CONTACTS
SUBJECTS
VA EGD Procedure Stricture Lower Esophageal Sphincter Valve LESV 10
2503 -
2503 - ..
2504 - Summary/Objective
2505 -
250501 - Follow up ref SDS K3 0000. ref SDS K0 0000.
250502 -
250503 - No diffuculty swallowing this cycle with LESV dilated to 16.5 mm last
250504 - week on 161206. ref SDS 0 VV6N Signed blank consent for the procedure
250505 - today, on assurance from Doctor Lee that stroke symptoms following
250506 - prior EGD on 160617, would not recur. ref SDS 0 8744 EGD dilation
250507 - procedure went smoothly, with no reports of difficulties. ref SDS 0
250508 - 7V6I Post procedure Doctor Lee reported LESV only contracted to 15
250509 - mm, and so he dilated to 18 mm, the maximum for this protocol, and the
250510 - best in over a year. ref SDS 0 433O Ulceration improved this past
250511 - week, which enabled the doctor to dilate LESV needed for better
250512 - swallowing. ref SDS 0 RZ3G New mild ulceration area forming adjacent
250513 - to LESV, possibly caused by resuming Naproxen the past 2 days even
250514 - with pills cut in half to aid swallowing. ref SDS 0 W46M Doctor Lee
250515 - prescribed continuing Pantoprazole 40 mg and Famotidine 40 mg both
250516 - twice a day, and avoid Naproxen, required for hiking. ref SDS 0 Q05K
250517 - We will meet in 2 days on 161215 1100, to review progress and plan
250518 - treatment for the periord ahead. ref SDS 0 4U5F After the procedure
250519 - patient developed left eye pain. Returned to GI Clinic; examination
250520 - showed left eye was swollen, red and the pupil was contracted to a
250521 - "pinpoint." ref SDS 0 R74J Was released for home care with Visine,
250522 - and over next few hours the condition appeared resolved. ref SDS 0
250523 - 3X9H
250525 - ..
250526 - [On 161214 0850 returned to VA GI Clinic. Gracy examined
250527 - eyes again, and found left eye appears fully recovered from
250528 - redness and contracted pupil that occurred after EGD
250529 - yesterday. ref SDS K7 K37G She will update Progress Notes,
250530 - and notify team contacting patinets for follow up on EGD
250531 - procedures yesterday, that patient has improved swallowing,
250532 - and no other after effects from EGD dilation. ref SDS K7
250533 - HU6H
250535 - ..
250536 - [On 161214 0850 next morning, applying Visine to left eye
250537 - caused no pain, indicating full recovery. ref SDS L0 K37G
250539 - ..
250540 - [On 161215 1100 Doctor Lee reviewed left eye injury issue,
250541 - during post-procedure meeting, and made referral to Doctor
250542 - Margalis in Eye Clinic at VA in Martinez. ref SDS L1 X15C
250544 - ..
250545 - [On 161221 1104 received call from Anthony in Eye Clinic at
250546 - VA Clinic in Martinez; scheduled meeting with optimitrist
250547 - ordered by Doctor Marguiles, and on 170104 0900.
250548 - ref SDS L2 M65I
250549 -
250550 -
250551 -
250552 -
250553 -
250555 - ..
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 K3 NU8L, ref SDS K0 NU8L.
251806 -
251807 - Meeting today, was scheduled last week after EGD dilation procedure on
251808 - 161206 1130. ref SDS K3 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 - 1133
2522 -
252201 - Pre-op Preparation No Problems Getting Blood Flow for Anesthesia IV
252202 -
252203 - Follow up ref SDS K3 EP75, ref SDS K0 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 - Crispen took vitals today, prior to procedure in a small office just
252211 - off the lobby, and not in the treatment center, reported on 120925
252212 - 0900. ref SDS 87 PT5P
252214 - ..
252215 - Vitals included...
252216 -
252217 - Weight.................. 180.6 (without shoes)
252218 - BP...................... 138 62
252219 - HR (pulse).............. 72
252220 - Oxygen.................. 96
252221 - Temp.................... 97.3
252223 - ..
252224 - Crispen took me directly into Prep Room.
252226 - ..
252227 - Appreciated being warmly greeted by all the nurses.
252229 - ..
252230 - Grace configured on gurney and connected equipment to monitor vitals
252231 - during the procedure.
252233 - ..
252234 - Gracy set catheter IV for sedation. Required 1 stick today, in right
252235 - arm.
252237 - ..
252238 - Case study on sticks required to set catheter is reported on 110429
252239 - 1230. ref SDS 76 UO3G
252241 - ..
252242 - Grace went through patient identification and medical profile filling
252243 - out forms on the computer based on prior information last week on
252245 - ..
