CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 52 0000. ref SDS 40 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Agenda...
040902 -
040903 - Earlier this morning, submitted letter to the doctor transmitting this
040904 - record, reported today on 181031 0323. ref SDS 66 QH5I
040905 -
040906 - 1. Hiking restored to normal past year due to 5-PRP injection
040907 - treatments in feet and knees, by Doctor Tucker in Nappa...
040908 -
040909 - 180824 1530, ref SDS 62 0001
040910 - 180620 1530, ref SDS 59 0001
040911 - 180105 1630. ref SDS 54 0001
040912 - 170816 1400, ref SDS 50 0001
040913 - 170726 1600, ref SDS 49 0001
040915 - ..
040916 - PRP injections were complemented by care for feet from Doctor
040917 - Tang in VAMCSF Podiatry, and for feet and knees in VAMCSF
040918 - Orthopedics by Doctor Thuillier, and further with Hoka Bondi 5
040919 - Wide shoes and inserts applying biomechanics by Mark Wachter at
040920 - On-the-Run. Strategic use of Naproxen pain medication
040921 - maintained hiking before PRP, and after effects of PRP began to
040922 - wear down again.
040924 - ..
040925 - During the meeting today, Doctor Simpson asked about PRP treatments?
040926 - He was familiar with the procedure, noting it has been used for many
040927 - years. The doctor was pleased this line of care has relieved pain in
040928 - feet and knees to enable hiking 3K miles, since prior examination last
040929 - year, which continued recovery from severe CAD symptoms, shown by
040930 - elevated HDL, lower blood pressure and heart rate, hiking Half Dome
040931 - on 180912.
040932 -
040934 - ..
040935 - Doctor Simpson cited using Hydrocodone in his Progress Notes
040936 - for meeting on 171011 1000. ref SDS 52 HQ8G
040938 - ..
040939 - Need replacement prescription, because Naproxen increases LDL
040940 - and blood pressure. It also reduces effects of PRP injection
040941 - treatments, so it has to be suspended for 6 weeks after PRP
040942 - treatments.
040944 - ..
040945 - This combination of care increased hiking from 1500 miles last
040946 - year, to over 3,000 miles this year, including Half Dome, see
040947 - spreadsheet...
040948 -
040949 - F:\05\00003\SM\CC\BNKG\120216cc\130101cc\hiking_miles_3.xlsx
040951 - ..
040952 - Increased hiking this year shows significant reversal of
040953 - decline in 2017, due to injuries, discussed with Doctor Simpson
040954 - during a meeting at VAMCSF on 170412 1000. ref SDS 40 QV8I
040956 - ..
040957 - Weight declined from 190 to 169, corrects "abd" fat" reported
040958 - in Progress Notes for examination on 171011 1000. ref SDS 52
040959 - U36F
040961 - ..
040962 - Blood pressure and heart rate declined.
040964 - ..
040965 - HDL increased to 69, shown in blood test at Quest labs on
040966 - 181029 1438. ref SDS 65 U45J
040968 - ..
040969 - Sarcopenia seems not yet affecting medical profile - doing 3
040970 - sets 20 - 30 pushups per day.
040972 - ..
040973 - Vision seems improved reading small text in documents, books,
040974 - magazines, etc., after having declined significantly over 20
040975 - years ago at about age 50, reported previousy to Primary Care
040976 - on 180724 1645, ref SDS 60 1I78, and following notice in a
040977 - letter on 180515 2228. ref SDS 56 7863
040979 - ..
040980 - On 180611 1052 letter to Doctor Tang with copy to Doctor
040981 - Thuillier and to Doctor Tucker reports improved vision from
040982 - increased hiking which increases HDL that regresses plaque in
040983 - blood vessels, and hiking also grows increased blood vessels
040984 - and dilates the vessels to bring increased nutrients and oxygen
040985 - to cells. ref SDS 58 VL5L
040987 - ..
040988 - There was discussion that hiking at a high level, here 3K+ miles this
040989 - year, per above, ref SDS 0 PH5H, raises HDL and EPCs with consequent
040990 - regression of atherosclerotic plaque. Maintaining full blood flow in
040991 - arteries, veins and capillaries may extend longevity and also improve
040992 - loss of biological function by allowing adequate oxygen and nutrients
040993 - to reach cells, thus extending vascular cell senescence.
040995 - ..
