CONTACTS
SUBJECTS
VA EGD Procedure Stricture Lower Esophageal Sphincter Valve LESV 10
2503 -
2503 - ..
2504 - Summary/Objective
2505 -
250501 - Follow up ref SDS I2 0000. ref SDS H7 0000.
250502 -
250503 - No diffuculty swallowing this cycle despite not having dilated LESV 3
250504 - weeks ago on 160909. ref SDS 0 VV6N Signed blank consent for the
250505 - procedure today, on assurance from Doctor Lee that he will minimize
250506 - triamcinolone to avoid adverse side effects. ref SDS 0 VV6N EGD
250507 - dilation procedure went smoothly, with no reports of difficulties.
250508 - ref SDS 0 7V6I Post procedure Doctor Lee reported LESV contracted
250509 - back to 9.5 mm, the worst in patient history, indicating 2 month delay
250510 - to 8 months performing procedure in December causing continual injury.
250511 - ref SDS H7 5H5J Ulceration got worse this past cycle, which prevented
250512 - the doctor from dilating LESV needed for better swallowing.
250513 - ref SDS H7 RZ3G Doctor Lee prescribed Pantoprazole 40 mg twice a day
250514 - to replace taking Omeprazole and Famotidine. ref SDS H7 Q05K Next
250515 - meeting in 3 weeks. ref SDS H7 4U5F
250516 -
250517 -
250518 -
250519 -
250520 -
250522 - ..
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 I2 NU8L, ref SDS H7 NU8L.
251806 -
251807 - Meeting today implements planning for EGD dilation today, scheduled by
251808 - Doctor Lee during meeting for prior procedure on 160909 0800.
251809 - ref SDS I2 4U5F
251811 - ..
251812 - Applied pre-proc requirements for NPO after midnight, from letter on
251813 - 101015 1547. ref SDS 59 4J9L Last food was at......
251815 - ..
251816 - Stayed in Concord last night. This morning, Kathy drove us to VA
251817 - Medical Center at Mather AFB in Sacrmento.
251819 - ..
251820 - Checked into GI Department at the customer counter..
251821 -
251822 - 800-382-8387
251823 -
251824 - 916 843 7000
251826 - ..
251827 - Kathy cell phone for designated driver...
251831 - ..
251832 - Kathy signed the discharge form affirming she will be designated
251833 - driver, and responsible to facilitate no driving for 24 hours.
251835 - ..
251836 - Nurse at customer counter asked questions on patient history to verify
251837 - ready for procedure, e.g., no allergies, and NPO after midnight to
251838 - avoid conflicts with anesthesia; no health problems, e.g., no
251839 - diabetes, alcohol, cigarettes.
251841 - ..
251842 - Waited in lobby for 10 minutes. Then Tommy called to prepare for
251843 - procedure.
251844 -
251846 - ..
2519 -
2520 -
2521 - 0817
2522 -
252201 - Pre-op Preparation No Problems Getting Blood Flow for Anesthesia IV
252202 -
252203 - Follow up ref SDS I2 EP75, ref SDS H7 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.................. 179.5 (fully dressed, shoes, cell phone)
252213 - BP...................... 132 74
252214 - HR (pulse).............. 61
252215 - Temp.................... 97.3
252217 - ..
252218 - Returned to patient waiting area.
252220 - ..
252221 - In about 5 minutes, Hazel 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 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 - Hazel 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 -
252247 - ..
2523 -
2524 -
2525 - 0816
2526 -
252601 - Hazel completed initial patient documentation.
252602 -
252603 -
252604 -
252605 -
252607 - ..
2527 -
2528 -
2529 - 0847
2530 -
253001 - Consent Signed EGD Dilation and Meeting Review Pending Issues
253002 - Consultation Pending Issues and Sign Consent for EGD Dilation
253003 -
253004 - Follow up ref SDS I2 RG9K, ref SDS H7 RG9K.
253005 -
253006 - Meeting Doctor Lee to sign form consenting to undergo EGD dilation
253007 - procedure today.
253009 - ..
253010 - Noted that signature is entered on completely black screen, required
253011 - without reading online documents.
253013 - ..
253014 - Agenda Meeting Doctor Lee...
253016 - ..
253017 - 1. Schedule follow up meeting for EGD dilation today...
253018 -
253019 - Can meeting be changed from 161012 1130, becuse have meeting
253020 - previously scheduled with Doctor Simpson 161012 1000 in San
253021 - Francisco, per letter to medical team on 161003 0628.
