THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com
S U M M A R Y
DIARY: August 16, 2016 08:00 AM Tuesday;
Rod Welch
VA EGD dilate LESV from 10 mm to 15 mm add triamcinalone injection.
1...Summary/Objective
2...Esophagogastroduodenoscopy (EGD) and Dilation LESV Administration
3...GI Department VA Sacramento Medical Center Administration EGD Dilation
4...Pre-op Preparation No Problems Getting Blood Flow for Anesthesia IV
5...Consent Signed EGD Dilation and Meeting Review Pending Issues
6...Consultation Pending Issues and Sign Consent for EGD Dilation
7...Swallowing Vomitting Difficulties Resolved with Triamcinolone Injections
8...Triamcinolone Injection Prevent LESV Contraction Avoid Swallowing Vomitting Problems
9...OR EGD Dilation with Application Lidocaine
10...EGD Dilation Procedure in OR Application Lidocaine
11...Meeting Doctor Lee Present Results EGD Dilation Procedure 10 MM
12...Results EGD Dilation Procedure Meeting Doctor Lee Present 10 MM
13...Ulceration LESV Increased Prevented Dilating LESV Above 10 MM
14...Dilated 10 MM Rather than Healthy LESV 20 MM Due to Increased Ulceration
15...Pantoprazole Prescirbed Replace Omeprazole and Famotidine
16...Next Meeting 3 Weeks to Recover Severe Symptoms
17...Release of Information ROI CD Contents Received on 151224
..............
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CONTACTS
SUBJECTS
VA EGD Procedure Stricture Lower Esophageal Sphincter Valve LESV 10
2503 -
2503 - ..
2504 - Summary/Objective
2505 -
250501 - Follow up ref SDS G8 0000. ref SDS G6 0000.
250502 -
250503 - Diffuculty swallowing this cycle began about 2 weeks ago. ref SDS 0
250504 - P55L Signed blank consent for the procedure today, on assurance from
250505 - Doctor Lee that stroke symptoms following prior EGD on 160617, would
250506 - not recur. ref SDS 0 BH9G EGD dilation procedure went smoothly, with
250507 - no reports of difficulties. ref SDS 0 7V6I Post procedure Doctor Lee
250508 - reported LESV contracted back to 9.5 mm, the wors in patient history,
250509 - indicating 2 month delay to 8 months performing procedure in December
250510 - causing continual injury. ref SDS 0 5H5J Ulceration got worse this
250511 - past cycle, which prevented the doctor from dilating LESV needed for
250512 - better swallowing. ref SDS 0 RZ3G Doctor Lee prescribed Pantoprazole
250513 - 40 mg twice a day to replace taking Omeprazole and Famotidine.
250514 - ref SDS 0 Q05K Next meeting in 3 weeks. ref SDS 0 4U5F
250515 -
250516 -
250517 -
250518 -
250519 -
250521 - ..
2506 -
2507 -
2508 - Background
2509 -
250901 - On 050629 meeting Primary Care swallowing and vomitting problems
250902 - reported. ref SDS 1 K78K
250904 - ..
250905 - On 050714 barrium swallow test, ref SDS 2 2I4S, showed esophagus
250906 - distorted by swallowing problems. ref SDS 2 WE4H
250908 - ..
250909 - On 050816 meeting Primary Care Doctor Sandhu diagnoses achalasia.
250910 - ref SDS 3 DG8G Ultrasound test ordered to verify initial diagnosis of
250911 - swallowing and vomitting problems. ref SDS 3 6E7H Primary Care made
250912 - referral to GI clinic for care to resolve swallowing problems.
250913 - ref SDS 3 0G7M
250915 - ..
250916 - On 050830 ultrasound test evaluate swallowing problems possible
250917 - diagnosis achalasia. ref SDS 4 DG8G
250919 - ..
250920 - On 050830 results received barrium swallow test performed on 050714,
250921 - findings in the lower espohagus and gastroesophageal junction are
250922 - consistent with achalasia - recommend endoscopic examination.
250923 - ref SDS 4 6H9S
250925 - ..
250926 - On 050906 report ultrasound test on 050830, finds no cause for
250927 - swallowing problems and does not diagnose achalasia. ref SDS 5 BM6R
250929 - ..
250930 - On 051202 meeting GI Clinic Doctor Lee diagnoses achalasia.
250931 - ref SDS 6 HP9H Orders endoscopy (EGD) test to verify diagnosis of
250932 - achalasia and assess for cancer. ref SDS 6 NZ5H
250934 - ..
250935 - On 051209 GI Clinic endoscopy examination preliminary findings no
250936 - evidence of cancer, ref SDS 7 0001; biopsy report should be submitted
250937 - in a few weeks to confirm status of cancer, ref SDS 7 PY5J, and if so,
250938 - then a procedure can be schedule for next month to dilate the
250939 - exophageal sphincter valve. ref SDS 7 NZ5H
250941 - ..
250942 - On 051222 biopsy reports no evidence of cancer. ref SDS 8 FT6M
250944 - ..
250945 - On 060111 received letter from Doctor Lee in the Gastrointestinal (GI)
250946 - Clinic reporting that the biopsy was negative for cancer and
250947 - infection; next step is manometry test to verify achalasia, then
250948 - treatment for achalasia. ref SDS 9 4Q3R
250950 - ..
250951 - On 060125 manomety test scheduled for 060209 0800. ref SDS 10 GG9I
250953 - ..
250954 - On 060209 meeting at VA Mather AFB in Sacramento, test was postponed
250955 - until 060223, due to equipment failure. ref SDS 11 OW6M
250957 - ..
250958 - On 060221 Jimmy in GI Department at Sacramento VA Medical Center
250959 - reports manometry equipment still broken; has been sent out for
250960 - repairs and there is no date at this time on when the equipment will
250961 - be available for use at the VA. ref SDS 12 ND7M
250963 - ..
250964 - On 060330 endoscopy follow up examination at GI Department Sacramento
250965 - Medical Center - Doctor Lee finds no evidence cancer performed at VA
250966 - Sacramento condition precedent treatment recover from achalasia.
250967 - ref SDS 13 VX4G
250969 - ..
250970 - On 060330 manometry test performed by Doctor Lee at VA in Sacramento,
250971 - ref SDS 13 MC7P, verifies diagnosis swallowing and vomitting problems
250972 - caused by achalasia, ref SDS 13 MD4N, patient meets criteria for
250973 - treatment with pneumatic dilation. ref SDS 13 MD5G
250975 - ..
