CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
1203 -
1203 - ..
1204 - Summary/Objective
1205 -
120501 - Follow up ref SDS 4 0000.
120502 -
120503 -
120504 -
120505 -
120506 -
120508 - ..
1206 -
1207 -
1208 - Progress
1209 -
120901 - Yesterday, may have suffered mild stroke based on loss of vision and
120902 - weakness and loss of some feeling in left hand, reported on 160617
120903 - 1637. ref SDS 4 5F6F
120905 - ..
120906 - In the evening drove to VA Medical Center in San Francisco. Had CT
120907 - test of head. ref SDS 4 DC6K This led to MRI test of head.
120908 - ref SDS 4 PQSQ Stayed overnight in ER for examination by Neurology
120909 - this morning.
120911 - ..
120912 - On waking up, greeted Doctor Alex Yoo who came into the examination
120913 - room.
120915 - ..
120916 - Was pleased to see the doctor, a familiar face from prior Neurology
120917 - examination for balance issues on 160603 1430. ref SDS 2 2Y7N
120919 - ..
120920 - Doctor Yoo said he has consulted Doctor Abrams. They feel patient
120921 - might be discharged today, and return Monday as out-patient for
120922 - further care.
120924 - ..
120925 - The doctor repeated clinical neurological tests performed by Doctor
120926 - Smith last night, reported on 160617 1637. ref SDS 4 DC6K
120928 - ..
120929 - Some of these tests were not performed well...
120930 -
120931 - 1. Gave correct location of VA on Clement Street.
120933 - ..
120934 - 2. Gave incorrect current date: 160618; think said 160620.
120936 - ..
120937 - 3. Was asked to explain an outline drawing.
120938 -
120939 - Correctly cited woman washing dishes at a sink in a
120940 - kitchen scene.
120942 - ..
120943 - Correctly identified an animal (dog or cat) laying at her
120944 - feet in front of the sink.
120946 - ..
120947 - Omitted explanation of a child standing on a stool reaching
120948 - up to get cookies or something from a jar on a shelf.
120950 - ..
120951 - At this point Doctor Yoo said he intends to admit the patient for
120952 - observation in the hospital.
120954 - ..
120955 - Alex said he would review the MRI test of the head done last night and
120956 - then consult Doctor Abrams, Chief of Neurology, on the course of care
120957 - in this case, seeming to indicate that patient might not be admitted
120958 - afterall.
120960 - ..
120961 - He left examination room.
120962 -
120963 -
120965 - ..
1210 -
1211 -
1212 - 1140
1213 -
121301 - Alex returned to the ER examination room.
121302 -
121303 - He reported the MRI shows a film of fluid inflammation across a
121304 - "large" section of the brain. There is nothing in the MRI imaging
121305 - that indicates the cause for this abnormal condition, nor that it has
121306 - affected any commonly recognized brain functions.
121308 - ..
121309 - Asked what might cause this fluid inflammation condition?
121311 - ..
121312 - The doctor said...
121313 -
121314 - 1. Bacteria
121315 - 2. Virus infection
121316 - 3. Tumor/cancer growth
121318 - ..
121319 - Asked if CT and MRI tests last night showed any evidence of
121320 - tumor/cancer growth.
121322 - ..
121323 - Alex said nothing cancerous is evident in the imaging.
121325 - ..
121326 - Asked if the MRI showed evidence of atherosclerosis plaques in the
121327 - blood vessels of the brain?
121329 - ..
121330 - Alex said blood vessels of the brain appear clear in the MRI study.
121331 -
121332 - Days later when VA provided the radiologist report for the MRI
121333 - performed last night, it reports "Aortic arch and branch
121334 - vessels are patent," shown in the record on 160618 1348.
121335 - ref SDS 6 J738
121336 -
121337 - [On 160715 1630 Doctor Yoo Neurology Progress Notes say in
121338 - part "given absence of vertebrobasilar disease..." which is
121339 - another way of saying there is no evidence of
121340 - atherosclerosis in the brain. ref SDS 8 TV4F
121342 - ..
121343 - [On 160820 0940 section on Diagnostic Data reports finding
121344 - MRI shows no evidence of atherosclerosis in the brain area.
121345 - ref SDS 10 PW4G
121347 - ..
121348 - Doctor Yoo related having talked to Doctor Abrams about his (Alex's)
121349 - impressions from the MRI test, and that this discussion led to work
121350 - plan for...
121351 -
121352 - 1. Lumbar puncture procedure.
121353 -
121354 - 2. Based on results, patient will be admitted or released, as
121355 - discussed earlier, per above. ref SDS 0 PR7O
121357 - ..
121358 - Asked Alex when this test will be performed?
121360 - ..
121361 - He said right now.
121363 - ..
