451 -            effects of statin drugs. ref SDS 24 O66N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
050453 -             ..
050454 -            [On 151119 2141 received letter from Doctor Stewart                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050455 -            submitting 6 medical articles on using CCTA to evaluate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050456 -            response to treatment for atherosclerosis, and on adverse                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050457 -            side effects of statin drugs. ref SDS 25 4X5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
050459 -  ..
050460 - Thanked Doctor Stewart for continuing interest following up                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
050461 - discussions on 150623 1300, ref SDS 7 1Y5L, reflected in the addendum                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
050462 - the doctor entered to Progress Notes saying she supports performing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050463 - CCTA and defers to Primary Care to order the test. ref SDS 7 UM4O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
050464 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050465 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050466 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050467 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050468 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050469 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050470 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050472 -  ..
0505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0506 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0507 - 1553                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0508 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
050801 - Ericka returned.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050802 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050803 - She related instructions from the Pharmacy that rather than provide                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050804 - Percocet for breakthrough pain used the past 2 days in the hospital,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050805 - the patient should take an additional tablet of the mainline treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050806 - with 2 capsules of Hydrocodone 5 MG with Acetaminophen 325 MG RX                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050807 - 90421826, at home, when breakthrough occurs between the 6 hour                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
050808 - treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
050810 -  ..
050811 - Additionally, for some reason Ericka provided an entire sack full of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050812 - supplies for dressing the wound using the strip gauze method first                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050813 - applied yesterday and initially continued this morning by Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050814 - Kornblith, per above, ref SDS 0 R16G, even though this was changed by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050815 - Christy Burns later n the afternoon, with clear instructions to avoid                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050816 - strip gauze and instead use Hydrofera Blue acterostatic Tunnel                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
050817 - Dressing with Mepilex Border dressing per above. ref SDS 0 J47K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050819 -  ..
050820 - Thus, was discharged with 2 sets of wound dressing supplies.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050822 -  ..
050823 - Thanked Ericka for terrific care by the entire team in Med Surg, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050824 - particularly for her tenacity accomplishing difficult coordination to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050825 - clarify confusing matters, and ultimately optimize favorable outcomes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050826 - today.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050827 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050828 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050829 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050830 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050831 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050832 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050833 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050834 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050835 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0509 -