250976 - On 060505 Martinez VA GI clinic Doctor Lee reported equipment and
250977 - pneumatic balloon materials on hand to perform dilation for treating
250978 - achalasia; treatment delayed until diagnostic data is received from
250979 - Sacramento VA Medical Center from manometry test performed on 060330;
250980 - doctor following up to obtain data; will submit test data to patient
250981 - during the week of 060508, along with a schedule to treat achalasia.
250982 - ref SDS 14 FT6M
250984 - ..
250985 - On 060614 Martinez VA GI clinic reports increased work load treating
250986 - soldiers returning from war in Iraq requires prioritizing; patient
250987 - advocate, Rubin Soto, will coordinate with the GI Clinic notifying the
250988 - customer of the schedule based on current priorities. ref SDS 15 J86N
250990 - ..
250991 - On 070220 letter to VA asks about progress getting test results from
250992 - VA in Sacramento, and scheduling surgery for achalasia, ref SDS 16
250993 - 5R5R
250995 - ..
250996 - On 090812 1030 continued vomitting achalasia causes weight loss 30
250997 - pounds in a few months, Primary Care physician notified GI clinic to
250998 - review schedule for dilation to relieve achalasia. ref SDS 17 7L5O
251000 - ..
251001 - On 090908 meeting GI Clinic in Martinez reports treatment for
251002 - achalasia still waiting to receive results for manometry test on
251003 - 060330, at Sacramento VA Medical Center. ref SDS 18 HX46 Prepared new
251004 - work plan to treat achalasia without manometry test results, because
251005 - the doctor performed the test 3 years ago, and is so knows results
251006 - consistent with achalasia, shown on 060330 0712, ref SDS 13 MD4N;
251007 - schedules treatment for achalasia after treadmill stress test,
251008 - ref SDS 18 BU6W, to evaluate new chest pains hiking hills at Lafayette
251009 - Reservoir which have not occurred doing extended exercise hiking 3 -
251010 - 14 miles a day over the past 5 years. ref SDS 18 MY4N
251012 - ..
251013 - On 091021 report history achalasia issue during meeting with
251014 - cardiothoracic surgery team to prepare for heart bypass surgery the
251015 - next day. ref SDS 20 NX6M Surgery team will coordinate with
251016 - anesthesia team to provide swallowing relief during heart surgery to
251017 - prevent choking. ref SDS 20 R78O
251019 - ..
251020 - On 091022 0700 meeting anesthesia team - Doctor Brezinski not familiar
251021 - with achalasia - asked if achalasia has been reported to the VA?
251022 - ref SDS 21 JF9K While being prepared with IVs for surgery, patient
251023 - assists anesthesia find VA records on achalasia, ref SDS 21 2W4K;
251024 - Doctor Brezenski makes plans for patient care and safety so that
251025 - achalasia does not risk death during heart surgery. ref SDS 21 GX4J
251027 - ..
251028 - On 091022 cabg x4 cardiothoracic surgery San Francisco Medical Center.
251029 - ref SDS 21 PQWU
251031 - ..
251032 - On 091030 0800 at 1406 meeting with Doctor Stewart at San Francisco
251033 - Medical Center during recovery from heart surgery, proposes Heller
251034 - Myotomy surgery rather than pneumatic (balloon) dilation as more
251035 - effective and longer lasting solution to recover from swallowing and
251036 - vomitting problems caused by achalasia. ref SDS 24 KE3B
251038 - ..
251039 - On 091030 0800 at 1430 received documentation from GI Department at
251040 - San Francisco Medical Center - review shows 3 different treatments for
251041 - achalasia - pills, pneumatic dilation, Heller Myotomy surgery.
251042 - ref SDS 24 495I
251044 - ..
251045 - On 091030 0800 at 1440 meeting cardiothoracic surgery team; Doctor
251046 - Ratcliff concerned about how to maintain nutrition for the patient to
251047 - recover from heart surgery while digestion remains problematic due to
251048 - achalasia; proposes feeding tube for several months until Heller
251049 - Myotomy surgery. ref SDS 24 03GF
251051 - ..
251052 - On 091216 Heller Myotomy surgery at San Francisco VA Medical Center to
251053 - recover from achalasia. 091216 0600, ref SDS 36 KE9U
251055 - ..
251056 - On 100202 meeting with Doctor Lee - report swallowing and vomitting
251057 - problems 3 months after Heller Myotomy surgery. Doctor explains
251058 - achalasia disease breaks nerve connections from the brain that
251059 - contract the esophagus to force food and liquid from the mouth through
251060 - the esophagus; as well broken nerve connections prevent the lower
251061 - esophageal sphincter valve (LESV) to relax so that content can pass
251062 - into the stomach. Without esophageal contractions, food and liquid
251063 - can only reach the stomach with gravity, but since the LESV won't
251064 - relax the patient continues to have swallowing and vomitting problems,
251065 - despite Heller Myotomy surgery on 091216, intended to maintain
251066 - adequate opening into the stomach. ref SDS 47 485W
251068 - ..
251069 - On 100305 meeting at GI Clinic in Martinez, EGD procedure dilated LESV
251070 - from 11 to 15 mm. ref SDS 48 WR6L
251072 - ..
251073 - On 100827 meeting at GI Clinic in Martinez, EGD procedure dilated LESV
251074 - from 11 to 15 mm. ref SDS 55 JE6X
251076 - ..
251077 - On 101210 EGD procedure dilated esophageal sphincter valve (LESV)
251078 - without sedation, ref SDS 67 BE7K - dilated LESV again from 11 to 14
251079 - mm. ref SDS 67 BF6L
251081 - ..
251082 - On 101216 1021 letter commends medical team for excellent work, and
251083 - confirms schedule next EGD on 110218 0730. ref SDS 69 K35G
251085 - ..
251086 - On 110218 0730 4th EGD procedure at VA in Martinez, and using
251087 - anesthesia with Fentanyl. ref SDS 72 PQWY LESV dilated 11 - 14 mm,
251088 - and added triamcinolone steriod injections to resist contraction of
251089 - LESV so that swallowing is maintained over the next 3 month cycle.
251090 - ref SDS 72 SR4G
251092 - ..
251093 - On 110429 0830 5th EGD dilation at VA in Martinez - triamcinolone
251094 - steriod injections worked well to resist contraction of LESV so that
251095 - swallowing was maintained over the prior 3 month cycle, ref SDS 76
251096 - FE3F, so LESV dilated from 13 - 16.5 mm, ref SDS 76 U23I, and
251097 - triamcinolone injections were continued. ref SDS 76 SS5N
251099 - ..
