CONTACTS
SUBJECTS
VA EGD Procedure Stricture Lower Esophageal Sphincter Valve LESV 10
2503 -
2503 - ..
2504 - Summary/Objective
2505 -
250501 - Follow up ref SDS K0 0000. ref SDS J8 0000.
250502 -
250503 - *******************************************************
250504 - ********** Content Prior Record Begins Here ***********
250505 - *******************************************************
250507 - ..
250508 - No diffuculty swallowing this cycle despite Lesv contracting to 6 mm
250509 - and dilating to only 12 mm last week on 161122. ref SDS K0 VV6N Signed
250510 - blank consent for the procedure today, on assurance from Doctor Lee
250511 - that stroke symptoms following prior EGD on 160617, would not recur.
250512 - ref SDS K0 8744 EGD dilation procedure went smoothly, with no reports
250513 - of difficulties. ref SDS J8 7V6I Post procedure Doctor Lee reported
250514 - LESV contracted back to 6 mm, the worst in patient history, indicating
250515 - 2 month delay to 8 months performing procedure in December causing
250516 - continual injury. ref SDS J8 5H5J Ulceration improved this past
250517 - week, which enabled the doctor to dilate LESV needed for better
250518 - swallowing. ref SDS J8 RZ3G Doctor Lee prescribed continuing
250519 - Pantoprazole 40 mg and Famotidine 40 mg both twice a day, and avoid
250520 - Naproxen, required for hiking. ref SDS J8 Q05K He will order refill
250521 - for Pantoprazole, and he will order prescription for Ensure to
250522 - maintian nutrition on liquid diet. ref SDS J8 743M Next meeting in 1
250523 - week. ref SDS J8 4U5F
250524 -
250526 - ..
250527 - [On 161207 0813 VA Pharmacy shows Ensure Plus Chocolate was
250528 - ordered; Gracy changed the ordered to Ensure regular and
250529 - vanilla. ref SDS K3 L132
250531 - ..
250532 - [On 161207 0813 called Gracy; she tried to correct the
250533 - order for Ensure regular Vanilla. ref SDS K4 L132
250534 -
250535 -
250536 -
250537 -
250539 - ..
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 G7 P55L Reported using
251387 - baking soda to relieve reflux that prevents ulceration LESV; this
251388 - reduced Omeprazole in order to avoid dehydration. ref SDS G7 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 G7 PXXY EGD dilation procedure went smoothly, with no reports
251393 - of difficulties. ref SDS G7 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 G7 5H5J
251398 - ..
251399 - On 161128 1119 called VA GI Clinic in Sacramento; LaPreia said meeting
251400 - Doctor Lee scheduled for 161214, has been changed to the next day on
251401 - 161215 1200. ref SDS J9 OZ9G
251403 - ..
251404 - On 161205 0846 anonomous flowers and chocolates sent wishing GI staff
251405 - Merry Christmas and Happy New Year for doing terrific work.
251406 - ref SDS K2 FS5I
251407 -
251408 -
251409 -
251410 -
251411 -
251413 - ..
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 K0 NU8L, ref SDS J8 NU8L.
251806 -
251807 - Meeting today, was scheduled last week after EGD dilation procedure on
251808 - 161130 1038. ref SDS K0 4U5F
251810 - ..
251811 - Performing EGD dilation 1 week after prior procedure on 161130 1038,
251812 - ref SDS K0 9V9J, represents continuing urgent, exigent care to recover
251813 - from severe contraction LESV 6 mm, worst condition in patient history,
251814 - found during procedure 2 weeks ago on, ref SDS J8 0001, 161122, and
251815 - which therefore prevented dilation above 12 mm, ref SDS J8 433O,
251816 - thereby requiring continued semi-liquid diet, and continuing interim
251817 - increased medication of Pantoprazole and Famotidine another week for
251818 - the purpose of resolving ulceration, and despite rising side effects
251819 - of frequent urination causing dehydration that injures feet,
251820 - preventing hiking required to raise HDL that regresses
251821 - atherosclerosis, reported ago on 161115. ref SDS J4 Q05K
251823 - ..
251824 - Additionally, pausing Naproxen to aid prevention of ulceration above
251825 - LESV, originally planned in the meeting on 161115 0800, ref SDS J4
251826 - 9K9G, and continued on 161122 1245, ref SDS J7 C26J, eliminates
251827 - suppression of inflammation in right knee, causing severe pain that
251828 - has limited hiking to just 2 6-mile hikes this week, most recently
251829 - yesterday on 161129, reported in case study on 160101 0700.