040996 - [...below on 181031 1000 during examination today, Doctor
040997 - Simpson reported recognizing heart function that normally
040998 - only occurs in young people, and declines with age.
040999 - ref SDS 0 JS83
041001 - ..
041002 - [On 181102 0936 received article from Doctor Simpson,
041003 - reporting study that found "Extremely high aerobic fitness
041004 - was associated with the greatest survival and was
041005 - associated with benefit in older patients and those with
041006 - hypertension." ref SDS 67 6E4G
041008 - ..
041009 - Telomeres are a related factor.
041011 - ..
041012 - Doctor Simpson seemed to say this causal scenario has not been
041013 - established. He seemed further to indicate that extending long-term
041014 - mortality may occur from raising general fitness with extended
041015 - endurance exercise, as in this case hiking 3K+ miles this year.
041016 -
041017 - [On 181102 0936 received article from Doctor Simpson,
041018 - reporting on a study that found "Extremely high aerobic
041019 - fitness was associated with the greatest survival and was
041020 - associated with benefit in older patients and those with
041021 - hypertension." ref SDS 67 6E4G
041023 - ..
041024 - Vascular cell scenescence is discussed in an article...
041025 -
041026 - PMC
041027 - frontiers in Cardiovascular Medicine
041029 - ..
041030 - Vascular Senescence in Cardiovascular and Metabolic Diseases
041031 -
041032 - Goro Katsuumi,1, Ippei Shimizu,1,2, Yohko Yoshida,1,2
041033 - and Tohru Minamino1,*
041034 -
041035 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845435/
041037 - ..
041038 - Front Cardiovasc Med. 2018; 5: 18
041039 - Published online 2018 Mar 5. doi: [10.3389/fcvm.2018.00018]
041041 - ..
041042 - PMCID: PMC5845435
041043 - PMID: 29556500
041045 - ..
041046 - This article does not make our point, but is interesting. It
041047 - discusses telomeres as getting shorter with age, as cells divide, and
041048 - eventually are too short for cells to continue replicating, thus cells
041049 - only die - therefore aging.
041050 -
041052 - ..
041053 - 2. Saphenous vein - Doctor Simpson's Progress Notes signed on
041054 - 151028, say in part...
041055 -
041056 - -Cor CTA shows open grafts, but is not sufficient
041057 - resolution to serve as an endpoint for worse or better
041058 - athero; in fact, the study could be read as showing some
041059 - early changes in the SVGs. This is about what I had
041060 - predicted. ref SDS 20 5Y6L
041062 - ..
041063 - Saphenous vein taken by Paula from right leg during CABG on
041064 - 091022 (see Progress Notes in record on 100928, ref SDS 3
041065 - 3J7N), some authorities indicate these veins "wear out" sooner,
041066 - reported on 091022 0700. ref SDS 1 156H
041068 - ..
041069 - During the meeting today, Doctor Simpson seemed to say saphenous vein
041070 - grafts should be sustained by increased blood flow fron extended
041071 - endurance exercise, here hiking, and so should not be at risk to "wear
041072 - out".
041073 -
041075 - ..
041076 - 3. Mortality 60% - 80% following 8 - 10 years after CABG,
041077 - discussed in an article...
041078 -
041079 - Science Daily
041081 - ..
041082 - Many good years after heart bypass surgery, but something
041083 - happens after ten years
041084 - ---------------------------------------------------------
041085 - Source: Aarhus University
041086 - Date: June 7, 2017
041087 -
041088 - https://www.sciencedaily.com/releases/2017/06/170607123935.htm
041090 - ..
041091 - Summary:
041092 - The prognosis following heart bypass surgery is both good
041093 - and has improved over the past three decades. In fact, the
041094 - survival rate for bypass patients who make it through the
041095 - first month after the operation is close to that of the
041096 - population in general.
041098 - ..
041099 - But 8-10 years after a heart bypass operation, mortality
041100 - increases by 60-80 per cent. This is new and important
041101 - knowledge for the doctors who monitor these patients.
041103 - ..
041104 - Did not have time to discuss this article today.
041105 -
041106 -
041108 - ..
041109 - 4. Doctor Simpson referral for patient to meet with Doctor Elaine
041110 - Tseng, attending for CABG procedure on 091022 0700. ref SDS 1
041111 - PQWU
041113 - ..
041114 - The doctor demurred on making referral to Elaine.
041116 - ..