251100 - On 110607 1414 visited GI Department, ref SDS 78 HC5H, and Charlene
251101 - reported a computer mistakes requires scheduling next EGD dilation on
251102 - 110819 0830. ref SDS 78 N642 Requested meeting with Doctor Lee to
251103 - review pending action items. ref SDS 78 4P6J,
251105 - ..
251106 - On 110819 0830 EGD and Dilation of stricture at lower esphageal sphincter
251107 - valve. Triamcinolone steriod injections worked well to resist
251108 - contraction of LESV so that swallowing is maintained over the prior 3
251109 - month cycle, so LESV dilated from 15 - 16.5 mm, ref SDS 81 J978, and
251110 - triamcinolone injections were continued. ref SDS 81 J985
251112 - ..
251113 - On 111115 1300 EGD dilation procedure - triamcinolone steriod injections
251114 - worked well over the prior 3 month cycle, so LESV dilated from 16.5 -
251115 - 18 mm, ref SDS 82 IR57; for some reason triamcinolone injections to
251116 - resist contraction of LESV was not performed. ref SDS 82 IS6L
251118 - ..
251119 - On 120322 1030 EGD dilation procedure - swallowing and vomitting problems
251120 - increased without triamcinolone steriod injections on prior 3 month
251121 - cycle. ref SDS 84 UI9H LESV dilated from 16.5 - 18 mm. ref SDS 84
251122 - 516N Triamcinolone injections to resist contraction of LESV was not
251123 - performed. ref SDS 84 5179
251125 - ..
251126 - On 120925 0900 meeting Doctor Lee reported schedule mistake using new VA
251127 - business unit; reported patient history. ref SDS 87 RG9K Scheduled
251128 - EGD and dilation procedure for 1300; returned and performed procedure,
251129 - ref SDS 87 TB4J; dilated from 15 mm to 18 mm. ref SDS 87 XB51
251130 - Swallowing and vomitting problems increased after omitting
251131 - triamcinolone steriod injections to resist contraction of LESV after
251132 - dilation, ref SDS 87 TZ4M; therefore, injections were resumed to
251133 - complement dilation to enable and maintain effective swallowing.
251134 - ref SDS 87 R87N
251136 - ..
251137 - On 130110 0900 meeting Doctor Lee EGD dilation procedure found
251138 - improvement recovering from acalasia, LESV contracted only slightly
251139 - from 18 mm down to 15 mm. ref SDS 95 Q333
251141 - ..
251142 - On 130416 1100 meeting Doctor Lee EGD procedure no dilation required LESV
251143 - remained at 18 MM, ref SDS A0 CO5N, same as dialated 4 months earlier
251144 - on 130110 0900. ref SDS 95 Q333 Report CT test on 130117, shows
251145 - esophagus fully recovered from severe distortions caused by achalasia
251146 - 8 years earlier. ref SDS A0 MT6F Doctor Lee injected steriod again to
251147 - maintain swallowing. ref SDS A0 F38G Prescribed reducing Omeprazole
251148 - to 1 pill per day. ref SDS A0 R74M Scheduled next EDG dilation in 6
251149 - months, instead of 3. ref SDS A0 6P6G
251151 - ..
251152 - On 131115 0700 meeting Doctor Lee EGD prodecure dialation LESV from 16.5
251153 - to 18 mm. ref SDS A6 CO5N Triamcinolone steriod injected again to
251154 - maintain improved swallowing. ref SDS A6 I167 Omeprazole medication
251155 - maintained 20 mg taken morning and evening for 1 month, then reduce to
251156 - 20 mg once per day. ref SDS A6 R74M Biopsies taken. ref SDS A6 3N8L
251158 - ..
251159 - On 131121 1604 ordered refill of Omeprazole to aid digestion. There
251160 - is 1 refill remaining. ref SDS A7 YS4O
251162 - ..
251163 - On 131205 1443 received order for Omeprazole prescription placed on
251164 - 131121. ref SDS A8 5N3O
251166 - ..
251167 - On 140318 1043 received letter cancelling meeting scheduled for
251168 - EGD/Dilation procedure on 140425 1000, ref SDS B1 935L; a second
251169 - letter scheduled prodedure on 140509 0900. ref SDS B1 5D7H
251171 - ..
251172 - On 140401 1659 ordered refill Omeprazole; none are remaining; need
251173 - Doctor Lee to order new prescription to increase refills. ref SDS B2
251174 - 4P5M
251176 - ..
251177 - On 140509 0900 meeting Doctor Lee for EGD Dilation at VA medical
251178 - center in Sacramento, Mather. ref SDS B4 K37G Pre-op preperation went
251179 - well - IV setup on first stick. ref SDS B4 EP75 Doctor ordered refills
251180 - for Omeprazole. ref SDS B4 AW5O Doctor patient partnership continues
251181 - to progress with doctor reading up on patient history to be prepared
251182 - for effective meeting. ref SDS B4 ZZ6J Doctor Lee recalled today
251183 - having made timely referral for having heart surgery, enabling patient
251184 - to recover and Half Dome 4 years later. ref SDS B4 0N6I Reported
251185 - swallowing and vomitting problems reduced past 6 months with
251186 - triamcinolone steriod injections to resist contraction of LESV.
251187 - ref SDS B4 VV6N Doctor Lee dilated LESV contracted to only 16.5 MM
251188 - over past 6 months with triamcinolone steriod injections to resist
251189 - contraction; he dilated LESV back to 18 MMy, ref SDS B4 5H5J, scheduled
251190 - next EGD dilation in 6 months since this worked well the past 6 months
251191 - with triamcinolone steriod injections. ref SDS B4 549I The doctor
251192 - explained that since there was no tearing of LESV during procedure
251193 - today, triamcinolone steriod was not injected into LESV to resist
251194 - contraction. ref SDS B4 I167 Progress notes report small tearing of
251195 - LESV during dilation procedure. ref SDS B4 P680
251197 - ..
251198 - On 140718 1017 planning for notifying VA to update current fill date
251199 - for Omeprazole. ref SDS B8 U88L Kathy visited VA in Sacramento, and
251200 - requested changing refill date for Omeprazole to 140718. ref SDS B8
251201 - OL5K VA representative called customer, and said Doctor Lee would
251202 - call back later that day to consider action on updating scheduled
251203 - refill date of Omeprazole to 140718. ref SDS B8 U76M
251205 - ..
251206 - On 140810 1839 letter to Doctor Lee requesting EGD dilation with
251207 - triamcinolone injection soonest, if cancellation occurs; but, not an
251208 - emergency, ref SDS C0 W83K, based on history rising vomitting
251209 - swallowing problems, shown in patient history case study on 120101,
251210 - beginning 140712. ref SDS 83 4E4M
251212 - ..