121364 - Asked about the nature of this procedure?
121366 - ..
121367 - The doctor advised that a thin wire is penetrated into the back and
121368 - forced up the spinal column to the brain.
121370 - ..
121371 - Asked the doctor how many of these procedures he has performed, i.e.,
121372 - 20, 30, 100?
121374 - ..
121375 - Alex seemed to say about 30.
121377 - ..
121378 - He said the procedure takes about 20 minutes and there is minimal
121379 - pain, i.e., level < 5.
121381 - ..
121382 - About this time Kathy returned and was admitted into ER examination
121383 - room as patient assistant. Introduced her to Doctor Yoo.
121384 -
121385 -
121386 -
121388 - ..
1214 -
1215 -
1216 - 1200
1217 -
121701 - We then did the lumbar penetration procedure. Started laying on left
121702 - side to expose the back to Alex working on the right side of the bed.
121704 - ..
121705 - The patient feels a series of pressing, as if with the doctor's
121706 - knuckle. Alex was teriffic giving notice of each step in the
121707 - process, initially pressing on the back to understand the terrain,
121708 - i.e., location of bones. He then advised there would a sting while
121709 - injecting lidocane to numb the lumbar puncture point.
121710 -
121711 - [On 160620 0707 performed another lumbar penetration
121712 - procedure; went much smoother than this first one.
121713 - ref SDS 7 5F6F
121714 -
121716 - ..
1218 -
1219 -
1220 - 1219
1221 -
122101 - The doctor reported this procedure was not going well today, as
122102 - sometimes occurs setting IVs. He asked to change postion. Currled
122103 - over several pillows piled up in the middle of the bed. Grasped the
122104 - edge of the side table to help in releasing tension from pain.
122106 - ..
122107 - The doctor again notified of lidocane injections to facilitate
122108 - advancement of the wire tube through the spinal column toward the
122109 - head.
122110 -
122111 -
122113 - ..
1222 -
1223 -
1224 - 1232
1225 -
122501 - The doctor requested assistance from colleagues. Doctor Miya, who had
122502 - been helping a patient with shingles in an adjacent bed, and Doctor
122503 - Kumar joined the procedure to perform lumbar puncture test. Doctor
122504 - Kumar completed the work. This went essentially, as Doctor Yoo had
122505 - explained. Pain level at all times was < 5, and mostly < 2.
122506 -
122507 - [On 160720 0505 Doctor Miya examined right knee injury in
122508 - ER, recalled favorably her work with the shingles patient.
122509 - ref SDS 9 HW9O
122511 - ..
122512 - Doctor Yoo advised the medical team would receive a report on findings
122513 - from the liquid drawn from the brain in the lumbar puncture test.
122514 -
122516 - ..
1226 -
1227 -
1228 - 1409
1229 -
122901 - Doctor Yoo returns. He reported good news. The lumbar puncture test
122902 - test found nothing indicating stroke nor myocardial infarction. He
122903 - has discussed the case further with Doctor Abrams. They want to admit
122904 - the patient for observation in the hospital over the next week. The
122905 - doctor also advised the Neurology team might propose performing
122906 - another lumbar puncture test that will draw a larger amount of fluid
122907 - inflammation from the brain.
122909 - ..
122910 - This additional test will provide additional data that may indicate
122911 - what has caused stroke-like symptoms beginning yesterday, after EGD
122912 - Dilation procedure in Sacramento.
122914 - ..
122915 - Doctor Abrams will meet with the patient in the morning to discuss
122916 - the work plan.
122918 - ..
122919 - The doctor left to arrange for admitting the patient into the
122920 - hospital.
122921 -
122922 -
122924 - ..
1230 -
1231 -
1232 - 1442
1233 -
123301 - Nurse Arianna came into the examination room. She performed similar
123302 - clinical neurological tests done previously last night by Megan and
123303 - Doctor Smith, reported on 160617 1637, ref SDS 4 N55I, and by Doctor
123304 - Yoo again this morning, per above. ref SDS 0 QR8F
123306 - ..
123307 - Repetition of tests might reflect training exercises for treating
123308 - possible stroke patients.
123310 - ..
123311 - Arianna seemed to take the lead in arranging for transfer to the 2nd
123312 - floor in Telemetry or TCU.
123314 - ..
123315 - Assumed would return to the care of Alona, who was very helpful on
123316 - the prior hospital stay in September.
123318 - ..
123319 - While arrangements were being made, Kathy went to get hamburgers for a
123320 - picnic in the hospital. Kumar explained she could drive back toward
123321 - the city on Clement, and see numberous fast food places.
123322 -
123323 -
123324 -
123325 -
123326 -
123327 -
123328 -
123329 -
123330 -
123331 -
123332 -
123333 -