252246 - She asked about pain? Reported level 0.
252247 -
252248 -
252250 - ..
2523 -
2524 -
2525 - 0745
2526 -
252601 - Waited about 25 minutes.
252602 -
252603 -
252604 -
252605 -
252607 - ..
2527 -
2528 -
2529 - 0812
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 K3 RG9K, ref SDS K0 RG9K.
253005 -
253006 - Meeting Doctor Lee to sign form consenting to undergo EGD dilation
253007 - procedure today.
253009 - ..
253010 - Doctor Lee advised he received a copy of the letter David Stockton,
253011 - Director of the Hospital, sent saying he appreciated hearing the GI
253012 - Clinic is doing a good job, reported on 161209 1011, ref SDS K5 918K,
253013 - and referencing the letter to the Director on 161208 2239. ref SDS K4
253014 - QR9K This followed up prior discussions 2 days earlier on
253016 - ..
253017 - Noted that signature is entered on completely black screen, required
253018 - without reading online documents.
253020 - ..
253021 - Advised that signature is based on following understandings...
253023 - ..
253024 - Agenda Meeting Doctor Lee...
253026 - ..
253027 - 1. Schedule follow up meeting for EGD dilation today...
253028 -
253029 - There is already a following up meeting scheduled on 161215
253030 - 1200, which was set during the prior EGD procedure on 161122
253031 - 1245. ref SDS J7 AZ6O On 161128 1119 called VA GI Clinic in
253032 - Sacramento; LaPreia said meeting Doctor Lee scheduled for
253033 - 161214, has been changed to the next day on 161215 1200.
253034 - ref SDS J9 OZ9G
253036 - ..
253037 - Will further review results of procedure today, during the
253038 - meeting with the doctor on 161215 1200.
253040 - ..
253041 - If unable to dilate today, will convert meeting scheduled on
253042 - 161215, which is Thursday, into another EGD for dilation after
253043 - continuing liquid diet?
253045 - ..
253046 - Gracy checked and confirmed still scheduled to see Doctor Lee on
253047 - Thursday, in 2 days on 161215 1200.
253048 -
253049 -
253051 - ..
253052 - 2. Naproxen liquid suspension requires doctor's prescription...
253053 -
253054 - CLINICAL PHARMACOLOGY
253055 -
253056 - Roxane Laboratories, Inc
253057 -
253058 - Rx only
253059 -
253060 - https://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=5701
253062 - ..
253063 - Naproxen oral suspension contains 125 mg naproxen per 5 mL.
253064 - In addition, the following inactive ingredients are present:
253065 - FD&C Yellow #6, fumaric acid, imitation orange flavor,
253066 - imitation pineapple flavor, magnesium aluminum silicate,
253067 - methylparaben, purified water, sodium chloride, sorbitol
253068 - solution and sucrose. It has a sodium content of 39.3 mg/5
253069 - mL, 1.71 mEq/5 mL, with a pH range of 2.2 to 3.7.
253071 - ..
253072 - Switching to liquid Naproxen would prevent pills from
253073 - accumulating on LESV causing severe recurrent ulceration,
253074 - reported on 160816 0800. ref SDS H9 RZ3G Continuing Naproxen
253075 - in liquid form would enable continuing extended endurance
253076 - exercise hiking 11 - 15 miles per day that raises HDL required
253077 - to regress atherosclerosis in order to maintain quality of
253078 - life, i.e., cardio pulmonary function, cognition, digestion,
253079 - immunity.
253081 - ..
253082 - Yesterday, Doctor Dang in Orthopedics at VAMCSF ordered knee
253083 - treatment with Synvisc, shown on 161212 1632. ref SDS K6 W579
253085 - ..
253086 - Treatment with Synvisc in about 2 weeks, may eliminate need for
253087 - taking Naproxen.
253089 - ..
253090 - Doctor Dang found liquid Naproxen is available in VA formulary. It
253091 - has to be ordered by Doctor Lee based on requirements for liquid
253092 - diet, i.e., avoiding large Naproxen pills that clog LESV and cause
253093 - ulceration.
253094 -
253095 -
253097 - ..
253098 - 3. Ensure was ordered by Doctor Lee during prior procedure on
253099 - 161122 1245 at 1534, and to support nutriation on liquid diet,
253100 - while recovering from severe ulceration, and extreme
253101 - contraction of LESV. ref SDS J8 7440
253103 - ..
253104 - Status of prescription for Ensure?
253106 - ..
253107 - Doctor Lee wanted to start procedure at 1200, and so did not discuss
253108 - this matter today, deferred to meeting next week.
253110 - ..
253111 - Asked Gracy about changing prescription of Ensure to non-plus, i.e.,
253112 - just regular, and vanilla not chocolate.
