CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 12 0000, ref SDS 11 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Doctor Gary Abrams and Doctor Alex Yoo arrived for meeting scheduled
040902 - yesterday, reported on 160618 0800. ref SDS 12 6O3M At this time was
040903 - entering the record of EGD dilation yesterday on 160617 0800,
040904 - ref SDS 10 0001, and the record of stroke symptoms later in the
040905 - afternoon at, 160617 1637, ref SDS 11 5F6F
040907 - ..
040908 - Doctor Abrams medical profile at UCSF is listed in part at...
040909 -
040910 - https://www.ucsfhealth.org/gary.abrams
040912 - ..
040913 - He is the director of...
040914 -
040915 - UCSF Neurorehabilitation Program
040916 -
040917 - https://www.ucsfhealth.org/clinics/neurorehabilitation_program/
040919 - ..
040920 - Doctor Abrams seemed to remember the meeting on 130227, on referral
040921 - from Doctor Stewart to evaluate for spinal stenosis. 130227 0930,
040922 - ref SDS 1 PPWW
040924 - ..
040925 - Doctor Abrams seemed to have been prepared by Alex for the hiking
040926 - issue. He said immediately that he approved hiking for effective
040927 - stroke therapy, discussed again, below. ref SDS 0 J66L
040929 - ..
040930 - The doctor asked for explanation of symptoms leading to examination on
040931 - 160617?
040933 - ..
040934 - Presented prior list reported at that time on 160617 1637. ref SDS 11
040935 - 5F6F
040937 - ..
040938 - Doctor Abrams performed further clinical tests, similar to Doctor Yoo
040939 - yesterday, reported on 160618 0800, ref SDS 12 QR8F, and previously by
040940 - Doctor Smith the night before on 160617 1637. ref SDS 11 DC6K
040941 -
040942 - [On 160620 0707 Doctor Massa performed same panel of
040943 - clincial tests and observed possible stroke symptoms seem
040944 - to have completely resolved. ref SDS 13 1I4H
040946 - ..
040947 - These included Romberg's test, performed previously by Primary Care
040948 - provider, Lauren Rettberg on 160504 1030. ref SDS 5 9L7K
040950 - ..
040951 - Also performed heel-toe test, which Lauren observed on 160504 1030,
040952 - ref SDS 5 WZ50, and which Mike also observed on 160523 0830.
040953 - ref SDS 7 HX4N
040955 - ..
040956 - Finally, the doctor presented the same picture which Alex showed
040957 - yesterday, and which led him to propose admission into the hospital
040958 - for further evaluation.
040960 - ..
040961 - Today, Alex smiled observing me stating the list correctly, which was
040962 - failed yesterday. Commented that "practice makes perfect." Commended
040963 - Doctor Yoo for giving heads up on correct answers. reported on 160618
040964 - 0800. ref SDS 12 ZO9M
040966 - ..
040967 - This was sort of a fun joke we all appreciated.
040969 - ..
040970 - Doctor Abrams said the Neurology team remains concerned about the
040971 - cause and implications of fluid inflammation layer over the top of the
040972 - brain, which was found in the MRI test yesterday, reported on 160618
040973 - 0800. ref SDS 12 MX8L
040975 - ..
040976 - They have ordered a test drawing more fluid from another lumbar
040977 - puncture test, scheduled for tomorrow morning.
040979 - ..
040980 - He seemed to indicate that after the test, I would be discharged to go
040981 - home. Further work up will be evaluated as an out patient.
040983 - ..
040984 - We discussed hiking at length.
040986 - ..
040987 - Doctor Abrams was familiar with patient history hiking 11 - 15 miles
040988 - per day, 300 miles per month. He strongly approved continuing this
040989 - regimen.
040991 - ..
040992 - Asked about any causative correlations between hiking at this level,
040993 - and evident stroke symptoms that occurred on Friday, reported to the
040994 - ER on 160617 1637? ref SDS 11 5F6F Asked specifically about aneurysm?
040996 - ..
040997 - Doctor Abrams indicated the level of hiking reported in this patient
040998 - history is the best medicine for maintaining nurological function. He
040999 - was aware of the benefits that elevated HDL provides for cognition,
041000 - and the doctor was aware that hiking directly increases HDL.
041001 -
041002 - [On 160622 1428 notified Doctor Yoo and Doctor Simpson that
041003 - hiking to support line of care for stroke-like symptoms
041004 - went well; reported minor neurapathy in left fingers of
041005 - left hand occurred and subsided for short periods
041006 - throughout the hike.; also reported new MCL injury right
041007 - knee will prevent hiking for 10 days or more. ref SDS 14
041008 - 5F6F
041010 - ..
041011 - Asked about current diagnosis?
041013 - ..
041014 - Doctor Abrams said the team has not yet settled on a diagnosis.
041016 - ..
041017 - He advised that initial symptoms indicate stroke, and tests (labs, CT,
041018 - MRI) show evidence of conditions that commonly establish stroke. The
041019 - doctor noted that this moring, patient seems fully functional. He
041020 - said that typing on the computer at high speed shows signficant
041021 - neurological function, noted initially this morning, per above.
041022 - ref SDS 0 5F6F Conducting the meeting this morning also shows
041023 - normality, without vision nor motor control deficits.
041024 -
041025 - [On 160620 0707 Doctor Yoo and Doctor Massa reported have
041026 - met with neuroradiologist who read MRI of head performed on
041027 - 160618; they jointly concluded MRI imaging shows evidence
041028 - of a clot in the brain, which nominally caused stroke-like
041029 - symptoms that occurred after EGD Dilation procedure on
041030 - 160617, and then subsided to zero the next day. ref SDS 13
041031 - LN8G
041033 - ..