041117 - If the doctor encounters Elaine in the halls or at a meeting, and
041118 - thinks of it, he might ask informally, if she would meet with a former
041119 - customer, who has done well as a result of her work.
041120 -
041122 - ..
041123 - 5. Telomeres
041124 -
041125 - Does VA support this line of testing?
041127 - ..
041128 - Evaluate effects hiking 300 miles per month, per research on
041129 - 180111 1143. ref SDS 55 EF5K
041131 - ..
041132 - Doctor Simpson seemed unfamiliar with telomeres, and so there was no
041133 - consideration of testing at the VA lab.
041134 -
041135 - [...on 181115 1037 blood draw for Telomere test.
041136 - ref SDS 72 3Y5V Results reported telomere comparable for
041137 - 77 year old. ref SDS 72 AY46
041138 -
041140 - ..
041141 - 6. HDL - some research reports quantity and quality of HDL
041142 - decline with age.
041144 - ..
041145 - Can tests be performed to evaluate effect of hiking 300 miles
041146 - per month on quality of HDL maintained above 60?
041148 - ..
041149 - Blood test at Quest labs on 181029, showing HDL 69.
041150 - ref SDS 65 U43O
041152 - ..
041153 - Doctor Simpson received the Quest lab results, shown in the record on
041154 - 181029 1438. ref SDS 65 U45J
041156 - ..
041157 - He seemed to say there is no evident medical basis for HDL to decline
041158 - in quality nor quantity for older patients, here age 73.
041159 -
041160 - [On 181029 1438 Quest lab advanced lipid panel report HDL
041161 - 73. 181029 1438, ref SDS 65 U45J
041162 -
041163 - [On 181112 1720 Labcorp reported NMR Lipid test found HDL
041164 - 83. ref SDS 71 U45J
041165 -
041167 - ..
041168 - 7. EPCs - can blood test be ordered for elevated EPCs similar to
041169 - HDL, necessary for maintaining reverse cholesterol transport
041170 - (RCT)?
041172 - ..
041173 - Did not discuss ordering lab for EPCs.
041174 -
041176 - ..
041177 - 8. CCTA - order to evaluate "early changes" to SVGs, and
041178 - maintaining full blood flow, reported 3 years ago in prior CCTA
041179 - addendum on 151019 0930. ref SDS 19 SU62
041181 - ..
041182 - Progress Notes addendum for meeting on 170412...
041184 - ..
041185 - I re-reviewed his coronary CTA w Radiology.
041187 - ..
041188 - They confirmed that his bypass grafts are open, w/o significant
041189 - stenoses. They confirmed that the technique cannot rule out
041190 - atherosclerosis, but can detect significant stenoses of = or >
041191 - 50% vessel diameter. ref SDS 40 8H5G
041192 -
041193 - /es/ Paul C. Simpson MD
041194 - Attending MD Cardiology, NPI 1548374093
041195 - Signed: 04/14/2017 16:17
041197 - ..
041198 - Doctor Simpson will order CCTA. Compare current condition can be
041199 - better, stable, or worse than prior test on 151019 0930. ref SDS 19
041200 - SU62
041201 -
041202 - [On 181107 1307 received call from Radiology scheduled CCTA
041203 - on 181108 0930. ref SDS 69 6K6F
041205 - ..
041206 - [On 181108 0930 meeting Radiology perform CCTA evaluate
041207 - response to treatment hiking 6K miles since prior CCTA 3
041208 - years ago. ref SDS 70 NV5I
041210 - ..
041211 - [On 181108 0930 radiologist report does not compare current
041212 - findings with amended findings from prior CCTA on 151019.
041213 - ref SDS 70 CH3K
041215 - ..
041216 - Correlate ultrasound test of stomach organs and related
041217 - arteries (e.g., aorta), performed on 180927 1000. ref SDS 64
041218 - RD50
041219 -
041220 -
041222 - ..
041223 - 9. Examination
041225 - ..
041226 - The doctor used a stethoscope to examine heart and breathing.
041228 - ..
041229 - He said heart and breathing are normal to excellent, expected for
041230 - hiking 300 miles per month.
041232 - ..
041233 - Doctor Simpson said he detected a "2nd sound" condition in the heart
041234 - function that typically is found in young people. This seems to be a
041235 - positive finding for patient age 73.
041237 - ..