251830 - ref SDS G0 Z87H
251832 - ..
251833 - Applied pre-proc requirements for NPO after midnight, from letter on
251834 - 101015 1547. ref SDS 59 4J9L Last food was at......
251836 - ..
251837 - Drove to Sacramento last night. This morning, Kathy drove us to VA
251838 - Medical Center at Mather AFB in Sacrmento.
251840 - ..
251841 - At 1127, checked into GI Department at the customer counter..
251842 -
251843 - 800-382-8387
251844 -
251845 - 916 843 7000
251847 - ..
251848 - Kathy cell phone for designated driver...
251852 - ..
251853 - Kathy signed the discharge form affirming she will be designated
251854 - driver, and responsible to facilitate no driving for 24 hours.
251856 - ..
251857 - Nurse at customer counter asked questions on patient history to verify
251858 - ready for procedure, e.g., no allergies, and NPO after midnight to
251859 - avoid conflicts with anesthesia; no health problems, e.g., no
251860 - diabetes, alcohol, cigarettes.
251861 -
251862 -
251863 -
251864 -
251865 -
251867 - ..
2519 -
2520 -
2521 - 0800
2522 -
252201 - Pre-op Preparation No Problems Getting Blood Flow for Anesthesia IV
252202 -
252203 - Follow up ref SDS K0 EP75, ref SDS J8 EP75.
252204 -
252205 - No objections nor concerns today, as occurred previously on 161115
252206 - 0800, ref SDS J4 WA5I, and again last week on 161130 1038. ref SDS K0
252207 - EP75
252209 - ..
252210 - Rose took vitals today, prior to procedure in a small office just off
252211 - the lobby, and not in the treatment center, reported on 120925 0900.
252212 - ref SDS 87 PT5P
252214 - ..
252215 - Vitals included...
252216 -
252217 - Weight.................. 180.1 (without shoes)
252218 - BP...................... 166 77
252219 - HR (pulse).............. 84
252220 - Oxygen.................. 97
252221 - Temp.................... 98.3
252223 - ..
252224 - Rose said to return to Patient Waiting Room. Gracy came in and said
252225 - the team is ready for the patient, so went immediately into GI work
252226 - area.
252228 - ..
252229 - Appreciated being warmly greeted by all the nurses.
252231 - ..
252232 - Gracy configured on gurney and connected equipment to monitor vitals
252233 - during the procedure.
252235 - ..
252236 - Gracy set catheter IV for sedation. Required 1 stick today, in right
252237 - arm.
252239 - ..
252240 - Case study on sticks required to set catheter is reported on 110429
252241 - 1230. ref SDS 76 UO3G
252243 - ..
252244 - Gracy went through patient identification and medical profile filling
252245 - out forms on the computer based on prior information last week on
252247 - ..
252248 - She asked about pain? Reported level 0.
252249 -
252250 -
252252 - ..
2523 -
2524 -
2525 - 0810
2526 -
252601 - Waited about 5 minutes.
252602 -
252603 -
252604 -
252605 -
252607 - ..
2527 -
2528 -
2529 - 0840
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 K0 RG9K, ref SDS J8 RG9K.
253005 -
253006 - Meeting Doctor Lee to sign form consenting to undergo EGD dilation
253007 - procedure today.
253009 - ..
253010 - Doctor Lee appreciated letter to David Stockwell, sent on
253011 -
253012 - was unaware of sending flowers and chocalates with a note
253013 - commending good work in the GI Clinic, reported on 161205 0846.
253014 - ref SDS K2 FS5I He walked to the Control Center and explained to
253015 - everyone who sent the commendation. Gracy said she thought yesterday,
253016 - I might have sent the flowers. She and Mimi and another nurse
253017 - insisted I get out of bed so they could hug me. Everyone seemed very
253018 - appreciative.
253020 - ..
253021 - LaPreia walked through the preparation area, and was very friendly.
253022 - Clara came through a little later and made a warm greeting. This
253023 - indicated the flowers and commendation seems to have had a positive
253024 - effect on morale, mending prior issues, reported on 161130 1038.
253025 - ref SDS K0 EP75
253027 - ..
253028 - Noted that signature is entered on completely black screen, required
253029 - without reading online documents.
253031 - ..
253032 - Advised that signature is based on following understandings...
253034 - ..