251213 - On 140819 0800 during meeting at VA Primary Care Clinic in Martinez,
251214 - Doctor Sandhu indicated Doctor Lee at VA Medical Center in Sacramento
251215 - will be notified about rising achalasia symptoms for consideration to
251216 - advance EGD dilation procedure. ref SDS C1 EX78
251218 - ..
251219 - On 141014 0943 Kathy visited VA Medical Center in Sacramento and met
251220 - with Lapria again, who advised that the VA responded in a letter on
251221 - 141001, to the letter on 140810, and further scheduled a meeting with
251222 - Doctor Lee on 141121 1530. ref SDS C2 QJ5N
251224 - ..
251225 - On 141103 2152 submitted agenda for meeting with Doctor Lee at VA
251226 - Sacramento Medical Center on 141107 0800, for next EGD dilation.
251227 - ref SDS C3 K37G Submit record showing normal swallowing occurs longer
251228 - with triamcinolone steriod injection to resist contraction of LESV.
251229 - ref SDS C3 3U97 Request schedule next EGD dilation in 4 months, and
251230 - if LESV does not contract, then schedule following EGD dilation in 6
251231 - months. ref SDS C3 3U66 Notified results of Half Dome hike.
251232 - ref SDS C3 3U6Y
251234 - ..
251235 - On 141107 0800 EGD dilation procedure - setting IV for conscious
251236 - sedation required 3 sticks. ref SDS C4 5W5I Meeting Doctor Lee guided
251237 - by agenda facilitated collaboration through doctor patient
251238 - partnership. ref SDS C4 VV6N Doctor explained increased difficulty
251239 - swallowing due to experiment omitting triamcinalone steriod injection
251240 - on prior procedure, ref SDS C4 4U8I, shown by LESV contracting back to
251241 - from 15 mm. ref SDS C4 T55I Progress Notes report finding ulceration
251242 - and hiatal hernia. ref SDS C4 MG6N Photographs seem to show
251243 - significantly different condition of fundoplication from a year
251244 - earlier. ref SDS C4 I74I
251246 - ..
251247 - On 150319 0800 meeting Doctor Lee in GI Clinic VA Medical Center
251248 - Sacramento report swallowing improved with triamcinalone steriod
251249 - injections on 141107 EGD dilation procedure. ref SDS D0 0M6I Doctor
251250 - Lee advised that increased orange juice consumption aids digestion,
251251 - and presents no health risks. ref SDS D0 YF5M Scheduled next EGD
251252 - dilation procedure on 150421 1300. ref SDS D0 PS4O Fundoplication
251253 - failure increases acid burn that caused ulceration with hiatal hernia
251254 - with increased recurrance achalasia. ref SDS D0 O56O Doctor Lee will
251255 - make referral to Doctor Stewart at General Surgery VA Medical Center
251256 - in San Francisco for consideration of "redo" fundaplicaiton.
251257 - ref SDS D0 JQ5J Doctor Lee completed Progress Notes for EGD dilation
251258 - on 141107. ref SDS D0 PS53 Doctor Lee will recommend Doctor Stewart
251259 - order CT test to evaluate recurrance achalasia due to failure
251260 - fundoplication. ref SDS D0 TH5M This test can include coronary CTA to
251261 - evaluate regression atherosclerosis. ref SDS D0 GB56
251263 - ..
251264 - On 150420 1752 submitted letter to Doctor Lee with agenda for meeting
251265 - the next day on 150421 1300 for EGD dilation. ref SDS D2 0M6I
251267 - ..
251268 - On 150421 Met with Doctor Lee at VA Medical Center in Sacramento
251269 - (Mather). ref SDS D3 K37G No difficulties setting IV for conscious
251270 - sedation. ref SDS D3 5W5I Reported pain level 2 right knee MCL.
251271 - ref SDS D3 LO9K Doctor Lee advised referral to San Francisco will be
251272 - filed after EDG dilation procedure (this day) to evaluate loosening
251273 - fundoplication. ref SDS D3 DZ4I Patient reported difficulty
251274 - swallowing this cycle did not occur until 4 weeks or so, because
251275 - triamcinalone steriod was injected during prior procedure on 141107,
251276 - ref SDS D3 P55L, and shown by EGD dilation LESV from 16.5 mm back to
251277 - 18 mm. ref SDS D3 HU42 Progress Notes report findings of hiatal
251278 - hernia. ref SDS D3 QD6O Impression today that ulceration has subsided
251279 - to mere errosions seems promising. ref SDS D3 PXXY
251281 - ..
251282 - On 150514 0130 letter to Doctor Lee requests file Progress Notes for
251283 - EGD Dilation today, and make referral to Doctor Stewart, to prepare
251284 - for meeting with Doctor Lee scheduled on 150521. ref SDS D5 K37G
251286 - ..
251287 - On 150521 0800 meeting with Doctor Lee at VAMC in Sacramento -
251288 - concensus uncharacteristic vomitting after recent EGD dilation
251289 - procedure on 150421, due to patient not eating slowly with small bites
251290 - and drinking liquids frequently, especially when eating meat products
251291 - that have high viscocity with esophageal tissue, and so tends to
251292 - stick, causing vomitting. ref SDS D7 WT9L
251294 - ..
251295 - On 150526 1300 meeting with Doctor Stewart Chief General Surgery VA
251296 - Medical Center San Francisco, review record indicating ulceration LESV
251297 - caused by reflux backwash into esophagus. ref SDS D8 3E4I Doctor
251298 - Stewart explained redo Dor Fundoplication required for "repairing"
251299 - original surgery, presents high risk of collateral damage. ref SDS D8
251300 - GT5G Considered increase dose Omeprazole (PPI) since ad hoc
251301 - experience occasionally taking 3 and sometimes 4 pills instead of only
251302 - 1 pill per day seemed to reduce reflux based on examination showing
251303 - ulceration of LESV declined; this would avoid need to redo Dor
251304 - Fundoplication. ref SDS D8 5Y4I
251306 - ..
251307 - On 150616 1624 received photographs on CD in word.docx file from
251308 - Phillip in ROI Department at VA MC in Sacramento (Mather) showing Dor
251309 - fundoplication in tact on 131115, beginning to unravel on 140507,
251310 - further unraveled on 141107, and unraveled on 150421. ref SDS E1 XW6M
251312 - ..
251313 - On 150623 1300 during follow up meeting, Doctor Stewart discussed
251314 - again increasing Omeprazole PPI to resolve ulceration of LESV rather
251315 - than risk difficult surgery to redo Dor fundoplication, and she
251316 - ordered prescription for H2 blocker to supplement Omeprazole PPI.