253114 - ..
253115 - Gracy said VA prescription system does not allow specifying non-Plus
253116 - Ensure. She entered a comment to send non-Plus, and she changed he
253117 - order to Vanilla.
253118 -
253119 -
253121 - ..
253122 - 4. Interim report on Peer Review.
253123 -
253124 - During meeting with Doctor Lee on 160921 1130, he indicated
253125 - Peer Review report on stroke symptoms following EGD on 160617,
253126 - was to have been presented to doctors conference earlier that
253127 - morning, but this didn't occur, because the doctor doing the
253128 - report was called away to perform emergency care at the time of
253129 - the meeting. ref SDS I6 QG6F
253131 - ..
253132 - On 161004, Doctor Lee said he has still not seen the report,
253133 - ref SDS I8 4W4N, despite notice during the meeting on 160921,
253134 - that the report has been completed. ref SDS I6 QG6F
253136 - ..
253137 - On 161019, Doctor Lee cited continued delays distributing
253138 - independent report on cause of stroke symptoms from procedure
253139 - on 160617. ref SDS J3 QG6F
253141 - ..
253142 - On 161122, Doctor Lee reported internal personnel problems have
253143 - caused extended administrative delays either completing several
253144 - reports of this kind, and/or delaying distribution. Doctor Lee
253145 - has notified VA management that the report on findings and
253146 - recommendations in the report on cause of stroke symptoms is
253147 - urgent for guiding continuing work. At this time status is
253148 - unknown. Doctor Lee will ask the Chief of Surgery for an
253149 - undate on getting at least an interim report from the doctor
253150 - assigned to perform Peer Review of stroke symptoms, ref SDS J7
253151 - 4W4N, that occurred following EGD dilation procecure on 160617.
253152 - ref SDS H0 5F6F
253154 - ..
253155 - Doctor Lee wanted to start procedure at 1200, and so did not discuss
253156 - this matter today, deferred to meeting next week.
253157 -
253159 - ..
253160 - 5. Review letter to medical team asking Doctor Massa to support
253161 - sedation medication regimen, shown on 161003 0628. ref SDS I7
253162 - WQ66
253164 - ..
253165 - Intravenous Medications
253166 - Diphenhydramine 25 mg (Benadryl)
253167 - Fentanyl 200 mcg
253168 - Midazolam 5 mg (Versed)
253170 - ..
253171 - Previously during the meeting on 161004 0800, showed the letter to
253172 - Doctor Lee because he no longer has an electronic address for
253173 - receiving correspondence to the medical team. ref SDS I8 554I
253175 - ..
253176 - At that time on 161004, Doctor Lee asked who is on the medical team
253177 - getting distribution of correspondence on this issue, ref SDS I8 W466,
253178 - and saw the list showing...
253179 -
253180 - Doctor Lee, GI
253181 - Doctor Massa, Neurology
253182 - Doctor Yoo, Neurology
253183 - Doctor Simpson, Cardiology
253184 - Doctor Stewart, General Surgery
253186 - ..
253187 - There was no discussion.
253188 -
253190 - ..
253191 - 6. 2nd opinion letter dated 160802, issued by Doctor Vora,
253192 - Attending, and Doctor Kim at Stanford Neuroscience, and
253193 - addressed to Doctor Massa in Neurology at VA Medical Center in
253194 - San Francisco, and with CC to Doctor Lee, and which was
253195 - received in the record on 160820 0940, ref SDS I1 R66J, and
253196 - which says in part...
253197 -
253198 - The diffuse leptomeningeal enhancement! increased
253199 - vascularity most prominent in a culprit right frontal
253200 - region raises question of anesthetic-related changes +/-
253201 - seizure, PRES, and less likely malignancy,
253202 - autoimmune/vasculitis, or infectious changes given bland
253203 - LP, patent's stability, and lack of headache. ref SDS I1
253204 - JF86
253206 - ..
253207 - On 161115, last week Doctor Lee took Stanford's bill of $855
253208 - and the 2nd opinion, both dated 160802, and made copies for his
253209 - use. He returned the originals, and advised that he will
253210 - incorporate these documents into patient Progress Notes for the
253211 - encounter today. Doctor Lee will further submit the bill of
253212 - $855 for payment to the patient. ref SDS J4 NW8O
253214 - ..
253215 - Have not seen Stanford 2nd opinion and the bill for $855 added
253216 - to Progress Notes for meeting on 161115 0800. ref SDS J4 NW8O
253218 - ..
253219 - Doctor Lee wanted to start procedure at 1200, and so did not discuss
253220 - this matter today, deferred to meeting next week.
253221 -
253222 -
253224 - ..