041238 - Finding today, that patient has restored heart function condition
041239 - normal for young people, and which declines with age, seems similar to
041240 - report to Primary Care that vision has improved after declining with
041241 - age 20+ years ago, cited above, ref SDS 0 BE4F, and referencing letter
041242 - to Primary Care on 180515 2228. ref SDS 56 7863
041243 -
041245 - ..
041246 - [...below on 181031 1000 Progress Notes report "hrt 1/6 sm
041247 - max base, nl split s2". ref SDS 0 Y45J
041249 - ..
041250 - [On 181205 1429 during follow up call Doctor Simpson
041251 - explained the heart condition he detected on 181031 was
041252 - "splitting of 2nd sound", ref SDS 74 865N Research found
041253 - "In younger people, maximal splitting during inspiration is
041254 - 40 to 50 msec and decreases with age. In people 40 years
041255 - and older, a single S2 during inspiration and expiration
041256 - may be normal." ref SDS 73 ZL4G
041258 - ..
041259 - The doctor further noticed a great many red scratch-like marks on the
041260 - back. These are likely from taking hot showers after hikes to relieve
041261 - pressures in neck, back and leg muscles.
041262 -
041263 - [...below on 181031 1000 Doctor Simpson's Progress Notes
041264 - make no mention of seeing scratches on back. ref SDS 0 U16G
041266 - ..
041267 - [On 190201 0800 examination of back for minor surgery to
041268 - remove small lipoma lump; doctors report observing no
041269 - scratches anywhere on the back. ref SDS 78 1A6G
041271 - ..
041272 - [On 190226 1530 Doctor Stewart examined back, and made
041273 - referral to Dermatology for examination of scratches on
041274 - back. ref SDS 79 N25H
041276 - ..
041277 - [On 190227 1025 redeived call from Aladin in Medical
041278 - Practice; he called for Lauren, Primary Care Provider.
041279 - Aladin scheduled meeting with Roving Dermatology doctor in
041280 - Medical Practice on 190301 0930. ref SDS 80 VN9S
041282 - ..
041283 - Dermatology doctor can examin. After the meeting found the record
041284 - shows last meetig with VA Dermatology at the Martinez Clinic was on
041285 - 160524 0800. ref SDS 26 NP5G
041287 - ..
041288 - Will ask Doctor Simpson to make referral to Dermatology at VA in San
041289 - Francisco.
041291 - ..
041292 - Doctor Simpson commented that daily blood pressures in the spreadsheet
041293 - received today, are all at or below healthy levels. This conflicts
041294 - with blood pressure taken today prior to meeting with him in
041295 - Cardiology - see Progress Notes below. ref SDS 0 MS6M
041296 -
041297 - [...below on 181031 1000 Doctor Simpson's Progress Notes
041298 - comment on elevated blood pressure. ref SDS 0 LQ3J
041300 - ..
041301 - There was discussion that blood pressures are taken twice 5 minutes
041302 - apart every morning, and again after hiking. The spreadsheet lists
041303 - only the lowest blood pressure for the day. Blood pressure falls
041304 - considerably after hiking for 3 - 6 hours due to dilation of blood
041305 - vessels and capillaries during the hike, and the 30 minutes or so
041306 - required for them to recede back to normal, explained on 110724 1547.
041307 - ref SDS 6 PL4H
041309 - ..
041310 - Blood pressures listed on days when no hiking occurs, like yesterday,
041311 - when patient visited VA GI Clinic in Sacramento for EGD dilation
041312 - procecure, and again today, visiting Doctor Simpson in Cardiology at
041313 - VA Medical Center in San Francisco, and taken early in the morning,
041314 - when no hiking occurred.
041316 - ..
041317 - There has been concern that Mylanta and possibly Calcium Carbonate
041318 - (Tums) both taken in the evening before bed, can significantly elevate
041319 - blood pressure the next morning. This was discussed with Doctor Lee
041320 - during meeting in GI Clinic at VA Medical Center in Sacramento. On
041321 - 180410, there was agreement to reduce taking Mylanta in order to
041322 - stabalize blood pressure at healthy level.
041324 - ..
041325 - Doctor Simpson asked to see the record of daily blood pressures taken
041326 - in the morning before hiking in the afternoon.
041328 - ..
041329 - Used notebook computer c23 to display case study diet, exercise,
041330 - vitals and medications shown on 180101 0820. ref SDS 53 QJ5I In this
041331 - record, scrolled to the report for today, Wednesday on 181031.
041332 - ref SDS 53 PWWX
041334 - ..