253035 - Agenda Meeting Doctor Lee...
253037 - ..
253038 - 1. Schedule follow up meeting for EGD dilation today...
253039 -
253040 - There is already a following up meeting scheduled on 161215
253041 - 1200, which was set during the prior EGD procedure on 161122
253042 - 1245. ref SDS J7 AZ6O On 161128 1119 called VA GI Clinic in
253043 - Sacramento; LaPreia said meeting Doctor Lee scheduled for
253044 - 161214, has been changed to the next day on 161215 1200.
253045 - ref SDS J9 OZ9G
253047 - ..
253048 - Will further review results of procedure today, during the
253049 - meeting with the doctor on 161215 1200.
253051 - ..
253052 - If unable to dilate today, will convert meeting scheduled on
253053 - 161215, which is Thursday, into another EGD for dilation after
253054 - continuing liquid diet?
253055 -
253057 - ..
253058 - 2. Naproxen liquid suspension requires doctor's prescription...
253059 -
253060 - CLINICAL PHARMACOLOGY
253061 -
253062 - Roxane Laboratories, Inc
253063 -
253064 - Rx only
253065 -
253066 - https://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=5701
253068 - ..
253069 - Naproxen oral suspension contains 125 mg naproxen per 5 mL.
253070 - In addition, the following inactive ingredients are present:
253071 - FD&C Yellow #6, fumaric acid, imitation orange flavor,
253072 - imitation pineapple flavor, magnesium aluminum silicate,
253073 - methylparaben, purified water, sodium chloride, sorbitol
253074 - solution and sucrose. It has a sodium content of 39.3 mg/5
253075 - mL, 1.71 mEq/5 mL, with a pH range of 2.2 to 3.7.
253077 - ..
253078 - This would prevent pills from accumulating on LESV causing
253079 - recurrent of ulceration.
253081 - ..
253082 - Could ask Doctor Dang in Orthopedics VAMCSF during meeting in
253083 - 2 weeks on 161212 1600.
253085 - ..
253086 - Doctor Lee wanted to start procedure at 1200, and so did not discuss
253087 - this matter today, deferred to meeting next week.
253088 -
253089 -
253091 - ..
253092 - 3. Ensure was ordered by Doctor Lee during prior procedure on
253093 - 161122 1245 at 1534, and to support nutriation on liquid diet,
253094 - while recovering from severe ulceration, and extreme
253095 - contraction of LESV. ref SDS J8 7440
253097 - ..
253098 - Status of prescription for Ensure?
253100 - ..
253101 - Doctor Lee wanted to start procedure at 1200, and so did not discuss
253102 - this matter today, deferred to meeting next week.
253103 -
253105 - ..
253106 - 4. Interim report on Peer Review.
253107 -
253108 - During meeting with Doctor Lee on 160921 1130, he indicated
253109 - Peer Review report on stroke symptoms following EGD on 160617,
253110 - was to have been presented to doctors conference earlier that
253111 - morning, but this didn't occur, because the doctor doing the
253112 - report was called away to perform emergency care at the time of
253113 - the meeting. ref SDS I6 QG6F
253115 - ..
253116 - On 161004, Doctor Lee said he has still not seen the report,
253117 - ref SDS I8 4W4N, despite notice during the meeting on 160921,
253118 - that the report has been completed. ref SDS I6 QG6F
253120 - ..
253121 - On 161019, Doctor Lee cited continued delays distributing
253122 - independent report on cause of stroke symptoms from procedure
253123 - on 160617. ref SDS J3 QG6F
253125 - ..
253126 - On 161122, Doctor Lee reported internal personnel problems have
253127 - caused extended administrative delays either completing several
253128 - reports of this kind, and/or delaying distribution. Doctor Lee
253129 - has notified VA management that the report on findings and
253130 - recommendations in the report on cause of stroke symptoms is
253131 - urgent for guiding continuing work. At this time status is
253132 - unknown. Doctor Lee will ask the Chief of Surgery for an
253133 - undate on getting at least an interim report from the doctor
253134 - assigned to perform Peer Review of stroke symptoms, ref SDS J7
253135 - 4W4N, that occurred following EGD dilation procecure on 160617.
253136 - ref SDS H0 5F6F
253138 - ..
253139 - Doctor Lee wanted to start procedure at 1200, and so did not discuss
253140 - this matter today, deferred to meeting next week.
253141 -
253143 - ..