251317 - ref SDS E2 WW5K
251319 - ..
251320 - On 150624 0924 letter notified Doctor Lee of work plan to try
251321 - controlling ulceration of LESV by increasing PPI with Omeprazole
251322 - rather than chance performing high risk surgery to repair Dor
251323 - fundoplication, and that Doctor Stewart ordered H2 Blocker for Doctor
251324 - Lee to consider supplementing PPI to control acid reflux. ref SDS E3
251325 - OP91
251327 - ..
251328 - On 150624 0924 at 1344 Doctor Lee called and will order new
251329 - prescription for PPI increasing Omeprazole from 20 mg twice per day to
251330 - 40 mg twice per day. ref SDS E3 L861
251332 - ..
251333 - On 150925 0336 request switch back to Omeprazole 20 mg twice per day
251334 - in order to reduce severe side effects of dehydration from frequent
251335 - urination causing scaling, peeling, bleeding feet; lower dose
251336 - Omeprazole enables hiking to raise HDL required to regress
251337 - atherosclerosis plaques, thereby lowering risks of CVD and CAD.
251338 - ref SDS E5 5G8T As a result, Pharmacy VA Medical Center San Francisco
251339 - entered new prescription for (PPI) Omeprazole 20 mg. ref SDS E5 FK66
251341 - ..
251342 - On 150925 0336 VA scheduled next meeting for EGD dilation on 151204
251343 - 0800. ref SDS E5 SR6L
251345 - ..
251346 - On 151002 1820 Doctor Lee returned call; will order Omeprazole 20 mg
251347 - prescription sufficient until next EGD Dilation procedure on 151204,
251348 - and complimenting prescription entered on 150925 for only 1 month.
251349 - ref SDS E6 NV5I
251351 - ..
251352 - On 151012 1151 VA Internet Pharmacy lists updated Omeprazole 20 mg
251353 - prescription. ref SDS D4 0C5H
251355 - ..
251356 - On 151204 0800 met with Doctor Lee at VA Medical Center in Sacramento
251357 - (Mather); initial administration went well. ref SDS F3 GD4H
251358 - Preparation for the procedure was professional; no difficulties
251359 - setting IV for conscious sedation today. ref SDS F3 544G The doctor
251360 - reported not receiving letter with agenda for the meeting today,
251361 - submitted on 151201. ref SDS F3 VV6N Patient difficulty swallowing
251362 - occurred after 5 months, because triamcinalone steriod injected prior
251363 - procedure on 150421. Swallowing difficulty/vomiting increased over
251364 - the next 3 months indicates dilate LESV 18 mm and doing EGD dilation
251365 - in 6 rather than 8 months. ref SDS F3 P55L Asked about Baking Soda to
251366 - clear throat in order to avoid vomitting, and prevent ulceration LESV
251367 - alternative to Omeprazole in order to avoid side effects causing
251368 - dehydration. ref SDS F3 G53K Performing EGD dilation procedure went
251369 - smoothly, with no difficulties. ref SDS F3 7V6I Post procedure Doctor
251370 - Lee reported LESV contracted to 10 mm, the worst results in patient
251371 - history, indicating 2 month delay performing procedure this cycle was
251372 - harmful. ref SDS F3 5H5J
251374 - ..
251375 - On 151210 meeting Doctor Lee after EGD on 151204, changed prescription
251376 - of Omeprazole (PPI) to 20 mg every other day to eliminate or reduce
251377 - dehydration from frequent urination, and in order for feet to recover
251378 - from peeling, cracking, bleeding so that hiking can be performed at
251379 - level of 300 miles per month required to raise HDL > 60, required to
251380 - regress athersclerosis. ref SDS F6 J56O Doctor prescribed adding
251381 - Famotidine an H2 blocker taken once a day to compliment Omeprazole.
251382 - ref SDS F6 YL3M
251384 - ..
251385 - On 160325 0900 Diffuculty swallowing this cycle began about 1 month
251386 - after prior EGD dilation on 151204. ref SDS G6 P55L Reported using
251387 - baking soda to relieve reflux that prevents ulceration LESV; this
251388 - reduced Omeprazole in order to avoid dehydration. ref SDS G6 Z84H
251389 - Progress Notes report there is no longer any erosive esophagitis and
251390 - there is no evidence of mass effect, which implies better acid
251391 - suppression compared to previous examination December 2015.
251392 - ref SDS G6 PXXY EGD dilation procedure went smoothly, with no reports
251393 - of difficulties. ref SDS G6 7V6I Post procedure Doctor Lee reported
251394 - LESV contracted to 9.5 mm, the smallest in patient history, indicating
251395 - 2 month delay to 8 months performing procedure in December causing
251396 - continual injury. ref SDS G6 5H5J
251397 -
251398 -
251399 -
251400 -
251401 -
251403 - ..
2515 -
2516 -
2517 - Progress
251801 - ..
251802 - Esophagogastroduodenoscopy (EGD) and Dilation LESV Administration
251803 - GI Department VA Sacramento Medical Center Administration EGD Dilation
251804 -
251805 - Follow up ref SDS G8 NU8L, ref SDS G6 NU8L.
251806 -
251807 - Meeting today implements planning for EGD dilation today, scheduled by
251808 - Doctor Lee during telecon on 160812 1626. ref SDS H6 G64I This is 3
251809 - weeks in advance of original schedule on 160909, ordered by Doctor Lee
251810 - following the prior procedure on 160617 0800. ref SDS G8 4U5F
251812 - ..
251813 - Applied pre-proc requirements for NPO after midnight, from letter on
251814 - 101015 1547. ref SDS 59 4J9L Last food was at......
251816 - ..
251817 - Stayed in Concord last night. This morning, Kathy drove us to VA
251818 - Medical Center at Mather AFB in Sacrmento.
251820 - ..
251821 - Checked into GI Department at the customer counter..
251822 -
251823 - 800-382-8387
251824 -
251825 - 916 843 7000
251827 - ..
251828 - Kathy cell phone for designated driver...
251832 - ..
251833 - Kathy signed the discharge form affirming she will be designated
251834 - driver, and responsible to facilitate no driving for 24 hours.
251836 - ..
251837 - Nurse at customer counter asked questions on patient history to verify
251838 - ready for procedure, e.g., no allergies, and NPO after midnight to
251839 - avoid conflicts with anesthesia; no health problems, e.g., no
251840 - diabetes, alcohol, cigarettes.
251842 - ..
251843 - Waited in lobby for 10 minutes. Then Jessica called to prepare for
251844 - procedure.
