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 -
140507 -
140509 - ..
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 33 JN3J, shown in case
140903 - study on 140101 0600. ref SDS 8 O85F Lauren performed a neurological
140904 - test, passed this including Romberg's balance test. ref SDS 33 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 36 FG5O
140909 - Lauren also planned to consult with Neurology about balance problem,
140910 - ref SDS 36 YK6J; she may make referral to Physical Therapy to evaluate
140911 - and assist with recovery balance problem. ref SDS 36 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 36 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 38 PG6N
140919 - Rose on the Appointment care 5/23, so called back and got correction
140920 - from Bridget. ref SDS 38 8M9M
140922 - ..
140923 - On 160523 0830 meeting with Mike in Physical Therapy, ref SDS 39 010U,
140924 - reviewed 4 falls past few years, ref SDS 39 EL7G; Mike performed
140925 - Dix-Hallpike head movement maneuver testing for BPPV, (Benign
140926 - paroxysmal positional vertigo), ref SDS 39 R657, explained in the
140927 - record on 160513 1100. ref SDS 36 4W62 Seemed to pass Romberg's test,
140928 - and heel-toe test. ref SDS 39 EQ9O Failed test in machine with feet
140929 - support moving and walls rotating. ref SDS 39 IZ6F Mike diagnosed
140930 - falls that seem unrelated to dizziness and with no awarness of falling
140931 - as "Vestibular Hypofunction." ref SDS 39 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 42 SY6N
140937 - Maneta called later and changed this to 1100. ref SDS 42 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 Alex in Neurology, he ordered certain
140946 - specific auditory tests that evaluate vestbular balance function other
140947 - than dizziness, that may shed light on why the fall on Half Dome, and
140948 - the fall in Crystal Rock Park did not register awareness of falling
140949 - until it was too late to make adjustments. ref SDS 45 PT9F
140951 - ..
140952 - On 160606 1409, on returning from visiting Sally and mother in Oregon,
140953 - there was a message recorded at 1038 from Audiology Balance Clinic,
140954 - that seemed to be from Bethany Wiseman. Called back to schedule
140955 - meeting at the number: 415 750 2242. ref SDS 46 WE8K Eventually,
140956 - talked to Marilyn and scheduled meeting on audiology on 160707 0900.
140957 - ref SDS 46 KX36 After Audiology meeting, will meet with Bethany
140958 - Wiseman same day at 1000 to work on dizziness problem. ref SDS 46 J151
140959 -
140960 -
140962 - ..
1410 -
1411 -
1412 - Progress
1413 -
141301 - Meeting Audiology Balance Department Resolve Dizziness BPPV
141302 -
141303 - Follow up ref SDS 46 QY5F, ref SDS 45 QY5F.
141304 -
141305 - Today, went to Audiology and Balance Department in Building #1, which
141306 - Mike showed the way 2 days ago on 160705 1100. ref SDS 48 1Y6L
141308 - ..
141309 - Met Jonie Metzger, AuD, Clinical Audiologist, and Laura Schmitt,
141310 - Audiology Intern. They performed a series of hearing tests, which
141311 - consisted of responding by pressing a switch to signal hearing
141312 - progressively weaker sounds in both ears, and then each ear
141313 - separately.
141315 - ..
141316 - After the tests, which took about 40 minutes, Jonie displayed on a
141317 - computer screen results, which she said show "excellent" hearing.
141319 - ..
141320 - Doctor Metzger and Laura were fun to work with. They were efficient,
141321 - and excellent explaining and performing each test.
141322 -
141323 -
141325 - ..
1414 -
1415 -
1416 - 1000
1417 -
141701 - Met Anna Black, Au D, Clinical Audiologist.
141702 -
141703 - Anna performed visual tests with specially designed goggles placed
141704 - over the eyes, and with electrical cables connected to a computer, so
141705 - the eyes can be seen on the computer monitor blown up in size. These
141706 - tests checked for response time between points of light coming into
141707 - view and when the brain shows recognition. Tests are performed in a
141708 - tight enclosure that closely surrounds a chair. The patient is
141709 - strapped into the chair, including chest, arms strapped to chair arms,
141710 - and feet are also strapped, to prevent falling from the chair due to
141711 - dizziness from spinning sensation that occurs with moving points of
141712 - light.
141714 - ..