253144 - 5. Review letter to medical team asking Doctor Massa to support
253145 - sedation medication regimen, shown on 161003 0628. ref SDS I7
253146 - WQ66
253148 - ..
253149 - Intravenous Medications
253150 - Diphenhydramine 25 mg (Benadryl)
253151 - Fentanyl 200 mcg
253152 - Midazolam 5 mg (Versed)
253154 - ..
253155 - Previously during the meeting on 161004 0800, showed the letter to
253156 - Doctor Lee because he no longer has an electronic address for
253157 - receiving correspondence to the medical team. ref SDS I8 554I
253159 - ..
253160 - At that time on 161004, Doctor Lee asked who is on the medical team
253161 - getting distribution of correspondence on this issue, ref SDS I8 W466,
253162 - and saw the list showing...
253163 -
253164 - Doctor Lee, GI
253165 - Doctor Massa, Neurology
253166 - Doctor Yoo, Neurology
253167 - Doctor Simpson, Cardiology
253168 - Doctor Stewart, General Surgery
253170 - ..
253171 - There was no discussion.
253172 -
253174 - ..
253175 - 6. 2nd opinion letter dated 160802, issued by Doctor Vora,
253176 - Attending, and Doctor Kim at Stanford Neuroscience, and
253177 - addressed to Doctor Massa in Neurology at VA Medical Center in
253178 - San Francisco, and with CC to Doctor Lee, and which was
253179 - received in the record on 160820 0940, ref SDS I1 R66J, and
253180 - which says in part...
253181 -
253182 - The diffuse leptomeningeal enhancement! increased
253183 - vascularity most prominent in a culprit right frontal
253184 - region raises question of anesthetic-related changes +/-
253185 - seizure, PRES, and less likely malignancy,
253186 - autoimmune/vasculitis, or infectious changes given bland
253187 - LP, patent's stability, and lack of headache. ref SDS I1
253188 - JF86
253190 - ..
253191 - On 161115, last week Doctor Lee took Stanford's bill of $855
253192 - and the 2nd opinion, both dated 160802, and made copies for his
253193 - use. He returned the originals, and advised that he will
253194 - incorporate these documents into patient Progress Notes for the
253195 - encounter today. Doctor Lee will further submit the bill of
253196 - $855 for payment to the patient. ref SDS J4 NW8O
253198 - ..
253199 - Have not seen Stanford 2nd opinion and the bill for $855 added
253200 - to Progress Notes for meeting on 161115 0800. ref SDS J4 NW8O
253202 - ..
253203 - Doctor Lee wanted to start procedure at 1200, and so did not discuss
253204 - this matter today, deferred to meeting next week.
253205 -
253206 -
253208 - ..
253209 - 7. Conscious sedation drugs for anesthesia will not exceed amounts
253210 - that have previously not caused neurological deficits, as
253211 - occurred on 160617 1637. ref SDS H0 5F6F
253213 - ..
253214 - We agreed that in signing the consent for the procedure today,
253215 - drugs will not be added above amounts that have previously not
253216 - caused neurological deficits (i.e., stroke symptoms). If the
253217 - procedure gets prolonged, as occurred on 160617 0800,
253218 - ref SDS G9 N16M, the patient will be allowed to drift out of
253219 - sedation in order to avoid increasing sedation drugs, and
253220 - because this patient may be biologically prone to over react to
253221 - excessive sedation drugs, reported on 161011 1330. ref SDS J0
253222 - P534 We further reviewed the record showing EGD dilation
253223 - procedure was performed entirely without sedation drugs, and
253224 - was successful on 101210 0930. ref SDS 67 PK8M
253226 - ..
253227 - Doctor Lee will closely monitor conscious sedation medications
253228 - in accordance with these understandings.
253229 -
253231 - ..
253232 - 8. Triamcinolone - less than 3 mL.
253233 -
253234 - We further discussed again limiting Triamcinolone steroid
253235 - injections to 3 mL, and in order to limit side effects of...
253236 -
253237 - Vison loss
253238 - High blood pressure
253239 - Weight gain
253240 - bloating
253242 - ..
253243 - This aligns with understandings during the meeting on 160921
253244 - 1130, ref SDS I6 TI3M, and again when meeting on for prior EGD
253245 - procedure last month on 161004 0800. ref SDS I8 VV6N
253247 - ..
253248 - What guides application of Triamcinolone?
253250 - ..