251845 -
251847 - ..
2519 -
2520 -
2521 - 0817
2522 -
252201 - Pre-op Preparation No Problems Getting Blood Flow for Anesthesia IV
252202 -
252203 - Follow up ref SDS G8 EP75, ref SDS G6 EP75.
252204 -
252205 - Tommy took vitals today, prior to procedure in a small office just off
252206 - the lobby, and not in the treatment center, reported on 120925 0900.
252207 - ref SDS 87 PT5P
252209 - ..
252210 - Vital included...
252211 -
252212 - Weight.................. 179.2 (fully dressed, shoes, cell phone)
252213 - BP...................... 132 78
252214 - HR (pulse).............. 61
252215 - Temp.................... 98.1
252217 - ..
252218 - Returned to patient waiting area.
252220 - ..
252221 - In about 5 minutes, Grace called patient into OR preparation room, and
252222 - assisted with dressing down and laying on a gurney.
252224 - ..
252225 - Grace configured on gurney and connected equipment to monitor vitals
252226 - during the procedure.
252228 - ..
252229 - Grace set catheter IV for sedation. Required only 1 stick, so better
252230 - today than last time on 141107 0800. ref SDS C4 544G
252232 - ..
252233 - Case study on sticks required to set catheter is reported on 110429
252234 - 1230. ref SDS 76 UO3G
252236 - ..
252237 - Grace went through patient identification and medical profile filling
252238 - out forms on the computer.
252240 - ..
252241 - She asked about pain? Reported level 0.
252243 - ..
252244 - Waited about 30 minutes.
252245 -
252246 -
252247 -
252249 - ..
2523 -
2524 -
2525 - 0847
2526 -
252601 - Consent Signed EGD Dilation and Meeting Review Pending Issues
252602 - Consultation Pending Issues and Sign Consent for EGD Dilation
252603 -
252604 - Follow up ref SDS G8 RG9K, ref SDS G6 RG9K.
252605 -
252606 - Meeting Doctor Lee to sign form consenting to undergo EGD dilation
252607 - procedure today.
252609 - ..
252610 - Noted that signature is entered on completely black screen, required
252611 - without reading online documents.
252613 - ..
252614 - Agenda Meeting Doctor Lee...
252615 -
252616 - 1. Schedule follow up meeting next week...
252618 - ..
252619 - Doctor Lee said he wants to keep the meeting previously scheduled on
252620 - 160909, so he can expand LESV to 18 mm.
252621 -
252623 - ..
252624 - 2. Interim report on Peer Review.
252625 -
252626 - What has been done?
252628 - ..
252629 - Doctor Lee was unaware of what has been done. He said the Peer
252630 - Review process is independent and so he is not involved in order to
252631 - ensure objective review.
252632 -
252634 - ..
252635 - What remains to be done?
252637 - ..
252638 - Doctor Lee said he does not know the status of the review provess.
252639 -
252641 - ..
252642 - Estimated completion date?
252644 - ..
252645 - Doctor Lee said he has not been briefed on the completion date.
252646 -
252648 - ..
252649 - Disposition?
252651 - ..
252652 - Doctor Lee seemed to say the Peer Review report will be discussed
252653 - during a meeting among the GI Clinic doctors.
252654 -
252656 - ..
252657 - 3. LESV contracted to 9.5 mm, reported on 160617 0800. ref SDS G8
252658 - 6P6G
252660 - ..
252661 - Hopefully, it will only be contracted to 11 or 12 mm since expanding
252662 - to 15 mm on 160617.
252663 -
252665 - ..
252666 - 4. Could we increase baking soda, given patient level of exercise
252667 - hiking that extricates excess salt, and thereby further reduce
252668 - ulceration?
252670 - ..
252671 - Doctor Lee does not support increasing baking soda, because results
252672 - are short term, and increased sodium intake conflicts with patient
252673 - profile of CAD, shown by CABG x4 surgery on 091022 0700. ref SDS 21
252674 - PQWU
252676 - ..
252677 - We reviewed the record using Baking Soda reported in EGD Progress
252678 - Notes showing ulceration/esophagitis completely resolved on 160315
252679 - 0900. ref SDS G6 PXXY
252681 - ..
252682 - On 151019, CCTA showed patient completely clear of atherosclerosis.
252683 - ref SDS F0 SU62 More recently, on 160618, MRI study found no evidence
252684 - of atherosclerosis in blood vessels of the brain. ref SDS H0 J738 The
252685 - test 2 weeks ago on 160805, confirmed this finding. ref SDS H3 HX5H
252686 - Since there is no evidence of atherosclerosis, the patient can absorb
252687 - some excessive salt in order to resolve severe ulceration.
252688 -
252690 - ..
252691 - 5. Surgical repair resolve achalasia cited in Progress Notes on
252692 - 160617 0800. ref SDS G8 TU9H
252693 -
252694 -
252695 - 1. Could Doctor Lee ask around at VAMC Sacramento for 2nd
252696 - opinion on surgical repair, to supplement Doctor Stewart's
252697 - considerations at VAMCSF?
252699 - ..
252700 - Doctor Lee did not comment on this initiative.
252701 -
252703 - ..
252704 - 2. Another idea would be to re-slice/cut LESV with the aim of
252705 - extending the time for closure from 2 - 3 months, back to 6
252706 - months.
252707 -
252708 -
252710 - ..
252711 - 3. Stent advantages and risks?
252713 - ..
252714 - Doctor Lee cited recent articles reporting poor results for stents.
252715 - He did not present any specific sources on this.
252716 -
252717 - [On 160823 1430 during meeting at VAMCSF Doctor Stewart
252718 - said several times that stent does not seem like a good
252719 - solution in this case. Mentioned Doctor Bhat as best GI
252720 - physician for performing this procedure at VAMCSF.
252721 - ref SDS H9 0T7O
252722 -
252724 - ..
252725 - 6. Medication - update prescription to 30 ml twice per day, so it
252726 - will last in the VA computer, planned in telecon on 160714
252727 - 0814. ref SDS 6 HV4N
252729 - ..
252730 - Doctor Lee placed this order before the procedure began.
252731 -
252733 - ..
252734 - 7. Medication - consider alternate PPI switch from Omeprazole that
252735 - has adverse side effects of severe dehydration due to freequent
252736 - urination, to another medication, discussed on 160714 0814.
252737 - ref SDS 6 HV4H
252739 - ..
252740 - Debbie in GI Clinic at VAMCSF mentioned Pantorazole
252741 - reported in the record on 160722 1335. ref SDS 9 3K32
252743 - ..