253225 - 7. Conscious sedation drugs for anesthesia will not exceed amounts
253226 - that have previously not caused neurological deficits, as
253227 - occurred on 160617 1637. ref SDS H0 5F6F
253229 - ..
253230 - We agreed that in signing the consent for the procedure today,
253231 - drugs will not be added above amounts that have previously not
253232 - caused neurological deficits (i.e., stroke symptoms). If the
253233 - procedure gets prolonged, as occurred on 160617 0800,
253234 - ref SDS G9 N16M, the patient will be allowed to drift out of
253235 - sedation in order to avoid increasing sedation drugs, and
253236 - because this patient may be biologically prone to over react to
253237 - excessive sedation drugs, reported on 161011 1330. ref SDS J0
253238 - P534 We further reviewed the record showing EGD dilation
253239 - procedure was performed entirely without sedation drugs, and
253240 - was successful on 101210 0930. ref SDS 67 PK8M
253242 - ..
253243 - Doctor Lee will closely monitor conscious sedation medications
253244 - in accordance with these understandings.
253245 -
253247 - ..
253248 - 8. Triamcinolone - less than 3 mL.
253249 -
253250 - We further discussed again limiting Triamcinolone steroid
253251 - injections to 3 mL, and in order to limit side effects of...
253252 -
253253 - Vison loss
253254 - High blood pressure
253255 - Weight gain
253256 - bloating
253258 - ..
253259 - This aligns with understandings during the meeting on 160921
253260 - 1130, ref SDS I6 TI3M, and again when meeting on for prior EGD
253261 - procedure last month on 161004 0800. ref SDS I8 VV6N
253263 - ..
253264 - What guides application of Triamcinolone?
253266 - ..
253267 - Has extreme contraction of LESV to 6 mm last week, reported on
253268 - 161122 1245, ref SDS J7 433O, resulted from reducing or
253269 - eliminating Triamcinolone?
253271 - ..
253272 - On 161130, Doctor Lee seemed to say today he has injected
253273 - Triamcinolone for the procedure 2 weeks ago on 161115, and for
253274 - all procedures this year, including last week on 161130. 161130
253275 - 1038, ref SDS K0 7M4K
253277 - ..
253278 - Ask about increasing Triamcialone to increase time LESV remains
253279 - expanded, based on amount of contraction today. The balance is
253280 - maintaining expansion of Triamcinalone, without accelerating
253281 - concentration week to week.
253282 -
253284 - ..
253285 - 9. Feet examined and found still normal, showing minimal effects
253286 - prescribing high dose Pantoprazole 40 mg twice-a-day, and
253287 - combined with increasing dose Ezetimibe 10 mg and Atorvastatin
253288 - 10 mg every other day, from every 3 days.
253290 - ..
253291 - Did not examine feet; was not enough time.
253293 - ..
253294 - Signed consent for the procedure, which is not visible - there is
253295 - merely a black screen to sign.
253296 -
253297 -
253298 -
253300 - ..
253301 - Swallowing Improved Vomitting Difficulties Decreased
253302 -
253303 - Follow up ref SDS K3 VV6N, ref SDS K0 VV6N.
253304 -
253305 - Reported no vomiting the past week with LESV dilated to 16.5mm last
253306 - week on 161206 1130. ref SDS K3 LP4I
253308 - ..
253309 - Estimated LESV will engage today at 14 mm, based no difficulties
253310 - swallowing this past week following semi-liquid diet.
253312 - ..
253313 - Discussed increasing Triamcinalone slightly to maintain LESV, i.e.,
253314 - prevent contraction going forward, that has occurred the past 2
253315 - months, shown in case study last week on 161206 1130. ref SDS K3 LP4I
253316 -
253317 -
253319 - ..
2534 -
2535 -
2536 - 0823
2537 -
253701 - Complete pre-op and meeting with Doctor Lee
253702 -
253703 - Waiting for OR.
253704 -
253705 -
253706 -
253708 - ..
2538 -
2539 -
2540 - 0842
2541 -
254101 - OR EGD Dilation with Application Lidocaine
254102 - EGD Dilation Procedure in OR Application Lidocaine
254103 -
254104 - Follow up ref SDS K3 7V6I, ref SDS K0 7V6I.
254106 - ..
254107 - Everything went smoothly, as always.
254109 - ..
254110 - Laura applied conscious sedation using the catheter set by Gracy
254111 - earlier in Preparation, per above. ref SDS 0 544G Assume
254112 - understandings were applied on sedation protocol reviewed with Doctor
254113 - Lee and agreed in signing the consent, per above. ref SDS 0 8744
254115 - ..
254116 - Raymond worked with Laura as technical assistant.
254118 - ..
254119 - The team then did the EDG/dilation procedure with Doctor Lee.
