THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com


S U M M A R Y


DIARY: September 27, 2018 10:00 AM Thursday; Rod Welch

VA Radiology ultrasound on stomach ordered by Liver Clinic.

1...Summary/Objective
2...Medical Chart Progress Notes for Ultrasound Test 180927
3...Progress Notes for Ultrasound Test 180927 Stomach Organs Arteries

ACTION ITEMS.................. Click here to comment!

1...Significance calcifications in left kidney, and cysts on left??
2...How does this report differ from report above? ref SDS 0 5N3J

CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0403 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0403 -    ..
0404 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040501 - Follow up ref SDS 7 0000, ref SDS 5 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040506 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040508 -  ..
0406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0408 - Background                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040901 - Meeting Radiology for ultrasound scheduled on 180919 1305. ref SDS 7                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040902 - RG6H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040904 -  ..
040905 - This was ordered by Doctor Wen (Doctor Monto, Attending) on 180802                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040906 - 1300. ref SDS 5 XH5U                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040908 -  ..
040909 - We are evaluating liver function after 10 years of elevated bilirubin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040910 - shown in recent lab on 180802 0640. ref SDS 4 015M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040912 -  ..
040913 - Elevated bilirubin can indicate disruptive liver function, shown by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040914 - HDL lower than expected.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040916 -  ..
040917 - Recently discovered that intoxication caused by acetaminophen                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040918 - (Tylonal) also lowers HDL 30%, reported in the record with Lauren on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040919 - 180724 1645. ref SDS 3 EN4L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040920 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040921 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040922 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040924 -  ..
0410 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0411 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0412 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0413 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041301 - Tech came to the waiting area and called for me.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041302 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041303 - He introduced himself as Patrick.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041305 -  ..
041306 - Went into Radiology area, and into a room.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041308 -  ..
041309 - Laid on a gurney.  Lifted shirt for access to skin on stomach and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041310 - sides.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041312 -  ..
041313 - Patrick applied a water-based gel on the skin.  He then applied the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041314 - transducer to all areas of the stomach and sides.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041316 -  ..
041317 - Initially, laid on back.  After about 5 minutes turned onto left side.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041318 - Since I had eaten scrambled eggs, sausage, and hashbrowns for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041319 - breakfast, expected this would cause reflux, which usually occurs                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041320 - attempting to lay on left side even hours after a meal.  Fortunately,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041321 - this did not occur today, despite being on left side for about 15                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041322 - minutes or more.  This favorable result may reflect Doctor Lee                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041323 - dilating LESV 20 mm for the first time on 180904, in combination with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041324 - focus during breakfast this morning on washing down each bite with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041325 - carbonated softdrink.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041327 -  ..
041328 - Eventually, turned to the back again, and later laid on right side.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041330 -  ..
041331 - Ultrasound examination of abdomen today, evaluates internal organs...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041332 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041333 -            liver                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041334 -            gallbladder                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041335 -            intestines                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041336 -            kidneys                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041337 -            spleen                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041338 -            pancreas                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041340 -  ..
041341 - Patrick noted all blood flows appear patent.  Research on 091022,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041342 - found that "patent" blood flows can occur with up to 70% blood vessel                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041343 - blockage (stenosis) with plaque. ref SDS 2 RY6H   At this time, after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041344 - maintaining HDL > 60 and elevated EPCs, there should be zero blockage                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041345 - in all blood vessels.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041347 -  ..
041348 - Patrick said the cost for ultrasound training is about $50K at the top                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041349 - radiology training centers.  Others charge less.  Patrick seemed to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041350 - say ultrasound training is offered at some junior colleges.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041352 -  ..
041353 - After about 30 minutes, the door opened.  A woman's voice introduced                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041354 - herself as Caittlyn.  At this time I was laying on the left side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041355 - facing away from Patrick.  Caitlyn eventually said to turn to my                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041356 - back, and then realized she had replaced Patrick, who was sitting on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041357 - an adjacent stool and observing the work.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041359 -  ..
041360 - Caitlyn then advised that Patrick is a student.  She asked if I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041361 - minded him getting training doing the initial ultrasound imaging.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041363 -  ..
041364 - I said this was fine.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041366 -  ..
041367 - After Caitlyn took over, she seemed to do the entire examination                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041368 - again, i.e., rolled to back, then left side, then back again, and then                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041369 - right side.  She pressed hard on the ribs, causing slight discomfort.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041370 - Laying on left side, she rolled the trasnducer along the right side,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041371 - and I commented this tickled a little.  Caitlyn said most patients                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041372 - are sensitive to this area.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041374 -  ..
041375 - Asked Caitlyn if ultrasound shows any evidence of vascular blockages?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041376 - Caitlyn said the blood vessels all appear completely open.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041377 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041378 -            [...below on 180927 1000 SONOGRAM ABDOMEN reports blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041379 -            vessels patent. ref SDS 0 PI97                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041381 -  ..
041382 - Asked if Caitlyn knew Irene, explaining that she did initial                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041383 - ultrasound test to verify carotid arteries were clear enough for CABG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041384 - surgery, reported on 091021 0716. ref SDS 1 04CH                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041386 -  ..