041335 - The doctor noticed the report shows initial entry at 0300, when the
041336 - patient began work to prepare for driving at an early time from
041337 - Concord to the VA hospital in San Francisco, and avoid heavy traffic.
041338 - Initial blood pressure was taken at 0310, and then again at 0315.
041340 - ..
041341 - Doctor Simpson asked what "0000" signifies in the time column.
041342 - Explained this shows nothing was done for the item listed on that
041343 - line for that day.
041345 - ..
041346 - The doctor described prescription taking Atorvastatin and Ezetimibe 10
041347 - mg every other day as "scant" compared to his normal prescription of
041348 - 80 mg per day.
041350 - ..
041351 - Doctor Simpson asked why "Baking Soda" is listed?
041353 - ..
041354 - Explained Doctor Lee in GI Clinic at VA Medical Center in Sacramento
041355 - prescribed Baking Soda to quickly relieve extreme pain from reflux.
041356 - This occurs very rarely, seen by entries for most days in the record
041357 - showing "0000 Baking Soda"
041359 - ..
041360 - The doctor asked if this case study includes daily hiking?
041362 - ..
041363 - Scrolled the file up, so he could see the record for 181029, reporting
041364 - the hike that day of 22 miles. ref SDS 53 E55K Narrative on the hike
041365 - says in part at line 121415...
041366 -
041367 - ...turned corner and hiked 4-mile loop on Crystal Ranch Road.
041368 - Good pace going 1 mile uphill breathing through nose entire way
041369 - up. At summit maintained pace... Turned onto Rolling Woods
041370 - Way. Going up steep hill felt strong - increased pace for .3
041371 - miles and breathing through nose entire way. ref SDS 53 PVSR
041373 - ..
041374 - The doctor indicated this report breathing through nose hiking uphill
041375 - for a mile reflects good conditioning at any age. He feels CCTA test
041376 - should be very favorable.
041377 -
041378 - [...below on 181031 1000 doctor's Progress Notes say "...he
041379 - is super-fit, can do a 1-mile incline w/o dyspnea."
041380 - ref SDS 0 BM86
041382 - ..
041383 - Doctor Simpson commented favorably on extensive detail in SDS records
041384 - for tracking health, exercise, medicine, diet and everything.
041386 - ..
041387 - Explained SDS developed 30 years ago to manage daily activity.
041388 - Integrates time, information and context to track cause and effect.
041389 - Scheduled tasks are linked to history for precision access.
041391 - ..
041392 - Doctor Simpson said we will discuss plans on follow up care in
041393 - Cardiology, when he calls to discuss results of CCTA.
041394 -
041395 - [...below on 181031 1000 doctor's Progress Notes plan to
041396 - discuss follow up care in call to review results of CCTA.
041397 - ref SDS 0 BM5M
041399 - ..
041400 - [On 181205 1429 Doctor Simpson called and scheduled next
041401 - examination 1 year after today, on 191030. ref SDS 73 ZW4J
041402 -
041403 -
041404 -
041405 -
041406 -
041407 -
041408 -
041410 - ..
0415 -
0416 -
0417 - 1116
0418 -
041801 - After meeting with Doctor Simpson went to Radiology Department on 2nd
041802 - Floor building 200.
041804 - ..
041805 - Talked to Carolyne. She said her colleague, Lourdes schedules CCTA
041806 - tests.
041808 - ..
041809 - Lourdes was in. She took name and phone number. When Doctor Simpson
041810 - enters order for CCTA, she will call to schedule the test.
041811 -
041812 - [On 181107 1307 Lourdes called and scheduled CCTA on 181108
041813 - 0930. ref SDS 69 6K6F
041814 -
041815 -
041816 -
0419 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Medical Chart Progress Notes for Cardiology Meeting 181031
050403 - Progress Notes Cardiology Meeting 181031 Doctor Simpson
050404 - Doctor Simpson Progress Notes Cardiology Meeting 181031
050405 -
050406 - Follow up ref SDS 52 ME9M, ref SDS 40 XG5I.
050407 -
050408 - VA Progress Notes for meeting with health care providers are
050409 - available at...
050410 -
050411 - https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel=mhvHome
050412 -
050425 - ..
050426 - 1. Date/Time: 31 Oct 2018 @ 1611
050427 - Note Title: CARDIOLOGY CLINIC ATTENDING NOTE (MED)
050428 - Location: San Francisco CA VAMC
050429 - Signed By: SIMPSON,PAUL C
050430 - Co-signed By: SIMPSON,PAUL C
050431 - Date/Time Signed: 31 Oct 2018 @ 1651
050432 - -------------------------------------------------------------------------
050434 - ..
