CONTACTS
SUBJECTS
VA Notify Injury Hematoma Left Leg Symptoms Worsening Pain Need Crut
1403 -
1403 - ..
1404 - Summary/Objective
1405 -
140501 - Follow up ref SDS 46 0000. ref SDS 45 0000.
140502 -
140503 -
140504 -
140505 -
140506 -
140508 - ..
1406 -
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.
140944 - ..
140945 - On 160603 1430 meeting with Doctor Alex Yoo in Neuorology Clinic at VA
140946 - Medical Center in San Francisco. At the conclusion of the meeting,
140947 - Alex explained comprehensive review of seemingly inexplicable falls
140948 - could indicate possible coronary causes. He proposed recommending
140949 - that Primary Care refer to Cardiology for continual heart function
140950 - test. ref SDS 44 SZ6K
140952 - ..
140953 - On 160608, visited briefly with Karen in Cardiology. She seemed to
140954 - feel that Halter Monitor test is a good idea.
140956 - ..
140957 - On 160610 letter to Doctor Simpson presents background on medical
140958 - review of balance issue. ref SDS 45 019K Asks about doing Holter
140959 - Monitor test. ref SDS 45 D162
140960 -
140961 -
140963 - ..
1410 -
1411 -
1412 - Progress
1413 -
141301 - Zio Cardio Monitor Test Evaluate Balance Issue
141302 -
141303 - Follow up ref SDS 46 QY5F, ref SDS 45 QY5F.
141304 -
141305 - After the hike this morning, reported in another record, ref SDS 7
141306 - WVPY, went to the cafeteria to work. While being served at the
141307 - breakfast counter, received call from Cardiology.
141309 - ..
141310 - It was difficult to hear because of noise in the cafeteria, and the
141311 - need to devote attention to moving forward to the check out station.
141313 - ..
141314 - The caller said that Doctor Simpson ordered Zio heart monitor test,
141315 - and it can be installed today at 1100.
141317 - ..
141318 - After working for 30 minutes or so, and eating some breakfast, went
141319 - to Cardiology.
141321 - ..
141322 - Initially, met with Karen. She assured that getting the Zio heart
141323 - monitor device installed today would not prevent getting normal
141324 - conscious seditation for EGD Dilation procedure tomorrow in
141325 - Sacramento.
141327 - ..
141328 - Thanked Karen for helpful clarification.
141330 - ..
141331 - Went down the hall to main Cardiology check-in Department.
141333 - ..
141334 - Was called shortly to install the...
141335 -
141336 - Zio Xt heart rate monitor
141338 - ..
141339 - This required scraping the skin to faciliate strong adhesion with the
141340 - device to the chest. The skin was then cleaned with an alchohol
141341 - based liquid.
141343 - ..
141344 - Received...
141345 -
141346 - Zio Xt
141347 - Patient Instructions and
141348 - Button Press Log
141350 - ..
141351 - Cannot get the device wet in a shower for 24 hours.
141353 - ..
141354 - Report any cardiovascular events in a log book.
141355 -
141356 - [On 160621 1024 copy of letter to neurology medical team
141357 - notifies Doctor Simpson that Zio XT heart monitor was
141358 - installed on 160616, later on same day did 6 mile hike,
141359 - which will be recorded on Zio device; but, hiking to test
141360 - normal activities was delayed 4 days for examination of
141361 - stroke symptoms. Also advises that lab on 160617 found
141362 - that HDL 63 increased above 60 again, with TG 66 that
141363 - together signal LDL large particle size. ref SDS 48 D469
141365 - ..
141366 - In 2 weeks OA 160630 remove the Zio patch using cleaning materials
141367 - provided on last page of the instruction booklet. Place the device
141368 - in the mailing box. Seal the box with a blue tape also on last page
141369 - of the booklet, and mail the box in any Post Office mailbox.
141370 -
141371 -
141373 - ..
1414 -
1415 -
1416 - 1637
1417 -
141701 - Received letter from Doctor Simpson saying...
141702 -
141703 - 1. Subject: SECURE procedure RE: Zio Cardiology Test Evaluate Balance Issue
141704 - Date: 2016-06-16 15:29
141708 - ..
141709 - 2. I am sure you will do this, it is important.
141710 -
141711 - We want to see if there is any correlation between your dizzy
141712 - spells or falls and the ECG rate or rhythm on the ZIO. So, be
141713 - sure to record anything that happens, and note the exact time.
141714 - Go about all your usual activities.
141716 - ..
141717 - Doctor Simpson refers to Zio XT heart monitor installed at the VA in
141718 - Cardiology earlier today, per above. ref SDS 0 DX58
141720 - ..
141721 - Doctor Simpson responds to the letter on 160611 1054. ref SDS 47 5U3J
141722 -
141723 - [On 160621 1024 copy of letter to neurology medical team
141724 - notifies Doctor Simpson that Zio XT heart monitor was
141725 - installed on 160616, later on same day did 6 mile hike,
141726 - which will be recorded on Zio device; but, hiking to test
141727 - normal activities was delayed 4 days for examination of
141728 - stroke symptoms. Also advises that lab on 160617 found
141729 - that HDL 63 increased above 60 again, with TG 66 that
141730 - together signal LDL large particle size. ref SDS 48 D469
141732 - ..
141733 - 3. Thanks
141734 -
141735 - Dr S
141736 -
141737 -
141738 -
141739 -
141740 -
141741 -
141742 -
141743 -