CONTACTS
SUBJECTS
Stroke Symptoms After EGD Dilation Procedure VAMC Sacramento Left Si
1103 -
1103 - ..
1104 - Summary/Objective
1105 -
110501 - Follow up ref SDS 5 0000.
110502 -
110519 - ..
1106 -
1107 -
1108 - Progress
1109 -
110901 - After EGD dilation procedure at VA Medical Center in Sacramento with
110902 - Doctor Lee, reported in another record on 160617 0800, ref SDS 5 0001,
110903 - on getting into the car at the VA in Sacramento, had difficulty
110904 - buckling the seat belt on the left side. Could not seem to line up
110905 - the fastening mechanisms. Kathy helped secure the seat belt. She
110906 - drove us from Sacramento, about 90 miles to Mudville Grill in Clayton
110907 - for late lunch/dinner.
110908 -
110949 - ..
110950 - Exiting the car on arrival, had difficulty unbuckling the seat belt on
110951 - the left side in the passenger seat, so Kathy again assisted. On
110952 - stepping out of the car reached over and grasped cellphone stored in
110953 - the cup holder between the 2 seats. Attempting to place the cellphone
110954 - in left pocket, it slipped from left hand. Picked it up and proceeded
110955 - into the restaraunt.
110957 - ..
110958 - In the restaraunt, thought we ordered usual meal splitting patty melt
110959 - and fries. Actually, Kathy said we ordered clam chowder. We had this
110960 - a month or so ago and planned to have it again; but, they serve clam
110961 - chowder only on Friday and Saturday, so today being a Friday, was the
110962 - first occassion to have it again.
110964 - ..
110965 - Ordered usual mug filled with ice and Doctor Pepper. Kathy brought
110966 - lemon juice to combine these ingredients, as usual.
110968 - ..
110969 - Sitting down at the table, dropped the cellphone again in left hand.
110970 - The waiter noticed and picked it up for me.
110972 - ..
110973 - I added the lemon juice to the Doctor Pepper.
110975 - ..
110976 - Moments/minutes later, while talking, I asked Kathy: "Where is the
110977 - Doctor Pepper?"
110979 - ..
110980 - She said it is on the table in front of me.
110982 - ..
110983 - I still did not see it. Asked Kathy to point to the glass. She did
110984 - and then I saw it and was able to pick it up and sip some liquid
110985 - through a straw.
110987 - ..
110988 - Thus, there was a progression of symptoms. Initially, saw the mug of
110989 - Doctor Pepper on the table to add lemon juice. Then a minute or so
110990 - later, could not see it.
111015 - ..
111016 - On leaving the restaraunt, needed Kathy's help to buckle the seatbelt
111017 - due to weakness and lack of feeling in left hand. Similiarly on
111018 - arriving home needed help to unbuckle seatbelt.
111020 - ..
111021 - ..
111022 - Finally recognized definite weakness and some numbness in left hand,
111023 - primarily in last three (3) fingers.
111025 - ..
111026 - Back at the house, I was unable to distinguish characters on the
111027 - computer screen in the bedroom. Kathy was sitting on the edge of the
111028 - bed. I could see her and interact normally. Kathy handed her cell
111029 - phone to me. I could not see the numbers on the screen to enter her
111030 - password. Looked at my cellphone and powered it up. Could not read
111031 - the 4-digit time posted in large letters on the screen.
111032 -
111033 - [...below on 160617 1637 at 2229 later in the evening at
111034 - the VA in ER could not see letter preceeding a string of
111035 - letters during vision test for possible stroke symptoms.
111036 - ref SDS 0 U95U
111038 - ..
111039 - Opening my records in the SDS Group Manager, I moved the pointer to
111040 - the line below my name. Did this several times even after Kathy told
111041 - me to move the pointer up 1 line to my name. Was unable to physically
111042 - move the pointer because was not seeing it correctly.
111044 - ..
111045 - Gave up on opening SDS.
111047 - ..
111048 - Had similar problem using remote control for Samsung 55" television.
111049 - Could press the up arrow, but could not see the down arrow to execute
111050 - a manauver switching between HDMI port 1 and 2, which switches between
111051 - using the display as a television and as a computer monitor. Kathy
111052 - pointed to the down arrow on the remote control. I then saw the down
111053 - arrow. When she removed her finger, could no longer see down arrow.