050435 - 2. LOCAL TITLE: CARDIOLOGY CLINIC ATTENDING NOTE (MED)
050436 - STANDARD TITLE: CARDIOLOGY ATTENDING NOTE
050437 - DATE OF NOTE: OCT 31, 2018@16:11 ENTRY DATE: OCT 31, 2018@16:11:09
050438 - AUTHOR: SIMPSON,PAUL C EXP COSIGNER:
050439 - URGENCY: STATUS: COMPLETED
050440 -
050445 - ..
050446 - 3. Most Recent VITAL SIGNS:
050447 - Height: 64 in [162.6 cm] (09/25/2018 07:26)
050448 - Weight: 179.2 lb [81.5 kg] (10/31/2018 09:28)
050449 - BMI: 30.8 (Obesity Level I)
050450 - Temp: 98.1 F [36.7 C] (09/25/2018 07:26)
050451 - Pulse: 63 (10/31/2018 09:28)
050452 - Comments:
050454 - ..
050455 - Resp: 18 (09/25/2018 07:26)
050456 - BP: 162/67 (10/31/2018 09:28)
050457 - O2 Sat: 10/31/18 09:28:43 O98
050459 - ..
050460 - 4. ID/CC:
050461 -
050462 - 73 swm from concord returns to routine f/u CAD sp CABG (2009)
050463 - and to monitor CRFs, esp lipids, since he does not want to take
050464 - high intensity statin, and to discuss a repeat coronary CTA.
050466 - ..
050467 - Last clinic 10-11-17.
050469 - ..
050470 - PHONE (925)849-4745
050471 -
050473 - ..
050474 - 5. ASSESS:
050475 -
050476 - -he continues to do extremely well clinically, w/o chest pain,
050477 - dyspnea, or syncope. Indeed he is super-fit, can do a 1-mile
050478 - incline w/o dyspnea.
050480 - ..
050481 - Doctor Simpson comment on SDS record he reviewed during the meeting
050482 - from case study on 180101 showing hiking on 181029. per above.
050483 - ref SDS 0 J27N
050485 - ..
050486 - Progress Notes 181031 Doctor Simpson continue...
050487 -
050488 - -platelet-rich plasma injections in his knees and feet
050489 - (provider in Napa at his own expense) have been very helpful,
050490 - and his walking mileage this year so far (through October) is
050491 - ~2800 miles at ~16 min/mile! (keeps a detailed spread sheet)
050492 -
050493 - [On 181210 0642 cited in letter to Doctor Thuillier in
050494 - Orthopedics Department considering continuing PRP
050495 - treatments. ref SDS 76 QP51
050497 - ..
050498 - -HDLs are high 60s and better than last year mid-50s, when he
050499 - was bothered by joints, and thus there is a positive
050500 - correlation between exercise dose and HDL.
050501 -
050502 - [On 200125 0538 letter to Doctor Simpson, ref SDS 82 9C9M,
050503 - reporting good results from IVUS examination in the cath
050504 - lab finding all grafts stenosis 0 now 10 years after
050505 - CABG-x4 and attributed to elevating HDL with hiking,
050506 - reported the day before on 200124 0705. ref SDS 81 ME8G
050507 -
050509 - ..
050510 - -BPs are high in clinic (see above and cover), but he assures
050511 - me that BPs are wnl at home. I emphasized he needs to check BP
050512 - 1st thing in AM, and not simply after his walks.
050514 - ..
050515 - Aligns with understandings during the meeting, per above. ref SDS 0
050516 - P64I
050518 - ..
050519 - Actually, blood pressure and heart rate are checked in morning after
050520 - getting up, and again after hikes.
050521 -
050522 - [On 190101 0730 daily blood pressure and heart rate
050523 - reported in case study on exercise, diet, medication and
050524 - vitals. ref SDS 77 TTRY
050525 -
050527 - ..
050528 - Progress Notes 181031 Doctor Simpson continue...
050529 -
050530 - 6. PLAN:
050531 -
050532 - -I am ordering a coronary CTA to compare with 10-19-15.