252744 - After the procedure, Doctor Lee ordered change from Omeprazole to
252745 - Panotrazole that will increase recovery from ulceration.
252747 - ..
252748 - After the procedure, and while in recovery, a nurse called Kathy into
252749 - the patient area. Gave Kathy VA card, and she went to the Pharmacy
252750 - and got the medication.
252751 -
252752 -
252754 - ..
252755 - Swallowing Vomitting Difficulties Resolved with Triamcinolone Injections
252756 - Triamcinolone Injection Prevent LESV Contraction Avoid Swallowing Vomitting Problems
252757 -
252758 - Follow up ref SDS G8 VV6N, ref SDS G6 VV6N.
252759 -
252760 - Doctor Lee did not discuss plans to use Triamcinolone steroid
252761 - injection during the procedure today. Background on prior use is
252762 - reported on 160617 0800. ref SDS G8 VV6N
252764 - ..
252765 - Case study on 160617, indicates Progress Notes show that 2 mL has
252766 - maintained LESV dilation for 6 month treatment cycles. 160617 0800.
252767 - ref SDS G8 LD8O This calculates to .33 mL/month. Since 161204,
252768 - patient has received 13 mL Triamcinolone over 8 months, which
252769 - calculates to 1.625 mL per month, a 500% increase.
252771 - ..
252772 - On 160617, patient received 5.0 mL, which added to 3 mL on 160315,
252773 - makes 8 mL in 3 months, which calculates to 2.57 mL/month, and so
252774 - equals 800% increase over patient history. Research indicates 1.5 mL
252775 - for common adult dose, but does not present frequency of dosage.
252776 - Agressive treatment of 2 - 3 mL in this case for 6 months, would
252777 - indicate 5.0 mL injected on 160617, would be effective for 12 months
252778 - until 170617.
252780 - ..
252781 - Accordingly, though not expressly discussed during the meeting today,
252782 - Triamcinolone was likely not injected for the procedure today, since
252783 - prior treatment should still be effective for several more months.
252784 -
252785 - [On 160907 1420 letter to medical team presents expectation
252786 - that Triamcinolone was not injected for procedure on
252787 - 160817, and would not be injected for follow on procedure
252788 - in 2 days on 160909, because Triamcinolone injection of 5
252789 - mL on 160617 would have continuing effects for several more
252790 - months. ref SDS I1 BI63
252792 - ..
252793 - [On 160909 0800 corrected erroneous expectation - Doctor
252794 - Lee advised during a meeting to perform another EGD
252795 - procedure that about 5.0 mL was injected into LESV during
252796 - prior procedure on 160816. ref SDS I2 L44J
252797 -
252799 - ..
252800 - LESV DILATE Triamcin Diphenhy Fenta Bena Midaz Lido
252801 - Months from - to olone Versed dramine nyl dryl olam caine
252802 - Interval Date mm mm mL mg mg mg mg mg mL
252803 - 2 160816 9.5 9.5....5.0.....6..............250.....50...............5...... ref SDS 0 HU42
252804 - *1 3 160617 9.5 15......5.0.....6..............250.....50...............5...... ref SDS G8 HU42
252805 - *2 4 160315 9.5 15......3.0............25......250.............5........5...... ref SDS G6 HU42
252806 - 8 151204 10 15......5.0............25......200.............5........5...... ref SDS F3 HU42
252807 - 6 150421 16.5 18......3.0............50......250.............4........5...... ref SDS D3 HU42
252808 - 6 141107 15 18......4.0............50......150.............5........5...... ref SDS C4 E54M
252809 - 6 140509 16.5 18.....................50......200.............5........5...... ref SDS B4 P680
252810 - 7 131115 16.5 18......2.0............50......200.............4........5...... ref SDS A6 RZ45
252811 - 3 130416 18 18......2.0.....5..............250.....50...............5...... ref SDS A0 Y850
252812 - 4 130110 15 18......3.0............50......100.............4........5...... ref SDS 95 Q333
252813 - *3 6 120925 15 18......4.0............50......200.............5........5...... ref SDS 87 XB51
252814 - 4 120322 16.5 18.....................50......150.............4........5...... ref SDS 84 516N
252815 - 3 111115 16.5 18.....................50......200.............4........5...... ref SDS 82 IR57
252816 - 4 110819 15 16.5....2.5............50......200.............5........5...... ref SDS 81 J978
252817 - 3 110429 13 16.5....3.5.....5..............200.....50...............5...... ref SDS 76 U23I
252818 - 3 110218 11 14......2.0............50......150.............4........5...... ref SDS 72 AA5O
252819 - 4 101210 11 14......................................................5...... ref SDS 67 H347
252820 - 5 100827 11 15..............5..............250.....50...............5...... ref SDS 55 JE6X
252821 - 3 100305 11 15..............5..............250.....50...............5...... ref SDS 48 WR6L
252822 - 091216 Heller Myotomy Fundoplication....................................... ref SDS 36 KE9U
252823 -
252824 -
252825 -
252827 - ..
252828 - Doctor Lee was familiar with rising swallowing problems shown by
252829 - increased vomiting the past several weeks, reported in the letter to
252830 - the medical team on 160801 1428. ref SDS H2 WX53 The problem was
252831 - discussed most recently, when Doctor Lee called last week on 160812
252832 - 1626, ref SDS H6 G64I, following up a letter to the medical team on
252833 - 160810 0453. ref SDS H4 2958 Doctor Lee also discussed rising
252834 - achalasia symptoms with Doctor Massa last week on 160611, where Doctor
252835 - Massa explained again patient suffering increased swallowing problems,
252836 - 160811 1546, ref SDS H5 HR5O, leading to Doctor Lee's decision to
252837 - order the EGD Dilation procedure today for exigent care.
252839 - ..
252840 - Estimated LESV will engage today at < 13mm, based on recent swallowing
252841 - problems (e.eg., see beginning on 160101, in case study on 140101
252842 - 0600. ref SDS A9 UA6K).
252843 -
252844 - [...below on 160816 0800 at 1120 after the procedure Doctor
252845 - Lee reported LESV contracted this cycle back to 9.5 mm from
252846 - 15 mm dilated 2 months ago on 160167, ref SDS 0 5H5J; he
252847 - also reported increased ulceration LESV prevented any
252848 - dilation, signaling worst condition in patient history.
252849 - ref SDS 0 RZ3G
252851 - ..
252852 - Asked Doctor Lee again, if he is sure today, that stroke symptoms of
252853 - left side motor control and vision impairment following EGD procedure
252854 - on 160167, ref SDS G9 5F6F, will not recur, repeating question
252855 - presented last week on 160812 1626? ref SDS H6 RS4F
252857 - ..