111054 - Tried and failed several times on this maneuver.
111055 -
111056 -
111058 - ..
1111 -
1112 -
1113 - 2106
1114 -
111401 - Gave up on doing anything constructive on the computer and watching
111402 - television.
111404 - ..
111405 - Went to bed.
111406 -
111408 - ..
1115 -
1116 -
1117 - 2136
1118 -
111801 - Vision issue did not resolve, so decided to request examination at VA
111802 - for possible stroke symptoms.
111804 - ..
111805 - Kathy drove us to VA Medical Center in San Francisco.
111806 -
111807 -
111809 - ..
1119 -
1120 -
1121 - 2229
1122 -
112201 - Reported to ER possible minor stroke.
112203 - ..
112204 - Triage occurred within a very few minutes.
112206 - ..
112207 - Then to an examination room.
112209 - ..
112210 - Nurse Megan did initial case review. Reported vision and left side
112211 - weakness, per above. ref SDS 0 5F6F
112213 - ..
112214 - Megan placed her hand beneath a string of letters on a plackard
112215 - fastened to the wall similar to a vision test at the DMV. She asked
112216 - what letters are shown above her hand?
112218 - ..
112219 - Said the letters that could be seen.
112221 - ..
112222 - Megan was kind offering hints on some of the letters. Megan asked
112223 - several times about letters left of the letters recognized. These
112224 - mistakes correlate with not seeing all 4 digits for time on the
112225 - cellphone, per above. ref SDS 0 TI7T
112227 - ..
112228 - There is also correlation with not placing pointer (mouse) on computer
112229 - screen to correct line for logging into SDS, per above. ref SDS 0 BE9M
112231 - ..
112232 - Significance of left side vision deficit is unclear.
112233 -
112234 - [On 160618 1348 MRI findings for MRA present "Likely left
112235 - anterior choroidal artery infundibulum. Fetal type right
112236 - PCA." Research anterior choroidal artery (AChA) supplies
112237 - several crucial anatomical structures of the brain
112238 - important for vision and motor control. ref SDS 7 PB3O
112240 - ..
112241 - [On 160802 1404 at 2024 after returning home from Stanford
112242 - Neuroscience Health Center in Palo Alto, received letter
112243 - from Doctor Massa presenting more details explaining new
112244 - efforts of the VA Neurology Department to review this case,
112245 - ref SDS 11 UH5L, and then determining that the MRI on
112246 - 160618, does not support a diagnosis of stroke. ref SDS 11
112247 - 5K34
112248 -
112249 -
112250 -
112252 - ..
1123 -
1124 -
1125 - 2319
1126 -
112601 - Doctor Jeneen Smith made initial review of symptoms and patient
112602 - history of vision problems.
112604 - ..
112605 - Related that today, and only today vision and left side strength
112606 - problems occurred, as per above. ref SDS 0 5F6F
112608 - ..
112609 - Received timely, thorough care performing clinical, neurological
112610 - tests, similar to tests to evaluate dizziness issue, and performed by
112611 - Doctor Yoo earlier this month on 160603 1430. ref SDS 2 2Y49
112613 - ..
112614 - Some of these tests included...
112615 -
112616 - 1. Grasping and squeezing 2 fingers on each of the doctor's
112617 - hands to compare strength differentials.
112618 -
112619 - 2. Recognizing fingers being moved by the doctor when held 18"
112620 - away, and at peripheral end points.
112622 - ..
112623 - 3. Recognizing number of fingers being held steady by the
112624 - doctor when held 18" and at peripheral points.
112626 - ..
112627 - 4. Merely following movement of the doctor's finger across the
112628 - field of vision and up and down covering a distance of 3'
112629 - or so up and across.
112631 - ..
112632 - 5. Touching the doctor's finger held up about 18" away, and
112633 - then touching my own nose, i.e., going back and forth.
112634 - Then alternating hands and repeating this exercise.
112636 - ..
112637 - 6. Doing same exercises with eyes closed.
112639 - ..