253251 - Has extreme contraction of LESV to 6 mm last week, reported on
253252 - 161122 1245, ref SDS J7 433O, resulted from reducing or
253253 - eliminating Triamcinolone?
253255 - ..
253256 - On 161130, Doctor Lee seemed to say today he has injected
253257 - Triamcinolone for the procedure 2 weeks ago on 161115, and for
253258 - all procedures this year, including last week on 161130. 161130
253259 - 1038, ref SDS K0 7M4K
253261 - ..
253262 - Ask about increasing Triamcialone to increase time LESV remains
253263 - expanded, based on amount of contraction today. The balance is
253264 - maintaining expansion of Triamcinalone, without accelerating
253265 - concentration week to week.
253266 -
253268 - ..
253269 - 9. Feet examined and found still normal, showing minimal effects
253270 - prescribing high dose Pantoprazole 40 mg twice-a-day, and
253271 - combined with increasing dose Ezetimibe 10 mg and Atorvastatin
253272 - 10 mg every other day, from every 3 days.
253274 - ..
253275 - Did not examine feet; was not enough time.
253277 - ..
253278 - Signed consent for the procedure, which is not visible - there is
253279 - merely a black screen to sign.
253280 -
253281 -
253282 -
253284 - ..
253285 - Swallowing Improved Vomitting Difficulties Decreased
253286 -
253287 - Follow up ref SDS K0 VV6N, ref SDS J8 VV6N.
253288 -
253289 - Reported significant improvement with no vomiting the past week.
253291 - ..
253292 - Estimated LESV will engage today at 14 mm, based on dilation last week
253293 - to 15 mm, reported on 161130 1038. ref SDS K0 LP4I
253295 - ..
253296 - Doctor Lee was pleased there was no vomitting this past week.
253297 -
253298 -
253299 -
253301 - ..
2534 -
2535 -
2536 - 1202
2537 -
253701 - OR EGD Dilation with Application Lidocaine
253702 - EGD Dilation Procedure in OR Application Lidocaine
253703 -
253704 - Follow up ref SDS K0 7V6I, ref SDS J8 7V6I.
253706 - ..
253707 - Everything went smoothly, as always.
253709 - ..
253710 - Gracy applied conscious sedation using the catheter set by Danis
253711 - earlier in Preparation, per above. ref SDS K0 544G Assume
253712 - understandings were applied on sedation protocol reviewed with Doctor
253713 - Lee and agreed in signing the consent, per above. ref SDS J8 8744
253715 - ..
253716 - Christi worked with Gracy in observing procedure for learning
253717 - experience.
253719 - ..
253720 - The team then did the EDG/dilation procedure.
253721 -
253722 -
253723 -
253725 - ..
253726 - LESV Contract 6 MM Dilation 12 MM Ulceration Resolved
253727 - Meeting Doctor Lee Present Results EGD Dilation Procedure 12 MM
253728 - Results EGD Dilation Procedure Meeting Doctor Lee Present 12 MM
253729 - Liquid Diet Continue LESV Contracted 6 MM Worst in Patient History
253730 -
253731 - Follow up ref SDS K0 5H5J, ref SDS J8 5H5J.
2538 -
2539 -
2540 - 1321
2541 -
254102 - ..
254103 - An hour or so after the procedure, met with Doctor Lee in the recovery
254104 - room.
254106 - ..
254107 - Doctor Lee reported better results again today.
254109 - ..
254110 - Good news - new deep ulcerated hole next to LESV found during EGD 2
254111 - weeks ago on 161115 0800, ref SDS J4 GD5K, was observed to now be
254112 - completely resolved today. This improvement enabled Doctor Lee to
254113 - dilate LESV.
254115 - ..
254116 - Bad news - Doctor Lee advised that LESV contracted from 15 mm down to
254117 - 11 mm, continuing severe contractions, similar to 161122 1245.
254118 - ref SDS J7 433O
254120 - ..
254121 - The doctor dilated the opening to 16.5 mm (aligns with Discharge
254122 - Instructions saying Dilation 11-16.5mm). As a result, liquid diet is
254123 - no longer necessary, however continue not swallowing big chunks of
254124 - anything, especially meet. Continue liquid diet may aid current
254125 - exigent care to eventually dilate LESV back to 18 mm.