253022 - ref SDS I4 R66J
253024 - ..
253025 - Doctor Lee will work with Jessica on making this change.
253026 -
253027 -
253029 - ..
253030 - 2. Interim report on Peer Review.
253031 -
253032 - During meeting with Doctor Lee on 160921 1130, he indicated
253033 - Peer Review report was to have been presented to a meeting with
253034 - GI doctors, but this didn't occur, because the doctor doing the
253035 - report was called away to perform emergency care at the time of
253036 - the meeting. ref SDS I3 QG6F
253038 - ..
253039 - Review report...
253041 - ..
253042 - We can do this on 161012, if not enough time today.
253044 - ..
253045 - Doctor Lee said he has still not seen the report, despite notice
253046 - during the meeting on 160921, that the report has been completed.
253047 - ref SDS I3 QG6F
253048 -
253049 -
253051 - ..
253052 - 3. Review letter to medical team asking Doctor Massa to support
253053 - sedation medication regimen, shown on 161003 0628. ref SDS I4
253054 - WQ66
253056 - ..
253057 - Intravenous Medications
253058 - Diphenhydramine 25 mg (Benadryl)
253059 - Fentanyl 200 mcg
253060 - Midazolam 5 mg (Versed)
253062 - ..
253063 - Showed the letter to Doctor Lee during the meeting today, because he
253064 - no longer has an electronic address for receiving correspondence to
253065 - the medical team.
253067 - ..
253068 - Today, he asked who is on the medical team for this issue?
253070 - ..
253071 - Listed...
253072 -
253073 - Doctor Lee, GI
253074 - Doctor Massa, Neurology
253075 - Doctor Yoo, Neurology
253076 - Doctor Simpson, Cardiology
253077 - Doctor Stewart, General Surgery
253078 -
253079 -
253081 - ..
253082 - 4. Triamcinolone - less than 3 mL.
253083 -
253084 - Since there was no dilation for the procedure on 160816, does
253085 - injecting 5 mL indicate there remained 5 splits from the prior
253086 - dilation procedure on 160617, 2 months earlier? Was lingering
253087 - split tissue the result of increased ulceration, action item
253088 - from meeting on 160921 1130. ref SDS I3 IR9K
253089 -
253090 -
253091 -
253092 -
253094 - ..
253095 - Swallowing Vomitting Difficulties Resolved with Triamcinolone Injections
253096 - Triamcinolone Injection Prevent LESV Contraction Avoid Swallowing Vomitting Problems
253097 -
253098 - Follow up ref SDS I2 VV6N, ref SDS H7 VV6N.
253100 - ..
253101 - Doctor Lee reviewed the case study on Triamcinolone steroid injections
253102 - in this case submitted with the letter to the medical team yesterday
253103 - on 161003 0628. ref SDS I4 WR35
253105 - ..
253106 - Today, he will try to minimize Triamcinolone in order to minimize side
253107 - effects, cited in a letter to the team on 160907 1420, ref SDS I1
253108 - BI6N, and referencing the list in the record following the procedure
253109 - in 160617, after which stroke symptoms of motor control and vision
253110 - loss were reported. 160617 0800, ref SDS G8 PG6I
253112 - ..
253113 - Doctor Lee read the section in the letter yesterday, on minimizing
253114 - risk of Triamcinolone side effects, cited on 161003 0628. ref SDS I4
253115 - WR69 This liste was previously reviewed with Doctor Lee during
253116 - post-procedure meeting 2 weeks ago on 160921 1130. ref SDS I3 TI3M
253117 -
253118 - problems with vision
253119 - dangerously high blood pressure
253120 - feeling short of breath with mild exertion
253121 - weight gain
253123 - ..
253124 - Advised today, there still been no vomiting, indicating good
253125 - swallowing functionality continuing favorable report in the letter to
253126 - medical team on 160907, reported no swallowing problems since EGD on
253127 - 160816. ref SDS I1 BJ3T
253129 - ..
253130 - Estimated LESV will engage today at > 12, based on having no
253131 - swallowing problems, and prior EGD on 160909, when Doctor Lee dilated
253132 - LESV from 9.5 to 15 mm, ref SDS I2 5H5J, and found significantly
253133 - reduced ulceration, and improved stricture, ref SDS I2 RZ3G, as
253134 - further presented during post-procedure meeting a few weeks ago on
253135 - 160921 1130. ref SDS I3 OG3H
253137 - ..