112640 - Jeneen contacted Doctor Abrams. He ordered a lab and CT test of head.
112642 - ..
112643 - Tech came from the lab to perform a blood draw.
112645 - ..
112646 - Nurse took me in a wheel chair to Radiology on 2nd floor.
112648 - ..
112649 - CT test on head will address part of review planned to be performed in
112650 - Audiology and Balance examination scheduled on 160707, reported in
112651 - telecon on 160606 1409. ref SDS 3 6H9I
112652 -
112653 -
112655 - ..
1127 -
1128 -
1129 - 0140
1130 -
113001 - Jeneen reported results of CT test to Doctor Abrams. He ordered
113002 - MRI test of head.
113003 -
113005 - ..
1131 -
1132 -
1133 - 0251 on 160618
1134 -
113401 - Kathy went home.
113403 - ..
113404 - Went for MRI test in Radiology Department.
113406 - ..
113407 - Met Bella who came into the facility as an "on call" tech just to
113408 - perform this cerebral MRI.
113409 -
113410 - [On 160618 1348 neuroradiologist report received and
113411 - entered in the record. ref SDS 7 W67N
113412 -
113413 - [On 160817 0800 Bella was technician for 3rd MRI to test
113414 - for stroke symptoms following next EGD on 160816.
113415 - ref SDS 12 MX82
113417 - ..
113418 - There was an issue with the Zio XT heart monitoring device. Bella
113419 - said the MRI cannot be performed with this device attached. She found
113420 - a doctor to get assistance. There was brief discussion about what to
113421 - do. Explained Zio XT test was ordered and installed to investigate
113422 - causes of occasional dizziness that may cause loss of balance and
113423 - falls, reported on 160616 0930. ref SDS 4 PU50
113425 - ..
113426 - On discussion, decided the doctor would remove the Zio XT device,
113427 - since determining scope of issues that may have caused stroke symptoms
113428 - has priority at the moment to evaluating heart performance that may be
113429 - causing dizziness, even though both may be related.
113431 - ..
113432 - The doctor removed the Zio XT device. He used a cloth soaked with
113433 - alcohol to loosen the adhesive that connects the straps the skin.
113435 - ..
113436 - MRI on brain today, was much more extensive than MRI test for the
113437 - right knee performed on 160504 0800. ref SDS 1 PP8O The prior test
113438 - took only 40 minutes. The test today seemed to take over an hour,
113439 - maybe 90 minutes. The prior test seemed like the body was moved on a
113440 - gurney up and down through the large radiation ring. This test was
113441 - not aware of the body moving. The body was moved on a gurney into the
113442 - rings and then seemed to be stable for the entire test. Gurney could
113443 - have been moving, and just was not aware. Most prominent aspect of
113444 - the test was very loud noise and the range of different noises
113445 - indicating different phases of the MRI test process.
113447 - ..
113448 - Bella was the technician who ran the equipment. She was very nice.
113449 - Enjoyed working with her.
113450 -
113451 - [On 160618 1348 neuroradiologist report received and
113452 - entered in the record. ref SDS 7 W67N
113453 -
113454 - [On 160817 0800 Bella was technician for 3rd MRI to test
113455 - for stroke symptoms following next EGD on 160816.
113456 - ref SDS 12 MX82
113458 - ..
113459 - After the test, the doctor pressed the Zio XT devce back to the
113460 - chest. Not sure if additional adhesive was applied. The device
113461 - seemed to remain in place though possibly less secure.
113462 -
113463 -
113465 - ..
1135 -
1136 -
1137 - 0410
1138 -
113801 - Returned on gurney to ER.
113802 -
113804 - ..
1139 -
1140 -
1141 - 0427
1142 -
114201 - Jeneen advised that Doctor Abrams recommends patient remain in ER
114202 - overnight for further examination in the morning.
114204 - ..
114205 - Sleeping for few hours.
114206 -
114207 - [On 160618 0800 examination Doctor Alex Yoo with Neurology
114208 - Department. ref SDS 6 7R7G Missed part of visual test
114209 - identifying things in a picture diagram. ref SDS 6 QR8F
114210 - Was admitted to hospital for further care. ref SDS 6 NX4M
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1143 -