252858 - Doctor Lee said there is no reason to believe prior problems will
252859 - recur today.
252861 - ..
252862 - Signed consent for the procedure, which is not visible - there is
252863 - merely a black screen to sign.
252864 -
252865 -
252866 -
252867 -
252869 - ..
2529 -
2530 -
2531 - 0922
2532 -
253201 - OR EGD Dilation with Application Lidocaine
253202 - EGD Dilation Procedure in OR Application Lidocaine
253203 -
253204 - Follow up ref SDS G8 7V6I, ref SDS G6 7V6I.
253205 -
253206 - Grace wheeled the gurney into the OR for the procedure.
253208 - ..
253209 - Everything went smoothly, as always.
253211 - ..
253212 - Grace applied conscious sedation using the catheter set in
253213 - Preparation, per above. ref SDS 0 544G
253215 - ..
253216 - The team then did the EDG/dilation procedure.
253217 -
253218 -
253219 -
253221 - ..
253222 - Meeting Doctor Lee Present Results EGD Dilation Procedure 10 MM
253223 - Results EGD Dilation Procedure Meeting Doctor Lee Present 10 MM
253224 -
253225 - Follow up ref SDS G8 5H5J, ref SDS G6 5H5J.
2533 -
2534 -
2535 - 1124
253601 - ..
253602 - An hour or so after the procedure, met with Doctor Lee in the recovery
253603 - room.
253605 - ..
253606 - Doctor Lee advised that EGD examination today, found LESV contracted
253607 - back to 9.5 mm again. Very disappointing there was again no
253608 - improvement since prior procedure 2 months earlier on 160617 0800,
253609 - ref SDS G8 6P6G, indicating continuing difficulties resulting from 2
253610 - month delay extending prior 6 month procedures to 8 months on 151204
253611 - 0800. ref SDS F3 6P6G
253613 - ..
253614 - Doctor Lee did not say that triamcinolone steriod was injected again
253615 - today, in order to restore and maintain swallowing. This may reflect
253616 - patient history receiving 5.0 mL injection of triamcinolone on 160167,
253617 - ref SDS G8 V48Y, and that it continues to be effective for several
253618 - more months, reviewed above. ref SDS 0 FJ5I
253619 -
253620 - [On 160816 1532 letter notifies medical team that LESV
253621 - contracted back to 9.5 mm, worst condition in patient
253622 - history, and that ulceration on LESV was so severe that
253623 - dilation could not be performed to improve swallowing.
253624 - ref SDS H7 NK98
253626 - ..
253627 - [On 160823 0920 Doctor Massa called and asked if Doctor Lee
253628 - injected LESV with Triamcinolone; advised that Progress
253629 - Notes not available to determine Triamcinolone was or was
253630 - not injected on 160816. ref SDS H8 NG47
253632 - ..
253633 - [On 160907 1420 letter notifies medical team that
253634 - Triamcinolone likely not administered for EGD on 160817,
253635 - because dose over prior 3 month period accumulated to
253636 - significantly more than commonly given in this case.
253637 - ref SDS H0 BI60
253638 -
253639 -
253640 -
253641 -
253642 -
253644 - ..
253645 - Ulceration LESV Increased Prevented Dilating LESV Above 10 MM
253646 - Dilated 10 MM Rather than Healthy LESV 20 MM Due to Increased Ulceration
253647 -
253648 - Follow up ref SDS G8 RZ3G, ref SDS G6 RZ3G.
253649 -
253650 - Doctor Lee reported significantly increased ulceration LESV from prior
253651 - examination on 160617 0800. ref SDS G8 RZ3G He was unable to dilate
253652 - LESV above 10 mm, because this would have damaged the component.
253654 - ..
253655 - He estimates dilation to 10 mm because that is the size of the Olympia
253656 - Gastroscope instrument used to perform EGD procedure by pushing it
253657 - through LESV which necessarily expands the opening to that diameter.
253659 - ..
253660 - Discharge documents show no dilation.
253661 -
253662 - [On 160816 1532 letter notifies medical team that LESV
253663 - contracted back to 9.5 mm, worst condition in patient
253664 - history, and that ulceration on LESV was so severe that
253665 - dilation could not be performed to improve swallowing.
253666 - ref SDS H7 NK98
253668 - ..
253669 - This aligns with eliminating Baking Soda, reducing Omeprazole taking
253670 - 20 mg every other day, to prevent debilitating side effects, discussed
253671 - with Doctor Lee on 160315 0900, ref SDS G6 RZ3G; and, further
253672 - increasing Famotidine to 20 mg twice per day, prescribed during prior
253673 - meeting with Doctor Lee on 160315 0900. ref SDS G6 ZQ4H
253674 -
253676 - ..
253677 - Pantoprazole Prescirbed Replace Omeprazole and Famotidine
253678 -
253679 - Doctor Lee prescribed eliminating Famotidine and Omeprazole, and
253680 - adding Pantoprazole 40 mg twice per day for resolving increased
253681 - esophagitis.
253682 -
253683 -
253685 - ..
253686 - Next Meeting 3 Weeks to Recover Severe Symptoms
253687 -
253688 - Follow up ref SDS G8 4U5F, ref SDS G6 4U5F.
253689 -
253690 - Doctor Lee left the priviously scheduled EGD Dilation on 160909, to
253691 - prevent severe contraction of LESV to 9.5 mm, that occurred over the
253692 - past 2 months causing severe vomiting, and leading to no dilation, and
253693 - in order to restore standard of care dilating to 18 mm, per above.
253694 - ref SDS 0 6P6G
253695 -
253696 -
253697 -
253698 -
253699 -
253700 -
253701 -
253702 -
253703 -
253704 -
2538 -
SUBJECTS
Medical Chart Progress Notes VA EGD Procedure Stricture Lower Esopha
5503 -
550401 - ..
550402 - Release of Information ROI CD Contents Received on 151224
550403 -
550404 - Follow up ref SDS G8 CY7I, ref SDS G6 CY7I.
550406 - ..
550407 - Request records on CD from ROI for this medical encounter due to
550408 - continual difficulties downloading medical records from VA website
550409 - at...
550410 -
550411 - https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel=mhvHome
550412 -
550419 - ..
550420 - On September 7, 2016, checked for Progress Notes for EGD on 160617,
550421 - and found they have not yet been posted for patient access.
550422 -
550423 -
550424 -
550425 -
550906 -
550907 -
550908 -
550909 -
550910 -
550911 -
550912 -
550913 -
550914 -
550915 -
550916 -
550917 -
550918 -