254126 -
254127 - Bena
254128 - Versed/ dryl
254129 - LESV DILATE Triamcin Midaz Diphenhy Fenta Lido
254130 - Months from - to olone olam dramine nyl caine
254131 - Interval Date mm mm mL mg mg mg mL
254132 - 0.25 161206 11 16.5....0.0.....5......25......200......5.... ref SDS 0 433O
254133 - 0.25 161130 11 15......0.0.....5......25......200......5.... ref SDS K0 433O
254134 - 0.25 161122 6 12......0.0.....5......25......200......5.... ref SDS J8 433O
254135 - 1.50 161115 10 10......0.0.....5......25......200......5.... ref SDS J4 5H5J
254136 - 0.75 161004 11 15......5.0.....5......25......200......5.... ref SDS I8 HU42
254137 - 0.75 160909 10 15......5.0.....5......25......200......5.... ref SDS H9 HU42
254138 - 2 160816 9.5 10......5.0.....4......50......150......5.... ref SDS H9 HU42
254139 - 3 160617 9.5 15......5.0.....6......50......250......5.... ref SDS G9 HU42
254140 - 4 160315 9.5 15......3.0.....5......25......250......5.... ref SDS G7 HU42
254141 - 8 151204 10 15......5.0.....5......25......200......5.... ref SDS F3 HU42
254142 - 6 150421 16.5 18......3.0.....4......50......250......5.... ref SDS D3 HU42
254143 - 6 141107 15 18......4.0.....5......50......150......5.... ref SDS C4 E54M
254144 - 6 140509 16.5 18..............5......50......200......5.... ref SDS B4 P680
254145 - 7 131115 16.5 18......2.0.....4......50......200......5.... ref SDS A6 RZ45
254146 - 3 130416 18 18......2.0.....5......50......250......5.... ref SDS A0 Y850
254147 - 4 130110 15 18......3.0.....4......50......100......5.... ref SDS 95 Q333
254148 - 6 120925 15 18......4.0.....5......50......200......5.... ref SDS 87 XB51
254149 - 4 120322 16.5 18..............4......50......150......5.... ref SDS 84 516N
254150 - 3 111115 16.5 18..............4......50......200......5.... ref SDS 82 IR57
254151 - 4 110819 15 16.5....2.5.....5......50......200......5.... ref SDS 81 J978
254152 - 3 110429 13 16.5....3.5.....5..............200......5.... ref SDS 76 U23I
254153 - 3 110218 11 14......2.0.....4......50......150......5.... ref SDS 72 AA5O
254154 - 4 101210 11 14......................................5.... ref SDS 67 H347
254155 - 5 100827 11 15..............5......50......250......5.... ref SDS 55 JE6X
254156 - 3 100305 11 15..............5......50......250......5.... ref SDS 48 WR6L
254157 - 091216 Heller Myotomy Fundoplication..................... ref SDS 36 KE9U
254158 -
254159 -
254161 - ..
254162 - Conscious Sedation Reduced Dose Applied for 15 Minutes
254163 -
254164 - Follow up ref SDS K0 714N, ref SDS J8 714N.
254165 -
254166 - No discussion of conscious sedation during post-procedure meeting.
254168 - ..
254169 - Assume understandings were applied on sedation protocol reviewed with
254170 - Doctor Lee and agreed in signing consent for the procedure today, per
254171 - above. ref SDS J8 8744
254172 -
254173 -
254174 -
254176 - ..
254177 - Ulceration Improved Stricture Decreased
254178 -
254179 - Follow up ref SDS K0 RZ3G, ref SDS J8 RZ3G.
254180 -
254181 - Doctor Lee presented pictures showing results of examination today.
254182 - He advised that ulceration has continued to be completely resolved.
254183 - The prior severe ulceration hole adjacent to LESV opening in the
254184 - esophagus found during the procedure 2 weeks ago on 161115 0800,
254185 - ref SDS J4 K44N, and continuing remnants of ulceration found during
254186 - EGD procedure week on 161122 1245, ref SDS J7 RZ3G, is still no longer
254187 - visible.
254189 - ..
254190 - This was a great relief, indicating effectiveness of Pantoprazole
254191 - prescribed beginning on 160816 0800, ref SDS H9 Q05K, and
254192 - particularly returning to 2 Pantoprazole each day, beginning on
254194 - ..
254195 - As a result, the doctor was able to dilate LESV from 11mm - 16.5mm,
254196 - which is the highest dilation in over a year, since 151204, shown in
254197 - the table above. ref SDS 0 433O
254198 -
254199 -
254200 -
254202 - ..