041034 - Asked what could have caused stroke-like symptoms reported in the ER
041035 - on Friday, shown in the record on 160617 1637. ref SDS 11 DC6K
041037 - ..
041038 - Doctor Abrams said the tests have not yielded medical conditions that
041039 - could have caused stroke-like symptoms. That is why the team
041040 - proposes doing another lumbar puncture lab tomorrow.
041042 - ..
041043 - Discussed possible events that might have caused stroke-like
041044 - symptoms...
041045 -
041046 - 1. EGD Dilation procedure the morning before symptoms started.
041047 -
041048 - Lack of symptoms prior to this procedure, proximity in time of
041049 - symptoms starting after the procedure, and evident complete
041050 - ending of symptoms with progression of time since the procedure
041051 - on 160617 at 0800, strongly suggests something occurred during
041052 - this event that caused stroke-like symptoms later, and as this
041053 - wore off, symptoms abated.
041055 - ..
041056 - 2. Fall hitting head on concrete floor, entering VA building 203,
041057 - reported on 160519 0527. ref SDS 6 MS5J
041059 - ..
041060 - 3. Fall attempting to step across shallow creek in Crystal Rock
041061 - Creek on 160501, reported in case study on 140101 0600.
041062 - ref SDS 2 YS8N
041064 - ..
041065 - 4. Fall hiking Half Dome on 150916 0535. ref SDS 3 O87H
041067 - ..
041068 - Doctor Abrams seemed to say the falls that occurred would not be
041069 - expected to cause stroke symptoms in this case.
041071 - ..
041072 - Discussed possibility that prescribed medicines could cause a
041073 - reaction that lead to stroke symptoms on Friday?
041075 - ..
041076 - Doctor Abrams said that anything is possible.
041078 - ..
041079 - He pointed out that since stroke symptoms seem to have fully resolved,
041080 - and since the medical regimen has continued while in the hospital,
041081 - this record indicates there is no causative relationship with stroke
041082 - symptoms.
041084 - ..
041085 - Asked the doctor about possible interaction between medication regimen
041086 - and EGD dilation with conscious sedation? Since EGD dilation was
041087 - completed 2 days ago and preceeded stroke symptoms could some
041088 - interaction have occurred, for example an overdose of sedation
041089 - treatment, or using a different sedation drug, which is no longer
041090 - occurring now that caused patient stroke symptoms? Explained there is
041091 - a follow up EGD dilation scheduled on 160909, which is important to
041092 - achieve a breakthrough in treating achalasia that worsened since
041093 - December.
041095 - ..
041096 - Doctor Abrams said the VA will do everything necessary to ensure the
041097 - next EGD procedure can be performed safely and on time. He said this
041098 - is critical, because another stroke episode could be much more
041099 - serious. The team needs to figure out what happened in order to avoid
041100 - recurrence in this case, and for other patients. He explained
041101 - investigation of harmful results from procedures is a constant
041102 - objective essential to advance medical practice.
041103 -
041104 - [On 160715 1630 meeting with Doctor Yoo - Progress Notes
041105 - cleared patient for another EGD procedure without
041106 - determining what occurred in prior EGD that caused stroke
041107 - symptoms. ref SDS 15 O466
041109 - ..
041110 - [On 160802 1300 meeting with Stanford Neuroscience for 2nd
041111 - opinion, examination found no stroke occurred based on MRI
041112 - examination on 160618, following EGD the day before,
041113 - ref SDS 16 SU3H; Stanford to make thorough review of
041114 - medical records for EGD procedures to determine what caused
041115 - stroke symptoms following EGD, and expects something
041116 - accumulated from preceding procedures that caused symptoms
041117 - in this case. ref SDS 16 PJ6N
041119 - ..
041120 - [On 160816 0800 another EGD procedure was performed, and
041121 - there were no adverse stroke symptoms. ref SDS 17 5H5J
041123 - ..
041124 - [On 160817 0800 another MRI was performed and found no
041125 - repeat neurological symptoms, following EGD the day before.
041126 - ref SDS 18 WQ85
041128 - ..
041129 - [On 160823 0920 Doctor Massa reported Triamcinolone
041130 - injection into LESV remains viable inquiry on cause of
041131 - stroke symptoms after EGD on 160617; he does not have time
041132 - to complete inquiry. ref SDS 19 SA5I
041134 - ..
041135 - [On 160907 1420 letter notifies medical team that
041136 - Triamcinolone may have caused stroke symptoms on 160617,
041137 - because dose over 3 month period accumulated to
041138 - significantly more than commonly given in this case.
041139 - ref SDS 20 BI60
041141 - ..
041142 - [On 170119 0843 letter to Doctor Abram requests assistance
041143 - for payment of $855 to Stanford Neuroscience for 2nd
041144 - Opinion work to identify causes of stroke symptoms were
041145 - related to anthesthetic changes. ref SDS 21 NN60
041147 - ..
041148 - [On 170120 1249 received payment from Stanford as a refund
041149 - directly to the bank, which fully resolves this matter.
041150 - ref SDS 22 NF6L
041152 - ..
041153 - Thanked Doctor Abrams and Doctor Yoo for taking time on Sunday,
041154 - especially today being Father's Day, for providing care in this case.
041155 -
041156 -
041157 -
041158 -
041159 -
041160 -
041161 -
041162 -
041163 -
041164 -
0412 -