CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 8 0000. ref SDS 7 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - While meeting with Doctor Kim, and Swapnil Mehta, Medical Student at
040902 - Stanford Neuroscience in Palo Alto to prepare the case for Doctor
040903 - Nirali Vora, reported in another record earlier today on 160802 1300.
040904 - ref SDS 9 VN9K, received call from Doctor Massa.
040906 - ..
040907 - The cellphone was on speaker mode so that the 2 doctors could hear
040908 - this discussion, in order to guide their 2nd opinion analysis.
040910 - ..
040911 - Doctor Massa initially said he called about the 2 questions I had the
040912 - other day.
040913 -
040914 - [...below on 160802 1404 at 2024 after returning home from
040915 - Stanford Neuroscience Health Center in Palo Alto, received
040916 - letter from Doctor Massa presenting more details explaining
040917 - new efforts of the VA Neurology Department to review this
040918 - case. ref SDS 0 QE4O
040920 - ..
040921 - I asked what questions and what day, as there have been numerous
040922 - questions and meetings in this case?
040924 - ..
040925 - The last time we met was 2 weeks ago in the lobby of Module #2 on
040926 - 160722 1304. ref SDS 4 PR5H However, under the circumstances of
040927 - meeting with Stanford Neuroscience for 2nd opinion on MRI findings,
040928 - and being engaged with 2 other doctors, could not remember any
040929 - details, except the general question to VA Neurology on the cause for
040930 - findings of a "likely infarct" (stroke), and "suspicious for
040931 - leptomeningeal enhancement" and further that the VA Neurology notice
040932 - seems premature, as issued on 160715, telling Doctor Lee with the GI
040933 - Clinic at VA Medical Center in Sacramento that the patient is cleared
040934 - by Neurology for repeat EGD dilation scheduled on 160909, which was
040935 - sent to Doctor Lee in a letter from VA Neurology on 160715 1630.
040936 - ref SDS 3 MO6F
040938 - ..
040939 - Doctor Massa advised VA Neurology now feels the EGD Dilation procedure
040940 - scheduled on 160909, may have to be delayed.
040942 - ..
040943 - The doctor said Neurology has changed assessment of MRI on 160618, and
040944 - no longer believes a stroke occurred, contrary to the express finding
040945 - in the radiology report on 160618 1348. ref SDS 2 IY8H
040946 -
040947 - [...below on 160802 1404 at 2024 after returning home from
040948 - Stanford Neuroscience Health Center in Palo Alto, received
040949 - letter from Doctor Massa presenting more details explaining
040950 - new efforts of the VA Neurology Department to review this
040951 - case, ref SDS 0 UH5L, and then determining that the MRI on
040952 - 160618, does not support a diagnosis of stroke. ref SDS 0
040953 - 5K34
040955 - ..
040956 - Doctor Massa said another MRI should be done before cerebral
040957 - angiography scheduled on 160824, to compare with the scan study on
040958 - 160618, and determine if symptoms have resolved. This modifies the
040959 - prior work plan calling for an MRI after cerebral angiography,
040960 - presented during the meeting on 160715, ref SDS 3 3K6N, and shown in
040961 - Progress Notes for the meeting that day.
040963 - ..
040964 - [On 160802 1300 Doctor Vora during meeting for 2nd opinion
040965 - from Stanford Neuroscience recommends immediate MRI to
040966 - compare with 1st MRI to see if white dots shown in 1st MRI
040967 - on 160618, have resolved, in line with resolution of stroke
040968 - symptoms 2 days after onset of symptoms on 160617, or are
040969 - still stable, or increased, toward diagnosing cause of
040970 - patient stroke symptoms, and risks for increased symptoms
040971 - in relation to repeating EGD with conscious sedation
040972 - procedures. ref SDS 9 SA4F
040974 - ..
040975 - Further advised the Doctor Massa about MRI scheduled on 160805, this
040976 - Friday to evaluate recent knee injuries. Possibly the MRI on the
040977 - brain could be done the same day.
040979 - ..
040980 - Explained that results of the meeting today with Stanford Neuroscience
040981 - will be provided to the medical team. He can then collaborate on
040982 - determinging causation, and line of care changes, if any for the next
040983 - EGD dilation on 160909.
040985 - ..