254203 - Liquid Diet Increase Pantoprazole to Heal Ulceration LESV
254204 - Pantoprazole Increased with Famotidine and Baking Soda or Tumms
254205 -
254206 - Follow up ref SDS K0 Q05K, ref SDS J8 Q05K.
254207 -
254208 - Doctor Lee prescribed continuing high dose Pantoprazole 40 mg twice a
254209 - day for at least another week, as prescribed 2 weeks ago on 161115
254210 - 0800. ref SDS J4 Q05K
254212 - ..
254213 - Doctor Lee approved taking Naproxen by cutting large pills in half, so
254214 - they can easily slip through LESV expanded today to 16.5mm, which
254215 - should prevent getting stuck on top of LESV and causing recurrence of
254216 - ulceration on LESV.
254218 - ..
254219 - Doctor Lee confirmed today, that he ordered Ensure. He considered
254220 - ordering chocolate, then specified vanilla, because if the patient
254221 - wants chocolate, this can added, as adding chocolate syrup to milk.
254222 -
254223 - [On 161207 0813 VA Pharmacy shows Ensure Plus Chocolate was
254224 - ordered; Gracy changed the ordered to Ensure regular and
254225 - vanilla. ref SDS K3 L132
254227 - ..
254228 - [On 161207 0813 called Gracy; she tried to correct the
254229 - order for Ensure regular Vanilla. ref SDS K4 L132
254231 - ..
254232 - [On 161224 1205 received 2nd delivery partially corrected
254233 - for Ensure Plus this flavor is vanilla, ordered by Gracy.
254234 - ref SDS K7 N98M
254236 - ..
254237 - Work plan - will maintain for another week Pantoprazole at 2 pills per
254238 - day, with goal to reduce after procedure next week on 161213, to 1
254239 - pill per day, and eventually dose reduce to 20 mg, instead of 40 mg,
254240 - and in order to resolve mounting side effects of frequent urination
254241 - that causes dehydration which injures feet, thereby preventing hiking.
254242 - Additionally, plan to restore Naproxen in order to enable hiking
254243 - needed to maintain elevated HDL that regresses atherosclerosis,
254244 -
254245 -
254247 - ..
254248 - Candidas Esophageal Infection Reduced by
254249 -
254250 - Follow up ref SDS K0 A23L, ref SDS J8 A23L.
254251 -
254252 - No discussion of candidas today.
254253 -
254255 - ..
254256 - Vocal Chords swollen
254257 -
254258 - Doctor Lee presented pictures taken today of swollen vocal chords. He
254259 - seemed to say this condition has occurred previously, but has not been
254260 - discussed.
254262 - ..
254263 - If it recurrs next week, then he will make referral to ENT Department
254264 - for treatment.
254265 -
254267 - ..
254268 - Commendation Letter to Director of Hospital
254269 -
254270 - Doctor Lee requested a letter sent to David Stockwell, Director of the
254271 - hospital, and mentioning nurses in the GI Clinic, reflecting the
254272 - letter sent with flowers to the GI Clinic on 161205 0846. ref SDS K2
254273 - FS5I
254275 - ..
254276 - [On 161208 2239 submitted letter to David Stockwell,
254277 - Director of VA Medical Center in Sacramento, commending
254278 - work of GI Clinic. ref SDS K6 QR9K
254279 -
254280 -
254282 - ..
254283 - Next Meeting 1 Week to Recover Severe Symptoms
254284 -
254285 - Follow up ref SDS K0 4U5F, ref SDS J8 4U5F.
254286 -
254287 - Doctor Lee scheduled another exigent procedure next week on 161213
254288 - 0800, and said to check-in OA 0730, implementing prior instructions on
254289 - 161122 1245. ref SDS J7 4U5F
254291 - ..
254292 - Consultation is already scheduled 2 days later on 161215 1200,
254293 - reported last week on 161122 1245. ref SDS J7 AZ6O, as modified On
254294 - 161128 1119 called VA GI Clinic in Sacramento; LaPreia said meeting
254295 - Doctor Lee scheduled for 161214, has been changed to the next day on
254296 - 161215 1200. ref SDS J9 OZ9G
254297 -
254298 -
254299 -
254300 -
254301 -
254302 -
2544 -
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 K0 CY7I, ref SDS J8 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 -
550908 -
550909 -
550910 -
550911 -
550912 -
550913 -
550914 -
550915 -
550916 -
550917 -
550918 -
550919 -
550920 -
5510 -