254120 -
254121 -
254122 -
254124 - ..
254125 - LESV Contract 6 MM Dilation 12 MM Ulceration Resolved
254126 - Meeting Doctor Lee Present Results EGD Dilation Procedure 12 MM
254127 - Results EGD Dilation Procedure Meeting Doctor Lee Present 12 MM
254128 - Liquid Diet Continue LESV Contracted 6 MM Worst in Patient History
254129 -
254130 - Follow up ref SDS K3 5H5J, ref SDS K0 5H5J.
2542 -
2543 -
2544 - 1051
2545 -
254502 - ..
254503 - An hour or so after the procedure, met with Doctor Lee in the recovery
254504 - room.
254506 - ..
254507 - Doctor Lee reported better results again today.
254509 - ..
254510 - Good news - new deep ulcerated hole next to LESV found during EGD 2
254511 - weeks ago on 161115 0800, ref SDS J4 GD5K, was observed to now be
254512 - completely resolved today. This improvement enabled Doctor Lee to
254513 - dilate LESV.
254515 - ..
254516 - Really good news - Doctor Lee advised that LESV contracted from 16.5
254517 - mm down to 15 mm, showing considerable improvement compared to recent
254518 - severe weekly contractions the past several months, evident from case
254519 - study below. ref SDS 0 SP5G
254521 - ..
254522 - Doctor Lee dilated the opening to 18 mm (aligns with Discharge
254523 - Instructions saying Dilation 15-18 mm). As a result, complete liquid
254524 - diet is no longer necessary, however continue not swallowing big
254525 - chunks of anything, especially meet. Continue semi-liquid diet that
254526 - aids current exigent care until patient history shows dilation is
254527 - maintained for normal treatment cycle of 6 months.
254528 -
254529 - Bena
254530 - Versed/ dryl
254531 - LESV DILATE Triamcin Midaz Diphenhy Fenta Lido
254532 - Months from - to olone olam dramine nyl caine
254533 - Interval Date mm mm mL mg mg mg mL
254534 - 0.25 161213 15 18......3.0.....5......25......200......5.... ref SDS 0 433O
254535 - 0.25 161206 11 16.5....1.0.....5......25......200......5.... ref SDS K3 433O
254536 - 0.25 161130 11 15......0.0.....5......25......200......5.... ref SDS K0 433O
254537 - 0.25 161122 6 12......0.0.....5......25......200......5.... ref SDS J8 433O
254538 - 1.50 161115 10 10......0.0.....5......25......200......5.... ref SDS J4 5H5J
254539 - 0.75 161004 11 15......5.0.....5......25......200......5.... ref SDS I8 HU42
254540 - 0.75 160909 10 15......5.0.....5......25......200......5.... ref SDS H9 HU42
254541 - 2 160816 9.5 10......5.0.....4......50......150......5.... ref SDS H9 HU42
254542 - 3 160617 9.5 15......5.0.....6......50......250......5.... ref SDS G9 HU42
254543 - 4 160315 9.5 15......3.0.....5......25......250......5.... ref SDS G7 HU42
254544 - 8 151204 10 15......5.0.....5......25......200......5.... ref SDS F3 HU42
254545 - 6 150421 16.5 18......3.0.....4......50......250......5.... ref SDS D3 HU42
254546 - 6 141107 15 18......4.0.....5......50......150......5.... ref SDS C4 E54M
254547 - 6 140509 16.5 18..............5......50......200......5.... ref SDS B4 P680
254548 - 7 131115 16.5 18......2.0.....4......50......200......5.... ref SDS A6 RZ45
254549 - 3 130416 18 18......2.0.....5......50......250......5.... ref SDS A0 Y850
254550 - 4 130110 15 18......3.0.....4......50......100......5.... ref SDS 95 Q333
254551 - 6 120925 15 18......4.0.....5......50......200......5.... ref SDS 87 XB51
254552 - 4 120322 16.5 18..............4......50......150......5.... ref SDS 84 516N
254553 - 3 111115 16.5 18..............4......50......200......5.... ref SDS 82 IR57
254554 - 4 110819 15 16.5....2.5.....5......50......200......5.... ref SDS 81 J978
254555 - 3 110429 13 16.5....3.5.....5..............200......5.... ref SDS 76 U23I
254556 - 3 110218 11 14......2.0.....4......50......150......5.... ref SDS 72 AA5O
254557 - 4 101210 11 14......................................5.... ref SDS 67 H347
254558 - 5 100827 11 15..............5......50......250......5.... ref SDS 55 JE6X
254559 - 3 100305 11 15..............5......50......250......5.... ref SDS 48 WR6L
254560 - 091216 Heller Myotomy Fundoplication..................... ref SDS 36 KE9U
254561 -
254562 -
254564 - ..