041387 - Caitlyn said Irene taught her ultrasound skills, and she is currently                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041388 - Patrick's teacher.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041390 -  ..
041391 - Irene can be reached at...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041392 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041393 -                     ileech@gurnick.edu                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041395 -  ..
041396 - She said to tell Irene that Caitlyn says hello (with a heart).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041398 -  ..
041399 - After the ultrasound, showed Caitlyn and Patrick pictures from recent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041400 - hike to top of Half Dome in Yosemite on 180912 0545. ref SDS 6 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041402 -  ..
041403 - Caitlyn likes hiking.  She showed her computer splashscreen there in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041404 - the examination room, which is a picture of her on top of Mount                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041405 - Tamalpais, with the Bay Area displayed in the background.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041407 -  ..
041408 - She was concerned about not having enough arm strength for ascending                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041409 - the cables to reach the top of Half Dome.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041411 -  ..
041412 - Explained that nearly half the people who get to the top of Half Dome                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041413 - are women.  My guide, Lindsey, is about like Caitlyn, and she has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041414 - beaten me to the top twice.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041415 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041416 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041417 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041419 -  ..
0415 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0416 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0417 - 1537                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0418 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041801 - Sent letter to Irene saying...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041802 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041803 -    1.  Subject:  You Have So Many Fans!!                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041804 -        Date:  2018-09-27 16:13                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041811 -         ..
041812 -    2.  Had an ultrasound on my stomach today at VAMCSF.  Patrick                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041813 -        started, and then Caitlyn finished up.  Nothing wrong with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041814 -        stomach, just ordered because the VA has radiology studies on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041815 -        everything but the stomach, so not to worry.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041817 -         ..
041818 -    3.  Asked Patrick if he knew "Irene, who used to work here?"  He                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041819 -        said yes.  Later a woman came into the room and took over.  She                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041820 -        explained that Patrick is a student, and asked if I minded him                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041821 -        working on me?  I said, no of course not.  Asked if she also                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041822 -        knew you.  Caitlyn explained you were her ultrasound teacher,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041823 -        and are currently teaching Patrick.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041825 -         ..
041826 -    4.  Caitlyn was kind enough to provide your work contact address,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041827 -        so I could write and say how terrific you were as part of the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041828 -        prep for my heart surgery now 9 years ago on 091021 (see line                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041829 -        400502. ref SDS 1 04CH                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041831 -         ..
041832 -    5.  She said to say "Hello" and with a heart!!!                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041834 -         ..
041835 -    6.  Have been fortunate to have many terrific care givers at the VA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041836 -        (e.g., Karen in Cardiology, Arora, Lana, Bella, Caroline, Pat,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041837 -        Bennie, Joe, Danis, Gracie, on and on and on..).  Now Karen has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041838 -        retired, and you moved on.  Just glad this chance came to thank                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041839 -        you, as I have others.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041841 -         ..
041842 -    7.  Letting you know your former heart patient has been lucky post                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041843 -        surgery.  Thanks to the VA team I am hiking 11 - 15 miles per                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041844 -        day.  Over the past 5 years have hiked 16K miles.  In 2013, 4                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041845 -        years after CABG in 2009, hiked to top of Half Dome in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041846 -        Yosemite. Did it again in 2016.  Two weeks ago made it to the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041847 -        top again on Sep 12 (see pictures).  Half Dome in September has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041848 -        become an annual medical metric to test functionality.  So far,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041849 -        so good. We'll see how next year goes.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041851 -         ..
041852 -    8.  Hired a guide, Lindsey, for assurance in 2016, and again this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041853 -        year.  Lindsey is 26, and thinking about becoming a teacher                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041854 -        like her older sister.  She has a degree in Environmental                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041855 -        Studies from UC Santa Cruz.  Seems very dedicated.  While on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041856 -        top of Half Dome 2 weeks ago, I dropped a plastic bag.  It was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041857 -        very windy, so the bag blew away before I (at age 73) could                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041858 -        grab it.  Lindsey chased and grabbed it just before either it                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041859 -        or both of them went over the edge.  It is a 1 mile drop to the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041860 -        valley floor.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041862 -         ..
041863 -    9.  This winter after hiking gigs end, Lindsey plans to waitress at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041864 -        the Ahwahnee Hotel, teach skiing, and being part of a singing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041865 -        group until hiking season opens next year.  Would be nice if                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041866 -        she could consider a career move into healthcare.  Radiology,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041867 -        sonography, et al, seems like a good entry.  What is the cost                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041868 -        and level of effort required to become credentialed, working as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041869 -        a student, like Patrick at VAMCSF today?  Any thoughts are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041870 -        greatly appreciated.  Haven't talked to Lindsey about this.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041871 -        Last we spoke was after the 14 hour hike on Sep 12th at 8pm,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041872 -        when we met up with her boyfriend for pizza.  After the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041873 -        ultrasound today, Caitlyn showed pictures of her hiking Mount                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041874 -        Tamalpais.  It occurred becoming a radiology tech might be a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041875 -        direction for Lindsey to consider.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041877 -         ..