253138 - Doctor Lee will closely monitor conscious sedation medications, as set
253139 - out in the letter to the medical team yesterday on 161003 0628.
253140 - ref SDS I4 WQ66
253142 - ..
253143 - Signed consent for the procedure, which is not visible - there is
253144 - merely a black screen to sign.
253145 -
253146 -
253147 -
253148 -
253150 - ..
2532 -
2533 -
2534 - 0922
2535 -
253501 - OR EGD Dilation with Application Lidocaine
253502 - EGD Dilation Procedure in OR Application Lidocaine
253503 -
253504 - Follow up ref SDS I2 7V6I, ref SDS H7 7V6I.
253505 -
253506 - Met Rodelia. She said most everybody calls her Rod, so we shook
253507 - hands on having common name.
253509 - ..
253510 - Rodelia wheeled the gurney into the OR for the procedure.
253512 - ..
253513 - Everything went smoothly, as always.
253515 - ..
253516 - Rodelia applied conscious sedation using the catheter set by Grace
253517 - earlier in Preparation, per above. ref SDS 0 544G
253519 - ..
253520 - The team then did the EDG/dilation procedure.
253521 -
253522 -
253523 -
253525 - ..
253526 - Dilated 15 MM Rather than Healthy LESV 20 MM Meeting Doctor Lee
253527 - Meeting Doctor Lee Present Results EGD Dilation Procedure 15 MM
253528 - Results EGD Dilation Procedure Meeting Doctor Lee Present 15 MM
253529 -
253530 - Follow up ref SDS I2 5H5J, ref SDS H7 5H5J.
2536 -
2537 -
2538 - 1204
253901 - ..
253902 - An hour or so after the procedure, met with Doctor Lee in the recovery
253903 - room.
253905 - ..
253906 - Doctor Lee advised that EGD examination today, found LESV contracted
253907 - back to 11 mm. This shows some improvement, compared to prior 2
253908 - procedures on 160816, and on 160909, compared to 2 months earlier on
253909 - 160617 0800, ref SDS G8 6P6G, indicating may finally be recovering
253910 - from achalasia and ulceration difficulties resulting caused by 2 month
253911 - delay extending prior 6 month procedures to 8 months on 151204 0800.
253912 - ref SDS F3 6P6G
253914 - ..
253915 - As a result of contracting back to 11 mm, Doctor Lee decided to
253916 - dilate only to 15 mm, instead of trying for 16 mm or 17 mm. He feels
253917 - that signs of improvement this cycle will enable dilating above 15 mm
253918 - next time.
253919 -
253920 - [...below on 161004 0800 at 1204 Doctor Lee scheduled next
253921 - EGD procedure in 6 weeks on 161115, based on evident good
253922 - results today, following 3 week interval. ref SDS 0 YT6J
253924 - ..
253925 - Doctor Lee said total of Triamcinolone 1.5 mL steriod was injected in
253926 - order to restore and maintain swallowing. This should help recover
253927 - from side effects receiving 5.0 mL injection of triamcinolone
253928 - discussed earlier this morning, per above. ref SDS 0 VV6N
253929 -
253930 -
253932 - ..
253933 - Conscious Sedation Reduced Dose Applied for 15 Minutes
253934 -
253935 - Doctor Lee explained today, that of the 3 medications given for
253936 - conscious sedation, listed in the letter reviewed this morning, and
253937 - sent to the medical team, per above, ref SDS 0 554I...
253938 -
253939 - Intravenous Medications
253940 - Diphenhydramine 25 mg (Benadryl)
253941 - Fentanyl 200 mcg
253942 - Midazolam 5 mg (Versed)
253943 -
253944 - ...he feels Benadryl has the longest lasting effect.
253946 - ..
253947 - He further explained that the amount listed in Progress Notes should
253948 - be the total given during the entire procedure. When the procedure
253949 - starts, the patient receives only 2 mg of Versed, and similar small
253950 - amounts of the other drugs. During the course of the procedure, the
253951 - nurse and tech monitor the patient for signs of stirring that evidence
253952 - waking from sedation. At that point another increment of Versed 2 mg
253953 - is injected, along with similar small amounts of the other drugs.
253955 - ..
253956 - This procecure suggests that the longer the procedure lasts, the
253957 - amount of medications increases to maintain the patient in a sedated
253958 - condition. Since the procedure on 160617, lasted about 100% longer
253959 - than prior procedures, the patient could have received double the
253960 - normal dose of sedation drugs.
