CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 22 0000. ref SDS 20 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Received letter from Doctor Massa saying...
040902 -
040903 - 1. Subject: Secure: RE: Agenda Meeting Neurology Resolve Stroke Symptoms Following EGD on Jun 17
040904 - Date: 2016-08-11 15:08
040908 - ..
040909 - 2. Rod,
040910 -
040911 - Got a hold of Dr Lee and discussed the case. Their review is
040912 - ongoing, but he recalls the procedure as quite standard. He
040913 - will get in touch with you to schedule another procedure there
040914 - soon. It will be on a Tues so we can attempt to get an MRI the
040915 - next day. Here is what I've put in the chart:
040917 - ..
040918 - This implements planning the meeting with Doctor Massa yesterday on
040919 - 160810 1130. ref SDS 22 SG7N
040920 -
040921 - [On 160812 1713 follow up letter later today notifies
040922 - medical team that Doctor Lee scheduled next EGD dilation
040923 - procedure on 160816 0800, ref SDS 26 OY40, and that he will
040924 - request interim report of ongoing Peer Review process, to
040925 - ensure that EGD procedure on 160816, does not repeat stroke
040926 - symptoms that occurred after prior procedure on 160617.
040927 - ref SDS 26 OY43
040929 - ..
040930 - Doctor Massa's letter continues...
040931 -
040932 - 3. Abn enhancement and cerebellar T2 were completely resolved on
040933 - the 8/5/16 MR.
040935 - ..
040936 - This may be saying "Abnormal enhancement..." and references favorable
040937 - findings in MRI on 160805 0845. ref SDS 17 WQ54
040939 - ..
040940 - Doctor Massa's letter continues...
040941 -
040942 - 4. Cerebellum appears nl w/o evidence of stroke.
040944 - ..
040945 - This may be saying "Cerebellum appears normal without evidence..."
040947 - ..
040948 - Doctor Massa's letter continues...
040949 -
040950 - 5. Spoke with pt at length about the course of events following
040951 - the EGD--there was an initial groginess, possible visual
040952 - inattention and manual clumsiness which might have been d/t
040953 - holdover anesthetic effects; however, subsequently and for
040954 - several hours, there appeared to be L visual field deficits or
040955 - neglect, though whether intermittant or continuous is unclear.
040957 - ..
040958 - This relates discussion in the meeting yesterday, when Doctor Massa
040959 - asked about symptoms on 160617, after EGD dilation; at that time on
040960 - 160810, there was discussion to rely on the record showing sequence of
040961 - symptoms, reported on 160810 1130. ref SDS 22 1E4K that followed EGD
040962 - dilation performed on 160617 1637. ref SDS 2 5F6F
040964 - ..
040965 - Doctor Massa's letter continues...
040966 -
040967 - 6. The temporal relationship of the resolution of this to the time
040968 - of the MRI is unclear. There were no other sx suggestive of
040969 - meningitis, and the CSF was non-inflammatory.
040971 - ..
040972 - 7. Spoke with Dr Lee, from NCHCS/Sacramento GI-- peer review of
040973 - the case is ongoing, but he notes no significant variances from
040974 - pts prior procedures, which have followed standard practices.
040976 - ..
040977 - 8. Further discussed possibilities of occult venous introduction
040978 - of triamcinolone which is injected at the site of the
040979 - dilitation, which may account for the pts neutrophilic WBC
040980 - bump.
040982 - ..
040983 - 9. and also discussed the production of partial esophageal tears
040984 - with the procedure, which rarely could admit venous air.
040986 - ..
040987 - These latter points address common compliations from EGD procedures,
040988 - though they occur rarely.
040989 -
040990 - [On 160812 1119 letter to Doctor Massa and medical team
040991 - noting Neurology VAMCSF has now listed specific lines of
040992 - inquiry on what caused stroke symptoms following EGD
040993 - dilation on 160617. ref SDS 24 IZ4U
040995 - ..
040996 - [On 160822 1321 at 1642 Doctor Kim called and seemed to
040997 - advised that Stanford Neuroscience has not reviewed
040998 - additional assessment Doctor Massa reported on 160811, for
040999 - 2n opinion determination of what caused stroke symptoms
041000 - after EGD procedure on 160617. ref SDS 27 VK4J
041002 - ..
041003 - Doctor Massa's letter continues...
041004 -
041005 - 10. However neither of these would be c/w the MRI findings, and no
041006 - stroke occurred. The cause and exact nature of the neurologic
041007 - sx remain unclear, as well as the MRI findings.
041009 - ..
041010 - 11. The significant possibility of a relationship to the EGD
041011 - remains, but no mechanism is forthcoming.
041013 - ..
041014 - There is still a mystery for Stanford Neuroscience to address, planned
041015 - by Doctor Vora on 160802 1300. ref SDS 12 GY48
041016 -
041017 - [On 160907 1420 letter notifies medical team that
041018 - Triamcinolone may have caused stroke symptoms on 160617,
041019 - because dose over 3 month period accumulated to
041020 - significantly more than commonly given in this case.
041021 - ref SDS 28 BI60
041023 - ..
041024 - Presenting "significant possibility of causal relationship between EGD
041025 - on 160617, and stroke symptoms reported following the procedure,
041026 - corrects VA prior letter saying no relationship could exist, shown in
041027 - the record on 160715 1630. ref SDS 4 MO5P
041029 - ..
041030 - Doctor Massa's letter continues...
041031 -
041032 - 12. Given the apparent reversibility of the findings and pt
041033 - tolerance of numerous past procedures, and progressive GI sx,
041034 - it is reasonable to plan another procedure soon. Dr Lee will
041035 - contact the pt to arrange.
041037 - ..
041038 - Doctor Massa's reference to "progressive GI sx [symptoms], reflects
041039 - the copy he received of the letter to Doctor Lee reporting rising
041040 - swallowing and vomiting problems, shown on 160801 1428. ref SDS 11
041041 - WX53 Doctor Massa's letter today further aligns with the letter to
041042 - the medical team yesterday requesting that next EGD procedure be
041043 - advanced to resolve rising symptoms, reported on 160810 0453.
041044 - ref SDS 21 2958, and which was then discussed in the meeting yesterday
041045 - on 160810 1130. ref SDS 22 UV4O
041046 -
041047 - [On 160812 1626 Doctor Lee called and advanced next EGD 3
041048 - weeks from 160909, to 160816. ref SDS 25 G64I
041050 - ..
041051 - [On 160812 1713 follow up letter later today notifies
041052 - medical team that Doctor Lee scheduled next EGD dilation
041053 - procedure on 160816 0800, ref SDS 26 OY40, and that he will
041054 - request interim report of ongoing Peer Review process, to
041055 - ensure that EGD procedure on 160816, does not repeat stroke
041056 - symptoms that occurred after prior procedure on 160617.
041057 - ref SDS 26 OY43
041059 - ..
041060 - 13. We will try to arrange repeat MRI for the day following the
041061 - procedure.
041063 - ..
041064 - Peforming another MRI after next EGD procedure aligns with planning
041065 - during the meeting yesterday with Doctor Massa, on 160810 1130.
041066 - ref SDS 22 SG8M
041068 - ..
041069 - 14. Thanks,
041070 - SMM
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