254565 - Conscious Sedation Reduced Dose Applied for 15 Minutes
254566 -
254567 - Follow up ref SDS K3 714N, ref SDS K0 714N.
254568 -
254569 - No discussion of conscious sedation during post-procedure meeting.
254571 - ..
254572 - Assume understandings were applied on sedation protocol reviewed with
254573 - Doctor Lee and agreed in signing consent for the procedure today, per
254574 - above. ref SDS 0 8744
254575 -
254576 - [...below on 161213 0800 at 1211 experienced mild side
254577 - effects left eye pain and pupil contracted to pinpoint,
254578 - ref SDS 0 R74J; called GI Clinic and Laura said this is
254579 - caused by conscious sedation. ref SDS 0 OD63
254580 -
254581 -
254582 -
254583 -
254585 - ..
254586 - Ulceration Improved Stricture Decreased
254587 -
254588 - Follow up ref SDS K3 RZ3G, ref SDS K0 RZ3G.
254589 -
254590 - Doctor Lee presented pictures showing results of examination today.
254591 - He advised that ulceration has continued to be completely resolved.
254592 - The prior severe ulceration hole adjacent to LESV opening in the
254593 - esophagus found during the procedure 4 weeks ago on 161115 0800,
254594 - ref SDS J4 K44N, and continuing remnants of ulceration found during
254595 - EGD procedure on 161122 1245, ref SDS J7 RZ3G, is still no longer
254596 - visible.
254598 - ..
254599 - This was a great relief, indicating effectiveness of Pantoprazole
254600 - prescribed beginning on 160816 0800, ref SDS H9 Q05K, and
254601 - particularly returning to 2 Pantoprazole each day, beginning on
254603 - ..
254604 - Doctor Lee reported finding new ulceration today, adjacent to Lesv and
254605 - on other side from where prior severe ulceration formed on 161115
254606 - 0800. ref SDS J4 K44N The doctor emphasized the new ulceration is
254607 - very mild, but disappointing, since the treatment goal is no
254608 - ulceration.
254610 - ..
254611 - As a result, the doctor was able to dilate LESV from 15mm - 18mm, for
254612 - the first time above 15mm in over a year, since 150421, shown in the
254613 - table above. ref SDS 0 433O
254614 -
254615 -
254616 -
254618 - ..
254619 - Liquid Diet Increase Pantoprazole to Heal Ulceration LESV
254620 - Pantoprazole Increased with Famotidine and Baking Soda or Tumms
254621 -
254622 - Follow up ref SDS K3 Q05K, ref SDS K0 Q05K.
254623 -
254624 - Doctor Lee prescribed continuing high dose Pantoprazole 40 mg twice a
254625 - day for next 2 days, until consultation meeting in 2 days scheduled on
254626 - 161215 - Thursday.
254628 - ..
254629 - Doctor Lee feels Naproxen should be avoided entirely for next 2 days
254630 - until meetng on Thursday. He feels new ulceration area may have been
254631 - caused by taking Napoxen the past 2 days, shown in case study on
254632 - 160101 0700. ref SDS G0 533N, and cut in half to facilitate swallowing
254633 - in LESV enlarged to 16.5 MM last week on 161206 1130. ref SDS K3 LP4I
254635 - ..
254636 - Work plan - will discuss on Thursday, 161215, with goal to reduce
254637 - Pantoprazole and Famotidine to 1 pill per day, and eventually dose
254638 - reduce to 20 mg, instead of 40 mg, and in order to resolve mounting
254639 - side effects of frequent urination that causes dehydration which
254640 - injures feet, thereby preventing hiking. Additionally, plan to
254641 - restore Naproxen in order to enable hiking needed to maintain elevated
254642 - HDL that regresses atherosclerosis,
254644 - ..
254645 - Yesterday, Doctor Dang in Orthopedics at VAMCSF, ordered treatment
254646 - with Synvisc for right knee. He found liquid Naproxen can be ordered
254647 - from VA formulary, but not by Orthopedics Department. He said to ask
254648 - GI Clinic and/or Primary Care.
254649 -
254650 -
254651 -
254653 - ..
254654 - Candidas Esophageal Infection Reduced by
254655 -
254656 - Follow up ref SDS K3 A23L, ref SDS K0 A23L.
254657 -
254658 - No discussion of candidas today.
254659 -
254661 - ..
254662 - Vocal Chords swollen
254663 -
254664 - Follow up ref SDS K3 FH6N.
254665 -
254666 - No discussion of vocal chords today.
254667 -
254668 -
254670 - ..