040986 - Emphasized to Doctor Massa the importance of maintaining schedule for
040987 - EGD dilation on 160909, since LESV seems to be shutting down, as set
040988 - out in the copy of letter he received on 160730 0926. ref SDS 8 WF5I
040989 -
040990 -
040991 -
040993 - ..
0410 -
0411 -
0412 - 2024
0413 -
041301 - On returning home from Stanford Medical Center after the meeting
041302 - today, there was a letter from Doctor Massa saying...
041303 -
041304 - 1. Subject: Secure: RE: Neuroscience center
041305 - Date: 2016-08-02 15:17
041309 - ..
041310 - 2. Rod, Here is what I've put in the chart today (sx=symptoms,
041311 - tx=treatment, c/w=consistent with):
041313 - ..
041314 - This letter responds to the letter to Stanford Neuroscience requesting
041315 - 2nd opinion, with copy to medical team at the VA, and issued on 160730
041316 - 0926. ref SDS 8 WF5I
041318 - ..
041319 - It was submitted after the doctor called earlier today, during the
041320 - meeting with the Stanford Neuroscience team, per above. ref SDS 0 WF5I
041321 -
041322 - [On 160802 2220 sent copy of this letter from Doctor Massa
041323 - setting new direction in diagnosing the affliction to be
041324 - treated, to Jesse at Stanford Neuroscience for submission
041325 - to Doctor Vora to guide her 2nd opinion work product.
041326 - ref SDS 10 4P97
041328 - ..
041329 - Letter from Doctor Massa continues...
041330 -
041331 - 3. The brain MR of 6/18/16 was initially read as consistent with a
041332 - subacute R SCA infarct, and with R holohemispheric
041333 - subarach/vascular enhancement c/w a leptomeningeal process. On
041334 - further review with Neuroradiology today it is noted that the
041335 - pia-arach/vascular enhancement is bilateral, though more
041336 - prominent on the R. In addition, it is suggested that the R
041337 - cerebellar DWI+ may represent shine-through rather than
041338 - subacute reduced diffusion, and that the T2/flair signal as
041339 - well as enhancement in this region may be a manifestation of
041340 - the same process affecting brain surface vessels elsewhere,
041341 - rather than a subacute stroke.
041343 - ..
041344 - This eliminates initial diagnosis of asymptomatic stroke.
041345 -
041346 - [On 160820 0940 received letter from Stanford Neuroscience
041347 - reporting the meeting on 160802, and describing MRI on
041348 - 160618, as showing no true restricted diffusion (which may
041349 - be another term for stroke), and citing "shine through" as
041350 - set out in Doctor Massa's letter today. ref SDS 11 JZ66
041352 - ..
041353 - Does this eliminate the need for another Zio XT test?
041355 - ..
041356 - 4. CSF exam w/ nl protein is against
041357 - inflammation/infection/neoplasia, as are the lack of sx at the
041358 - time of the MR/LP and since then, without specific tx.
041360 - ..
041361 - 5. Though the LP was traumatic making the cell count a bit
041362 - unclear, there was no evidence of significant inflammation.
041364 - ..
041365 - 6. Thus the nature of the apparent meningovascular abnormality, as
041366 - well as its relationship to the pts sx and/or the GI procedure
041367 - remains unclear.
041369 - ..
041370 - 7. Whether those sx might have been a prolonged effect of the
041371 - anesthetic remains to be further queried.
041373 - ..
041374 - 8. Repeat MR at this point is important to determine whether the
041375 - findings have resolved or otherwise evolved, and will help to
041376 - determine the next steps, which could include large volume LP
041377 - and/or angiogram (the latter currently already scheduled for
041378 - 8/24). Have requested the brain MR to be done at the time of
041379 - his upcoming knee MR on 8/5.
041381 - ..
041382 - 9. I've put in an order for your head MRI on Friday and discussed
041383 - it with Neuroradiology, so it should happen. Please let me
041384 - know if there is a problem with this.
041386 - ..
041387 - Best,
041389 - ..
041390 - SMM
041391 -
041392 -
041393 -
041394 -
041395 -
041396 -
041397 -
041398 -
041399 -
041400 -
041401 -
041402 -
041403 -
041404 -
041405 -
041406 -
041407 -
041408 -