141715 - Several tests were similar but performed at different times, where an
141716 - array is displayed on the circular wall consisting of virtical bars of
141717 - alternate shades of grey and off-white. This array is moved or
141718 - swirlled around the patient, who is asked speak out loud counting the
141719 - numbr of either dark or lighter vertical bars. The speed of the
141720 - moving bars passing in front of the eyes is such that merely counter
141721 - as fast as possible is the only option without conscious awareness of
141722 - how many bars actually pass by. Seemed like this test was done 3 or 4
141723 - times for 30 - 60 seconds each.
141725 - ..
141726 - Another test displayed a point of red light that was moved up and
141727 - down, left and right and at various angles. The exercise was for the
141728 - eyes to follow the light without moving the head.
141730 - ..
141731 - This battery of tests took about 20 minutes.
141732 -
141733 -
141735 - ..
1418 -
1419 -
1420 - 1026
1421 -
142101 - Met Bethany Wiseman.
142103 - ..
142104 - Bethany asked about falling events?
142106 - ..
142107 - Presented the list shown in the record meeting with Mike in Physical
142108 - Therapy on 160523 0830. ref SDS 39 EL7G Explained meeting with Doctor
142109 - Yoo in Neurology on 160603 1430, ref SDS 45 QY5F, and that the doctor
142110 - made referral to Audiology and Balance for the meeting today.
142111 - ref SDS 45 PT9F
142113 - ..
142114 - Bethany asked for circumstances causing dizziness?
142116 - ..
142117 - Generally dizziness only occurs in 2 situations...
142118 -
142119 - 1. Laying in bed on left side, or on the back with head turned to
142120 - the left. Rolling to the back or turning head from the left
142121 - to vertical or to right side, causes momentary dizziness that
142122 - lasts a few seconds.
142124 - ..
142125 - This does not occur every time.
142127 - ..
142128 - 2. Occasionally, bending over for example to connect a cable to
142129 - the back of a computer, there can be moments to noticable
142130 - dizziness.
142132 - ..
142133 - This does not occur every time. Demosntrated this by doing a
142134 - few windmills bending down with feet spread and touching
142135 - opposite toe on alternate feet did not cause dizziness today.
142137 - ..
142138 - Reviewed the record of Mike performing Dix-Hallpike maneuver that did
142139 - not yield rapid eye movement required to establish BPPV, reported on
142140 - 160523 0830. ref SDS 39 R657 Later, On 160616 1000 Mike advised that
142141 - rapid eye movement was observed with severe dizziness after doing
142142 - Epley manauver again, and so Mike confirmed diagnosis of BPPV in this
142143 - case. ref SDS 47 JQ4O
142145 - ..
142146 - Today, Bethany performed alternatively, Dix-Hallpike and Epley
142147 - maneuvers (research explained in the record on 160513 1100.
142148 - ref SDS 36 4W62). She found rapid eye movement (nystagmus) that
142149 - diagnosed BPPV.
142151 - ..
142152 - These efforts, including eventually the Semont maneuver, explained on
142153 - 160513 1100. ref SDS 36 M23M, were performed possibly 20 times, with
142154 - Bethany using her hands to position the head and body that caused
142155 - dizziness, and observe rapid movement, i.e., nystagmus. She was
142156 - really terrific being persistent and confident in her skills to
142157 - resolve the problem. Anyone else might have given up, but Bethany was
142158 - generous with her time to accomplish a solution.
142160 - ..
142161 - Repeating these maneuvers brought to mind the more precise sequence of
142162 - head positions that have caused dizziness. In this case, we found
142163 - that twisting the head to the left and cocking it up by looking up and
142164 - to the left readily caused dizziness every time today.
142166 - ..
142167 - Then surmised that fall hiking Half Dome last year on 150916, could
142168 - have occurred by looking up and over left shoulder to see Half Dome
142169 - and surrounding granite cliffs, which is part of the normal experience
142170 - doing this hike.
142172 - ..
142173 - Another scenario could simply have been bending over going up the
142174 - steep trail nearing Neveda Falls. Since bending over can sometimes
142175 - trigger dizziness, and since there is some bending over when the trail
142176 - is steep touching the next rock-step to steady the body, this might
142177 - caused slight dizziness which combined with fatigue to cause the
142178 - fall, rather than looking up over the left shoulder to see the top of
142179 - Half Dome.