254671 - Next Meeting 1 Week to Recover Severe Symptoms
254672 -
254673 - Follow up ref SDS K3 4U5F, ref SDS K0 4U5F.
254674 -
254675 - Doctor Lee requested meeting at 1100 on Thursday, 161215, moved up
254676 - from 1200.
254678 - ..
254679 - Consultation is already scheduled in 2 days on 161215 1200, reported
254680 - last on 161122 1245. ref SDS J7 AZ6O, as modified On 161128 1119
254681 - called VA GI Clinic in Sacramento; LaPreia said meeting Doctor Lee
254682 - scheduled for 161214, has been changed to the next day on 161215 1200.
254683 - ref SDS J9 OZ9G
254684 -
254685 -
254687 - ..
2547 -
2548 -
2549 - 1211
2550 -
255001 - Left Eye Hurts Red Pupil Contracts to Pinpoint
255002 -
255003 - On leaving the GI Clinic after meeting with Doctor Lee, eyes seemed to
255004 - hurt in outdoor light. This was a mild side effect possibly from
255005 - conscious sedation, per above. ref SDS 0 714N
255007 - ..
255008 - Driving home, pain in left eye increased, so closed it and covered
255009 - left eye with hand. Right eye less pain than left.
255011 - ..
255012 - Back at the house, Kathy left to go grocery shopping.
255014 - ..
255015 - Tried to work. Pain in left eye got gradually worse.
255016 -
255017 - [On 161221 1104 received call from Anthony in Eye Clinic at
255018 - VA Clinic in Martinez; scheduled meeting with optimitrist
255019 - ordered by Doctor Marguiles, and on 170104 0900.
255020 - ref SDS L2 M65I
255021 -
255023 - ..
2551 -
2552 -
2553 - 1240
2554 -
255401 - Called GI Clinic.
255403 - ..
255404 - Laura answered. She remembered me from doing sedation during EGD
255405 - procedure with Doctor Lee this morning, per above. ref SDS 0 7V6I
255407 - ..
255408 - Explained left eye hurts when opened. Right eye is not as bad.
255410 - ..
255411 - Laura said this is a common problem with EGD procedures using
255412 - conscious sedation. She said to come into the GI Clinic immediately
255413 - for treatment.
255414 -
255415 - [On 161215 1100 Doctor Lee reviewed left eye injury issue,
255416 - during post-procedure meeting, and made referral to Doctor
255417 - Margalis in Eye Clinic at VA in Martinez. ref SDS L1 X15C
255419 - ..
255420 - [On 161221 1104 received call from Anthony in Eye Clinic at
255421 - VA Clinic in Martinez; scheduled meeting with optimitrist
255422 - ordered by Doctor Marguiles, and on 170104 0900.
255423 - ref SDS L2 M65I
255424 -
255426 - ..
2555 -
2556 -
2557 - 1242
2558 -
255801 - Called Kathy. She has completed shopping and is in line to get us a
255802 - sandwich for lunch. She will return home immediately.
255804 - ..
255805 - Kathy arrived home. She looked at the eyes. She said left eye pupil
255806 - is severely "pointed."
255808 - ..
255809 - We drove back to GI Clinic at VA Medical Center Mather Field.
255810 -
255811 -
255813 - ..
2559 -
2560 -
2561 - 1322
2562 -
256201 - Arrived in GI Clinic.
256203 - ..
256204 - The person at the front desk said to go directly into the GI work
256205 - area, so she evidently was alerted about this matter.
256207 - ..
256208 - She pressed the buttons on the door for access.
256210 - ..
256211 - Saw Gracy. She noticed me covering the left eye with my hand.
256213 - ..
256214 - She asked why I have returned?
256216 - ..
256217 - Explained difficulty with eyes, mostly the left; that I called the
256218 - office here about 15 minutes ago, and Laura said to come in for
256219 - treatment.
256221 - ..
256222 - Gracy said she could see the left eye was red and pupil is contracted
256223 - like a "pinpoint."
256224 -
256225 - [On 161214 0850 Gracy examines eye and finds significant
256226 - improvement - redness seems gone, and pupil no longer looks
256227 - like a "pinpoint." ref SDS K8 K37G
256229 - ..
256230 - [On 161221 1104 received call from Anthony in Eye Clinic at
256231 - VA Clinic in Martinez; scheduled meeting with optimitrist
256232 - ordered by Doctor Marguiles, and on 170104 0900.
256233 - ref SDS L2 M65I
256235 - ..
256236 - She said to sit in the consultation room, where we met with Doctor Lee
256237 - earlier today for reviewing results of the EGD procedure, per above.
256238 - ref SDS 0 5H5J
256240 - ..
256241 - Gracy left to look for Laure and/or Doctor Lee.
256242 -
256243 -
256245 - ..