253961 -
253962 -
253963 -
253965 - ..
253966 - Ulceration LESV and Stricture Reduced Enabled Dilating LESV
253967 -
253968 - Follow up ref SDS I2 RZ3G, ref SDS H7 RZ3G.
253969 -
253970 - Doctor Lee reported continuing reduced ulceration of LESV and that
253971 - stricture has also declined. These improvements align with
253972 - continuing improved swallowing with no vomiting since 160816.
253974 - ..
253975 - Discharge documents do not report dilation today.
253977 - ..
253978 - Favorable findings on reduced ulceration and stricture also aligns
253979 - with new medication protocol prescribed on 160909 0800. ref SDS I2
253980 - Q05K
253981 -
253982 -
253984 - ..
253985 - Pantoprazole Reduced Add Famotidine and Baking Soda or Tumms
253986 -
253987 - Follow up ref SDS I2 Q05K, ref SDS H7 Q05K.
253988 -
253989 - Doctor Lee prescribed continuing medication protocol taking
253990 - Pantoprazole 40 mg once a day, and taking Famotidine 40 mg once per
253991 - day, developed 3 weeks ago on 160909 0800. ref SDS I2 Q05K
253993 - ..
253994 - He will order Tumms from the pharmacy for delivery to the patient, as
253995 - a substitute for Mylanta.
253996 -
253997 -
253999 - ..
254000 - Candidas Esophageal Infection Reduced by
254001 -
254002 - Doctor Lee reported seeing streaks of white tissue in the esophagous.
254003 - He seemed to say these are biopsied and reported to be candidas
254004 - infection. The doctor said that drinking softdrinks with carbonation
254005 - resolves this condition.
254007 - ..
254008 - This aligns with historical patient practice using carbonated drinks
254009 - to clear the throat.
254010 -
254011 -
254013 - ..
254014 - Next Meeting 6 Weeks to Recover Severe Symptoms
254015 -
254016 - Follow up ref SDS I2 4U5F, ref SDS H7 4U5F.
254017 -
254018 - Doctor Lee scheduled review meeting on 161019 1130, to discuss
254019 - Progress Notes for the meeting today, and plan adjustments to
254020 - treatment protocol.
254021 -
254022 - [On 161013 1211 received call from Sonja, saying Doctor Lee
254023 - wants to change the time for meeting on 161019 from 1130 to
254024 - 1100. ref SDS I6 SC6K
254026 - ..
254027 - [On 161018 1508 drove to Kathy's house in Sacramento, to
254028 - stay over and attend meeting with Doctor Lee tomorrow at
254029 - 1100. ref SDS I7 4N5I
254031 - ..
254032 - [On 161019 1100 meeting Doctor Lee confirmed schedule next
254033 - EGD on 161115 0800 and follow up review meeting scheduled
254034 - 161130 1200; Doctor Lee waiting for release of report on
254035 - cause and remedies of stroke symptoms following EGD on
254036 - 160617, ref SDS I9 KQ5I
254037 -
254039 - ..
254040 - Doctor Lee scheduled next EGD dilation in 6 weeks OA 161115, rather
254041 - than setting another 2 or 3 week interval for the next EGD dilation.
254042 - He feels evident improvement by contracting back to 11 mm, rather than
254043 - back to 9 or 10 mm, indicates achalasia is recovering enough to try
254044 - for 6 week interval, per above. ref SDS 0 ZH4O
254045 -
254046 - [On 161010 1826 received letter from VA Medical Center in
254047 - Sacramento scheduling next EGD on 161223, about 12 weeks
254048 - after procedure on 161004, and conflicts with Doctor Lee's
254049 - work plan to perform next EGD 6 weeks after procedure on
254050 - 161004. ref SDS I5 FK5J
254051 -
254052 -
254053 -
254054 -
254055 -
254056 -
254057 -
2541 -
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 I2 CY7I, ref SDS H7 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/track-health
550412 -
550413 -
550420 - ..
550421 - On September 7, 2016, checked for Progress Notes for EGD on 160617,
550422 - and found they have not yet been posted for patient access.
550423 -
550424 -
550425 -
550426 -
550926 -
550927 -
550928 -
550929 -
550930 -
550931 -
550932 -
550933 -
550934 -
550935 -
550936 -
550937 -
550938 -
5510 -