050533 -
050534 - [On 181108 0930 meeting Radiology perform CCTA evaluate
050535 - response to treatment hiking 7K miles that raised HDL 83,
050536 - since prior CCTA 3 years ago. ref SDS 70 NV5I
050538 - ..
050539 - -we will discuss plans after that (I will call), meanwhile same
050540 - rx.
050542 - ..
050543 - This aligns with understandings during the meeting, per above.
050544 - ref SDS 0 4W5M
050545 -
050546 - [On 181205 1429 Doctor Simpson called and scheduled next
050547 - examination 1 year after today, on 191030. ref SDS 73 ZW4J
050549 - ..
050550 - Progress Notes 181031 Doctor Simpson continue...
050551 -
050552 - -monitor AM BPs.
050553 -
050554 - -RV prn.
050555 -
050557 - ..
050558 - 7. CARD PROBLEMS:
050559 -
050560 - 1. CAD sp CABG here 10-22-09 (LIMA, SVG diag, ramus, PDA)
050561 - -for angina and severe 3VD
050562 - -last seen CT Surg 11-19-09
050563 - -last TTE here 7-15-16 wnl
050564 - -carotid US 9-20-16 sml plaque R bulb, no stenoses
050565 - -cor CTA 10-19-15 all grafts open; reading "Coronary calcium score is
050566 - calculated to be 1360.
050567 -
050568 - No significant calcified plaque is seen in the bypass
050569 - grafts. All the bypass grafts are opacified with
050570 - contrast without evidence for filling defect or wall
050571 - calcifications.
050573 - ..
050574 - No calcification is seen in the aortic wall in the
050575 - visualized portions of the thoracic aorta. No ostial
050576 - calcifications at the origins of great vessels from
050577 - the aortic arch."
050579 - ..
050580 - 04/14/2017 ADDENDUM I re-reviewed his coronary CTA w
050581 - Radiology. They confirmed that his bypass grafts are
050582 - open, w/o significant stenoses. They confirmed that the
050583 - technique cannot rule out atherosclerosis, but can detect
050584 - significant stenoses of = or > 50% vessel diameter.
050585 -
050586 - 2. hyperlipidemia; LDL varies greatly w extent of statin rx
050587 -
050588 - 3. overwt/obesity (BMI ~30). but very fit.
050589 -
050590 - 4. statin SEs: freq urination, dry feet, pain left arm; ok
050591 - on low dose
050593 - ..
050594 - 5. HTN, intermittent
050595 -
050596 - 6. no ASA rx due to achalasia
050597 -
050598 - 7. systolic m (likely flow, nl TTE 2016)
050599 -
050600 - 8. hyperbili, unconjugated, likely Gilberts, per GI/Liver
050601 - 8-2-18, neg abd US 9-
050602 - 27-18.
050603 -
050605 - ..
050606 - 8. OTHER:
050607 -
050608 - 1. achalasia sp ops, frequent egd/dilation
050609 - 2. LLE hematoma w cellulitis sp fall (adm here 9-23 to 9-25-15)
050610 - 3. fx R radius (same fall)
050611 - 4. may16 balance issues possiblky ear, resolved
050612 - 5. stroke-like event at EGD jun16; no recur, brain MRIs wnl,
050613 - possibly periop med-related
050614 - 6. R foot plantart plate tear
050615 - 7. MVA sep17
050617 - ..
050618 - The record should further list injuries from automobile crash driving
050619 - off a cliff at 65 MPH on highway 580, which occurred on 170905 2230.
050620 - ref SDS 51 0001
050621 -
050622 - LLE hematoma lower left leg
050623 - BPPV - dizziness
050624 - Facial abrasions
050626 - ..
050627 - Progress Notes 181031 Doctor Simpson continue...
050628 -
050629 - 9. SH:
050630 -
050631 - lives concord
050632 - single has gf
050633 - wife of many years died of breast ca a few yrs ago
050635 - ..
050636 - Gets up 3-6 am often to walk, on asphalt, bed early am, so not
050637 - much sleep.
050639 - ..
050640 - one meal a day in evening, but healthy (fish, avocados, vegs).
050641 -
050642 - militaray VN clerk
050643 - cigs 0
050644 - drugs
050645 - alcohol
050646 -
050648 - ..
050649 - 10. HPI
050650 -
050651 - super fit
050652 - ~2800 miles so far through Oct at 16 min/mile
050653 - no cv sxs.
