CONTACTS
SUBJECTS
VA Notify Injury Hematoma Left Leg Symptoms Worsening Pain Need Crut
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1403 - ..
1404 - Summary/Objective
1405 -
140501 - Follow up ref SDS 44 0000. ref SDS 43 0000.
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1407 -
1408 - Background
1409 -
140901 - On 160504, met Lauren Rettberg, NP PA, in Primary Care. Reported loss
140902 - of balance that caused fall on 160501, ref SDS 31 JN3J, shown in case
140903 - study on 140101 0600. ref SDS 7 O85F Lauren performed a neurological
140904 - test, passed this including Romberg's balance test. ref SDS 31 WZ50
140906 - ..
140907 - On 160513 Lauren called and discussed referral to Wound Care for
140908 - treatment of new injury to left leg Achilles' tendon. ref SDS 34 FG5O
140909 - Lauren also planned to consult with Neurology about balance problem,
140910 - ref SDS 34 YK6J; she may make referral to Physical Therapy to evaluate
140911 - and assist with recovery balance problem. ref SDS 34 YK68 Lauren will
140912 - schedule visit for performing care to recover from calcified crystals
140913 - breaking loose from vestibular chamber and falling into semicircular
140914 - canals that cause loss of balance. ref SDS 34 YK72
140916 - ..
140917 - On 160523 visited Rose (Marie) in Medical Practice, scheduled call
140918 - from Lauren for Primary Care support on 160525 1130. ref SDS 36 PG6N
140919 - Rose on the Appointment care 5/23, so called back and got correction
140920 - from Bridget. ref SDS 36 8M9M
140922 - ..
140923 - On 160523 0830 meeting with Mike in Physical Therapy, ref SDS 37 010U,
140924 - reviewed 4 falls past few years, ref SDS 37 EL7G; Mike performed
140925 - Dix-Hallpike head movement maneuver testing for BPPV, (Benign
140926 - paroxysmal positional vertigo), ref SDS 37 R657, explained in the
140927 - record on 160513 1100. ref SDS 34 4W62 Seemed to pass Romberg's test,
140928 - and heel-toe test. ref SDS 37 EQ9O Failed test in machine with feet
140929 - support moving and walls rotating. ref SDS 37 IZ6F Mike diagnosed
140930 - falls that seem unrelated to dizziness and with no awarness of falling
140931 - as "Vestibular Hypofunction." ref SDS 37 X89J
140933 - ..
140934 - On 160525 1130 Lauren called - she scheduled meeting on 160603 1030,
140935 - to maneuver head for resolving balance problem by dislodging calcified
140936 - crystals from semicircle balance canals near the hears. ref SDS 40 SY6N
140937 - Maneta called later and changed this to 1100. ref SDS 40 GT5G Lauren
140938 - also contacted Neurology and advised they want to meet with patient
140939 - immediately. She asked if a meeting has been scheduled. Since this
140940 - has not happened, she will call them again. She said that if
140941 - Neurology has not scheduled a meeting by this Friday, on 160527, to
140942 - call and request a meeting.
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1412 - Progress
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141301 - Holter Monitor Test Evaluate Balance Issue
141302 -
141303 - Follow up ref SDS 44 QY5F, ref SDS 43 QY5F.
141304 -
141305 - On 160603 1430 meeting with Doctor Alex Yoo in Neuorology Clinic at
141306 - VA Medical Center in San Francisco.
141308 - ..
141309 - At the conclusion of the meeting, Alex explained comprehensive review
141310 - of seemingly inexplicable falls could indicate possible coronary
141311 - causes. He proposed recommending that Primary Care refer to
141312 - Cardiology for continual heart function test. ref SDS 44 SZ6K
141314 - ..
141315 - On 160608, visited briefly with Karen in Cardiology. She seemed to
141316 - feel that Halter Monitor test is a good idea.
141318 - ..
141319 - Submitted letter to Doctor Simpson saying...
141320 -
141321 - 1. Subject: Holter Monitor Test Evaluate Balance Issue
141322 - Date: 2016-06-10 15:30
141331 - ..
141332 - 2. During our meeting on 160504, we reviewed recent fall while
141333 - hiking at Castle Rock Park in Walnut Creek, that occurred on
141334 - 160501 (see line 041554. ref SDS 30 FZ7I
141336 - ..
141337 - 3. After our meeting at 1000, I met with Lauren in Primary Care at
141338 - 1030. She performed clinical neurology testing for BPPV that
141339 - indicated normal balance. ref SDS 31 JN3J On 160523, Mike in
141340 - Physical Therapy used the Dix-Hallpike maneuver to diagnose
141341 - dizziness arising in left vestibular chamber. ref SDS 37 R657
141342 - Mike advised that this case does not meet criteria for BPPV,
141343 - because there is no rapid eye movement occurring with
141344 - dizziness. ref SDS 37 8O6N
141346 - ..
141347 - 4. Last week on 160603, Doctor Yoo in the Neurology Clinic
141348 - repeated balance tests and surmised that dizziness was not a
141349 - factor in the fall hiking Half Dome on 150916, which required
141350 - treatment to recover from hematoma injury. ref SDS 44 2Y7N As
141351 - well, he feels dizziness did not cause falling last month in
141352 - Crystal Rock Park. Most likely both were due to fatigue, which
141353 - others have cited as well. ref SDS 44 2Y53
141355 - ..
141356 - 5. None-the-less Doctor Yoo ordered follow up testing in Audiology
141357 - and Balance clinic. Meeting is scheduled on 160707.
141359 - ..
141360 - 6. He also ordered Holter Monitor testing in Cardiology. I was on
141361 - site this past Wednesday for Physical Therapy to improve
141362 - balance. Stopped in Cardiology to see you. Karen indicated
141363 - your office would schedule Holter Monitor testing in this case.
141365 - ..
141366 - 7. Will be onsite next Tuesday, 160614 0830, to meet with Doctor
141367 - Hewitson in Podiatry on progress resolving Biomechanics issues
141368 - (related to balance), applying orthotics, ankle and knee
141369 - braces. You can guess there are complicated side effects to
141370 - raising HDL with extended endurance exercise. Takes about 40
141371 - minutes to configure wound care protections and Biomechanics
141372 - equipment implementing VA guidance. Takes another 20 minutes
141373 - or so to undo everything after hiking.
141375 - ..
141376 - 8. If you plan to order the Holter Monitor test, could I get the
141377 - equipment at that time next Tuesday? Doctor Egan ordered this
141378 - test at the VA Clinic in Martinez 5 years ago on 110310, to
141379 - assess afib events a year+ after CABG x4. Results for the
141380 - prior test are reported on 110415 (see line 680742. ref SDS 4
141381 - 356O
141383 - ..
141384 - 9. Might be interesting to do this comparison, based on reduced
141385 - hiking due to continual injuries the past 8 months.
141387 - ..
141388 - 10. Please let me know.
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