142181 - ..
142182 - Eventually, Bethany slightly modified the maneuvers by adding a
142183 - vigerous, vertical head shake 3 times. This was done the last 3 or 4
142184 - times the maneuver was performed.
142186 - ..
142187 - The degree of dizziness from repeatedly inducing this condition caused
142188 - nausea. Had to go to the restroom to vomit. Fortunately, this did
142189 - not deter Bethany. On returning to the treatment room, she continued
142190 - to try variations of maneuvers to cause calcified crystals to drift
142191 - and drop back into the vestibular chamber, required to resolve BPPV
142192 - dizziness.
142194 - ..
142195 - Bethany advised that BPPV dizziness can be caused by receiving a
142196 - vigorous jolt to the head, for example getting hit in football or
142197 - boxing, being dropped to the mat in wrestling, possibly being bumped
142198 - (blocked out) in basketball, hocky, even a catcher being hit by a
142199 - sliding runner at home plate, etc.
142201 - ..
142202 - In this case, about 2 years ago or so, on 140816, I jumped on a
142203 - trampoline and found skills from 23 years earlier had significantly
142204 - degraded. ref SDS 9 IY77 For example, on 910525 demonstrated common
142205 - trampoline tricks to Morris' kids when he set up a trampoline for them
142206 - in the backyard of his new home in Saratoga. ref SDS 1 0001 The next
142207 - previous experience with trampoline was with Richard, Ross, and Nina
142208 - in about 1975, when we all went to a commercial playgound that had a
142209 - lot of trampolines, where customers rent use for so much per hour.
142211 - ..
142212 - Using the trampoline on 140816 caused a severe jolt to the back and
142213 - head from landing wrong on the stomach. 140816 0937, ref SDS 9 IY80
142214 - This was a year before the fall at Half Dome, so the time fits the
142215 - circumstances in that dizziness occurred for sometime prior to Half
142216 - Dome. There is no record of specific incidents prior to Half Dome,
142217 - because dizziness was considered a benign aging effect.
142219 - ..
142220 - Today, despite prodigous efforts we were both disappointed that
142221 - continued testing seemed to indicate dizziness was not resolved;
142222 - though on leaving there seemed some improvement. We just were not
142223 - sure.
142224 -
142225 - [On 160712 0426 since Bethany's work in Audiology and
142226 - Balance, there have no episodes of dizziness nor loss of
142227 - balance, indicating possible resolution of BPPV.
142228 - ref SDS 49 QY5F
142230 - ..
142231 - [On 160715 1200 visited Audiology and Balance clinic; saw
142232 - Anna briefly, and told her that since Bethany performed
142233 - Dix-Hallpike, Epley, and Semont maneuvers on 160707, there
142234 - have been no further dizziness nor balance problems. Asked
142235 - her to notify Bethany, and to express appreciation for
142236 - great work. ref SDS 51 PP8P
142238 - ..
142239 - [On 160715 1630 during meeting with Doctor Yoo in
142240 - Neurology, reported there have been no further episodes of
142241 - dizziness nor balance problems. ref SDS 52 S19F
142242 -
142244 - ..
142245 - Bethany was kind offering to do another session. She said to let her
142246 - know if meeting again for further maneuvers would be helpful to
142247 - better resolve dizziness problems.
142249 - ..
142250 - Thanked Bethany and Anna for working with such a clutzy customer.
142251 -
142252 - [On 160715 1200 while on campus for other matters, stopped
142253 - at Audiology and Balance clinic. Saw Anna, and reported
142254 - there have been no further dizziness nor balance problems,
142255 - since Bethany's work on 160707. ref SDS 50 PP8P
142256 -
142257 -
142258 -
142259 -
1423 -
SUBJECTS
Default Null Subject Account for Blank Record
1503 -
150401 - ..
150402 - Progress Notes Audiology
150404 - ..
150405 - VA medical records website is at...
150406 -
150407 - https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel=mhvHome
150409 - ..
150410 - Customer....
150414 -
150415 -
150416 -
150417 -
150418 -
150419 -
150420 -
150421 -
150422 -
150423 -
150424 -
150425 -
150426 -
150427 -
150428 -
150429 -
150430 -
150431 -
150432 -
150433 -
150434 -
150435 -
150436 -
150437 -
150438 -
150439 -
150440 -
1505 -