041878 -   10.  Anyway, hope you like the pictures.  I look a little different                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041879 -        from when you saw me on the gurney.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041880 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041887 -         ..
041888 -   13.  Attachments:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041889 -        20180912_070758.jpg	3.1 MB                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041890 -        20180912_102657.jpg	4.5 MB                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041891 -        20180912_122859.jpg	4.7 MB                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041892 -        20180912_140008.jpg	7.9 MB                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041893 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041894 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041895 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041896 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0419 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Ultrasound Stomach Sonogram Abdomen Liver Spleen Gallbladder Spleen                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0903 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090401 -  ..
090402 - Medical Chart Progress Notes for Ultrasound Test 180927                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
090403 - Progress Notes for Ultrasound Test 180927 Stomach Organs Arteries                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090404 - 
090405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090423 -         ..
090424 -    1.  Procedure/Test Name:          SONOGRAM ABDOMEN COMPLETE [DESCENDANT]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
090425 -        Date/Time Exam Performed:     27 Sep 2018 @ 0952                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090426 -        Ordering Location:            San Francisco CA VAMC                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
090427 -        Requesting Provider:          MONTO,ALEXANDER                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090428 -        Reasons for Study:            73y.o. M, elevated LFT's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090430 -         ..
090431 -    2.  Clinical History:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
090432 -        73y.o. M, no known chronic liver disease, r/o cirrhotic liver,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090433 -        r/o liver masses, r/o portal HTN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090434 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090436 -         ..
090437 -    3.  Performing Location:          San Francisco CA VAMC 4150 CLEMENT STREET, SAN FRANCISCO 94121                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090439 -         ..
090440 -    4.  Radiologist:                  SUN,DEREK C                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090441 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090442 -        --------------------------------------------------------------------------                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090444 -         ..
090445 -    5.  RADIOLOGY REPORT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090446 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090447 -        Report:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
090448 -        Exam: Limited Abdominal Ultrasound                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
090450 -         ..
090451 -    6.  History: 73-year-old with elevated LFTs                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
090453 -         ..
090454 -    7.  Technique: Grayscale and Doppler ultrasound images with spectral                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090455 -        analysis were obtained of the abdomen.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090457 -         ..
090458 -    8.  Comparison Studies: CT abdomen/pelvis 11/2/2009                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090460 -         ..
090461 -    9.  Findings:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090463 -         ..
090464 -        Pancreas: The visualized portion of the pancreas is unremarkable.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
090465 -        The pancreatic head and tail is obscured by overlying bowel gas.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090467 -         ..
090468 -   10.  Liver:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090470 -         ..
090471 -        Length: 12.1 cm.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090473 -         ..
090474 -        Liver parenchyma: Normal in echogenicity without focal masses.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090475 -        Liver contour is smooth.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090477 -         ..
090478 -   11.  Ducts:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090480 -         ..
090481 -        Common hepatic duct: 0.3 cm                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090483 -         ..
090484 -        CBD: 0 point. cm.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
090486 -         ..
090487 -        Portal vein: Patent, antegrade and normal in size.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
090489 -         ..
090490 -   12.  Hepatic veins: Patent, antegrade                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090492 -         ..
090493 -        Visualized Inferior Vena Cava: Patent, antegrade                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090495 -         ..
090496 -        Gallbladder: Contracted due to nonfasting state without                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
090497 -        gallstones, pericholecystic fluid, or sonographic Murphy's sign.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090499 -         ..
090500 -        Ascites: None                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090502 -         ..
090503 -   13.  Spleen: 9 cm in greatest craniocaudad dimension without focal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090504 -        lesions.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090506 -         ..
090507 -        No right or left hydronephrosis. 2 parenchymal calcifications in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090508 -        the left kidney measuring up to 0.6 cm. Bilateral renal cysts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090509 -        measuring up to 1.1 cm on the left.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
090511 -  ..
090512 - Significance calcifications in left kidney, and cysts on left??                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090513 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090515 -         ..
090516 -   14.  Impression:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090517 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090518 -        1. No acute findings. Unremarkable abdominal ultrasound.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090519 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090521 -         ..
090522 -        Primary Diagnostic Code:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090523 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090524 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090525 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090526 -        =========================================================================                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090527 -   15.  Procedure/Test Name:          SONOGRAM ARTERIAL/VENOUS FLOW                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090528 -        Date/Time Exam Performed:     27 Sep 2018 @ 0952                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090529 -        Ordering Location:            San Francisco CA VAMC                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
090530 -        Requesting Provider:          MONTO,ALEXANDER                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090531 -        Reasons for Study:            73y.o. M, elevated LFT's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090532 -        Clinical History:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
090533 -        73y.o. M, no known chronic liver disease, r/o cirrhotic liver,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090534 -        r/o liver masses, r/o portal HTN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090535 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090537 -         ..
090538 -        Performing Location:          San Francisco CA VAMC 4150 CLEMENT STREET, SAN FRANCISCO 94121                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090539 -        Radiologist:                  SUN,DEREK C                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090540 -        --------------------------------------------------------------------------                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090541 -        RADIOLOGY REPORT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090543 -  ..
090544 - How does this report differ from report above? ref SDS 0 5N3J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090546 -  ..