2563 -
2564 -
2565 - 1324
2566 -
256601 - Gracy returned. She said both Laura and Doctor Lee are in procedures.
256602 - Doctor Lee's procedure will last 2 hours.
256604 - ..
256605 - Gacy left to look for medication to relieve pain in the left eye.
256606 -
256608 - ..
2567 -
2568 -
2569 - 1328
2570 -
257001 - Gracy returned. She has been unable to find any medication for eyes
257002 - in the GI Clinic. Nobody has any ideas.
257004 - ..
257005 - Said the severity of pain has dropped in the past 20 minutes.
257007 - ..
257008 - Gracy said the left eye looks better, less red and the pupil is
257009 - bigger now.
257011 - ..
257012 - Seems to hurt less when opened to the light.
257014 - ..
257015 - Gracy seemed to say patients have this condition in left eye from
257016 - laying on left side for EGD procedure.
257017 -
257018 - [On 161214 0850 returned to VA GI Clinic. Gracy examined
257019 - eyes again, and found left eye appears fully recovered from
257020 - redness and contracted pupil that occurred after EGD
257021 - yesterday. ref SDS K7 K37G She will update Progress Notes,
257022 - and notify team contacting patinets for follow up on EGD
257023 - procedures yesterday, that patient has improved swallowing,
257024 - and no other after effects from EGD dilation. ref SDS K7
257025 - HU6H
257027 - ..
257028 - [On 161215 1100 Doctor Lee reviewed left eye injury issue,
257029 - during post-procedure meeting, and made referral to Doctor
257030 - Margalis in Eye Clinic at VA in Martinez. ref SDS L1 X15C
257032 - ..
257033 - [On 161221 1104 received call from Anthony in Eye Clinic at
257034 - VA Clinic in Martinez; scheduled meeting with optimitrist
257035 - ordered by Doctor Marguiles, and on 170104 0900.
257036 - ref SDS L2 M65I
257037 -
257039 - ..
257040 - We reviewed the record of never having this problem for 26 prior
257041 - procedures beginning 7 years ago on 100305, listed above. ref SDS 0
257042 - LP4I
257044 - ..
257045 - Decided to leave, and get eye medication at Long's Drugs or
257046 - someplace. If the eye continues to be problematic, Doctor Lee can
257047 - examin for solution, when we meet on Thursday.
257049 - ..
257050 - Gracy said if it gets worse, go to ER for immediate care.
257051 -
257052 -
257053 -
257055 - ..
2571 -
2572 -
2573 - 1341
2574 -
257401 - Left VA. Went to Long's Drugs. Kathy bought Visine.
257402 -
257403 -
257405 - ..
2575 -
2576 -
2577 - 1410
2578 -
257801 - Arrived at St Charles Barroneo school, and picked up Kathy's
257802 - grandchildren, Simone and Mia.
257803 -
257805 - ..
2579 -
2580 -
2581 - 1538
2582 -
258201 - Arrived at Amy's house. Eye seems better. Kathy applied Visine.
258202 -
258203 - This stings in the left eye, but not the right.
258205 - ..
258206 - Kathy noticed the redness has dimenished, and the pupil has expanded.
258208 - ..
258209 - Definiely feeling better.
258211 - ..
258212 - Able to work, see computer screen without prior pain. Left eye seems
258213 - slightly more difficult to open, but otherwise seems recovered.
258214 -
258216 - ..
2583 -
2584 -
2585 - 1648
2586 -
258601 - Called VA and talked to Lapriea. She will tell Gracy to enter in
258602 - Progress Notes that Visine helped reduce pain, and restore pupil to
258603 - normal size.
258604 -
258606 - ..
2587 -
2588 -
2589 - 1708
2590 -
259001 - Left eye hurting again, so Kathy added more Visine to both eyes.
259002 -
259003 - This initialy stings left eye, but not right eye. In a few minutes
259004 - pain subsides.
259005 -
259007 - ..
2591 -
2592 -
2593 - 1739
2594 -
259401 - Kathy adding more Visine.
259402 -
259403 - Still hurts left eye for about 30 seconds, but not right eye.
259405 - ..
259406 - This was last application of Visine.
259407 -
259408 - [On 161214 0850 next morning, applying Visine to left eye
259409 - caused no pain, indicating full recovery. ref SDS L0 K37G
259410 -
259411 - [On 161215 1100 Doctor Lee reviewed left eye injury issue,
259412 - during post-procedure meeting, and made referral to Doctor
259413 - Margalis in Eye Clinic at VA in Martinez. ref SDS L1 X15C
259414 -
259415 -
259416 -
259417 -
259418 -
259419 -
2595 -
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 K3 CY7I, ref SDS K0 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 -