050654 - knees and feet much better after PRP injections
050655 - using Hoka Bondi 5 shoes
050656 -
050657 - [On 181210 0642 cited in letter to Doctor Thuillier in
050658 - Orthopedics Department considering continuing PRP
050659 - treatments. ref SDS 76 QP51
050660 -
050662 - ..
050663 - 11. Active Medications:
050664 -
050665 - 1. AMMONIUM LACTATE 12% LOTION APPLY LOTION TOPICALLY
050666 - EVERY DAY AS DIRECTED TO FEET AFTER BATHING FOR DRY
050667 - SKIN
050668 - 2. ATORVASTATIN CALCIUM 20MG TAB TAKE ONE-HALF TABLET
050669 - ORALLY EVERY OTHER DAY FOR CHOLESTEROL **NOTE
050670 - DIRECTIONS**
050671 - 3. NAPROXEN 250MG TAB TAKE ONE TABLET ORALLY EVERY DAY
050672 - AS NEEDED FOR PAIN
050673 - 4. EZETIMIDE 10 QOD (EXPIRED) (WILL RENEW)
050674 - 5. PANTOPRAZOLE 40 HS (REMOTE)
050675 - 6. FAMOTIDINE 40 BID (REMOTE)
050676 -
050678 - ..
050679 - 12. Computerized Problem List is the source for the following:
050680 -
050681 - 1. Metatarsalgia 05/25/2016
050682 - 2. Fall on same level, Onset 00/00/2015 05/25/2016
050683 - 3. History of coronary artery bypass grafting, 10/14/2015
050684 - Onset 10/00/2009
050685 - SFVA LIMA, SVGs diag, ramus, PDA
050686 - 4. Hyperlipidemia 10/14/2015
050687 - 5. Body mass index 30+ - obesity 10/14/2015
050688 - 6. Chronic ischemic heart disease 10/14/2015
050689 - 7. Esophageal stricture (SNOMED CT 63305008) 05/04/2016
050690 -
050692 - ..
050693 - 13. EXAM
050694 -
050695 - asx, good mood, looks very fit, in shorts as usual
050696 - vs above OK x bp/wt as usual
050697 - jvp nl, ajr neg
050698 - car palp no B
050699 - chest clear
050700 - hrt 1/6 sm max base, nl split s2
050701 - abd sl fat, no B, no tender
050702 - ext tanned legs, warm, no edema
050704 - ..
050705 - This section of Progress Notes saying...
050706 -
050707 - "hrt 1/6 sm max base, nl split s2"
050709 - ..
050710 - Seems to align with understandings during meeting that the doctor
050711 - detected a heart diagnostic called "second sound" normal for young
050712 - people, per above. ref SDS 0 JS83
050713 -
050714 - [On 181205 1429 during follow up call Doctor Simpson
050715 - explained the heart condition he detected on 181031 was
050716 - "splitting of 2nd sound", ref SDS 74 865N Research found
050717 - "In younger people, maximal splitting during inspiration is
050718 - 40 to 50 msec and decreases with age. In people 40 years
050719 - and older, a single S2 during inspiration and expiration
050720 - may be normal." ref SDS 73 ZL4G
050722 - ..
050723 - [On 200613 0519 examination for discharge from hospital
050724 - treating ischemic colitis, reported "2nd sound" condition
050725 - of heart function. ref SDS 83 L83J
050727 - ..
050728 - Progress Notes 181031 Doctor Simpson continue...
050729 -
050730 - 14. ECG sinus at 55 w APCs, o/w wnl
050731 -
050733 - ..
050734 - 15. LABS (since last visit):
050735 -
050736 - CBC on 180913 1350. ref SDS 63 FK6I
050737 - Electrolytes on 180913 1350. ref SDS 63 WJ5H
050738 - Lipids on 180913 1350. ref SDS 63 5C7M
050739 -
050741 - ..
050742 - CBC on 180802 0640. ref SDS 61 PS6G
050743 - Electrolytes on 180802 0640. ref SDS 61 WJ5H
050744 - Lipids on 180802 0640. ref SDS 61 BE6O
050746 - ..
050747 - Several more labs are entered...
050748 -
050749 -
050750 - /es/ Paul C. Simpson MD
050751 - Attending MD Cardiology, NPI 1548374093
050752 - Signed: 10/31/2018 16:51
050753 -
050754 -
050755 -
050756 -
050757 -
050758 -
050759 -
050760 -
050761 -
050762 -
050763 -
050764 -
050765 -
050766 -
0508 -