090547 - This says "arterial/venous flow", but there is no evident discussion                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090548 - of "flow."                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
090550 -  ..
090551 - 2nd Ultrasound report continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090552 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090553 -        Report:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
090554 -        Exam: Limited Abdominal Ultrasound                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
090556 -         ..
090557 -        History: 73-year-old with elevated LFTs                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
090559 -         ..
090560 -        Technique: Grayscale and Doppler ultrasound images with spectral                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090561 -        analysis were obtained of the abdomen.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090563 -         ..
090564 -        Comparison Studies: CT abdomen/pelvis 11/2/2009                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090566 -         ..
090567 -        Findings:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090569 -         ..
090570 -        Pancreas: The visualized portion of the pancreas is unremarkable.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
090571 -        The pancreatic head and tail is obscured by overlying bowel gas.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090573 -         ..
090574 -        Liver:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090576 -         ..
090577 -        Length: 12.1 cm.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090579 -         ..
090580 -        Liver parenchyma: Normal in echogenicity without focal masses.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090581 -        Liver contour is smooth.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090583 -         ..
090584 -        Ducts:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090586 -         ..
090587 -        Common hepatic duct: 0.3 cm                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090589 -         ..
090590 -        CBD: 0 point. cm.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
090592 -         ..
090593 -        Portal vein: Patent, antegrade and normal in size.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
090595 -         ..
090596 -        Hepatic veins: Patent, antegrade                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090598 -         ..
090599 -        Visualized Inferior Vena Cava: Patent, antegrade                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090601 -         ..
090602 -        Gallbladder: Contracted due to nonfasting state without                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
090603 -        gallstones, pericholecystic fluid, or sonographic Murphy's sign.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090605 -         ..
090606 -        Ascites: None                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090608 -         ..
090609 -        Spleen: 9 cm in greatest craniocaudad dimension without focal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090610 -        lesions.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090612 -         ..
090613 -        No right or left hydronephrosis. 2 parenchymal calcifications in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090614 -        the left kidney measuring up to 0.6 cm. Bilateral renal cysts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090615 -        measuring up to 1.1 cm on the left.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
090616 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090618 -         ..
090619 -        Impression:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090620 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090621 -        1. No acute findings. Unremarkable abdominal ultrasound.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090622 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090623 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090625 -         ..
090626 -        Primary Diagnostic Code:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090627 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090628 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090629 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090630 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090631 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090632 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090633 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090634 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090635 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090636 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090637 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090638 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090639 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090640 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090641 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090642 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090643 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090644 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090645 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090646 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090647 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090648 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090649 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090650 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090651 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090652 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090653 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090654 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090655 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090656 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090657 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090658 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090659 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090660 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090661 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090662 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090663 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090664 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090665 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090666 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090667 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090668 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090669 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090670 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090671 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090672 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090673 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090674 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090675 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090676 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090677 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090678 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090679 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090680 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090681 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090682 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090683 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090684 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090685 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090686 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090687 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090688 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090689 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090690 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090691 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090692 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090693 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090694 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090695 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090696 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090697 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090698 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090699 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090700 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090701 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090702 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090703 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090704 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090705 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090706 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090707 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090708 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090709 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090710 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090711 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090712 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090713 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090714 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0908 -