CONTACTS
SUBJECTS
Versed > 5 MG Anesthesia Patient Sensitivity Low Dose Cumulative Eff
0703 -
0703 - ..
0704 - Summary/Objective
0705 -
070501 - Follow up ref SDS 24 0000. ref SDS 23 0000.
070502 -
070503 -
070504 -
070505 -
070506 -
070508 - ..
0706 -
0707 -
0708 - Background
0709 -
070901 - On 091030 0810 at 1406 met Doctor Stewart to evaluate performing
070902 - Heller Myotmy surgery for resolving achalasia. ref SDS 5 KE3B
070904 - ..
070905 - On 180615 1058 letter to Doctor Stewart at Gen Surgery request meeting
070906 - on 180619, at VAMCSF to review achalasia and hematoma wound issues.
070907 - ref SDS 23 VN9S
070909 - ..
070910 - On 180615 1058 at 1521 received letter from Doctor Stewart saying she
070911 - will be out of town on 180619, so call Mike and schedule time with her
070912 - on 180626 clinic. ref SDS 23 1Z4N
070914 - ..
070915 - On 180615 1058 at 1539 called Mike - he was able to schedule meeting
070916 - with Doctor Stewart on 180622 0930. ref SDS 23 517K
070918 - ..
070919 - On 180622 0930 meeting Doctor Stewart to facilitate timely treatment
070920 - achalasia to dilate LESV. ref SDS 24 TV5I Doctor Stewart scheduled
070921 - treatment with Doctor Kaltenbach in GI Clinic at VAMCSF. ref SDS 24
070922 - E66H
070924 - ..
070925 - On 180627 1300 EGD dilation performed, ref SDS 27 NU8L, by Doctor
070926 - Kaltenbach, who arrived in OR after patient sedated; Doctor Patel,
070927 - Fellow, explained after procedure that LESV contracted to 12 mm and so
070928 - Doctor Kaltenbach could only dilate to 16.5 mm, and did not apply
070929 - Triamcinalone, which has been used the past 8 years in this case.
070931 - ..
070932 - On 180625 0823 letter thanks Doctor Stewart for coordinating EGD
070933 - dilation treatment next week with Doctor Kaltenbach in GI Clinic at
070934 - VAMCSF. ref SDS 25 VN9S
070936 - ..
070937 - On 190102 1025 called VAMCSF General Surgery and asked to speak with
070938 - Mike for scheduling meeting with Doctor Stewart. Talked to Teri. She
070939 - said Mike has retired. Someone will call back on scheduling meeting
070940 - with Doctor Stewart. ref SDS 28 IG4M Sent letter to Doctor Stewart
070941 - discussing meeting to evaluate surgery to remove growing lump on back.
070942 - ref SDS 28 WY7O
070944 - ..
070945 - On 190122 1520 meeting Doctor Stewart; Sarah did initial interview,
070946 - discussed Versed should not cause cumulative effects getting sedation
070947 - every 4 weeks for EGD procedures. ref SDS 0 1N67 Doctor Stewart said
070948 - to discuss with anesthesiologist. ref SDS 0 WS9F The doctor scheduled
070949 - surgery on 190204, to remove lump on back. Sarah prepared consent for
070950 - surgery. Signed consent. ref SDS 0 QU39
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070956 - ..
0710 -
0711 -
0712 - Progress
0713 -
071301 - Met Didi at the front desk. She checked me in. Complimented her
071302 - long fingernails.
071304 - ..
071305 - Met with Sarah Mohamedaly, 6th year resident.
071307 - ..
071308 - Agenda...
071309 -
071310 - 1. Versed for conscious sedation EGD procedures every 4 weeks past
071311 - 12 months, and same schedule this year. Amount limited to 3 -
071312 - 4 mg.
071314 - ..
071315 - On 160617 patient diagnosed stroke symptoms following versed 6
071316 - mg administered for EGD procedure. No recurrence of stroke
071317 - symptoms with versed limited 3 - 4 mg.
071319 - ..
071320 - Question: can adverse effects of versed build up to stroke
071321 - risks with 4 week intervals, similar to peripheral neuropathy
071322 - recurring 5 years after reducing statins to 10 mg every other
071323 - day?
071325 - ..
071326 - On 160619 Doctor Abrams, Chief Neurology at VAMCSF advised that
071327 - recurrence of stroke symptoms that occurred on 160617, could
071328 - cause death. 160619 0800, ref SDS 18 SV54
071330 - ..
071331 - Sarah said versed wears off in minutes. Therefore this sedation
071332 - medication should not have effects that aggregate over a 4 week
071333 - period.
071335 - ..
071336 - Doctor Stewart said the matter should be considered by anesthesiology.
071338 - ..
071339 - We reviewed the record on 170912, when Doctor Stewart advised that
071340 - versed should have worn off within minutes, ref SDS 22 OS4K, after EGD
071341 - ended at 1007 on 170905, ref SDS 20 P341 Therefore, sedation care
071342 - should not have induced sleep that caused vehicle collision on 170905
071343 - 2230. ref SDS 21 0001
071345 - ..
071346 - Doctor Stewart still wants the question of versed having accumulating
071347 - affects from continual EGD procedures every 4 weeks the next year, to
071348 - be reviewed by anesthesiology.
071349 -
071351 - ..
071352 - Lump Upper Back Since December 2002
071353 -
071354 - Sarah asked about history of current problem.
071355 -
071356 - 2. On 051209 1130 lump on back was noticed by Millie when changing
071357 - into a hospital gown for examination of achalasia symptoms, by
071358 - Doctor Lee in GI Clinic at VA in Martinez. At that time the
071359 - nurse made examination and called Primary Care to schedule
071360 - examination. ref SDS 1 3X5F
071362 - ..
071363 - 3. On 051222 examination by primary care physician indicates lump
071364 - on back is not cancer, and looks like lipoma; made referral to
071365 - plastic surgery for examination to confirm diagnosis.
071366 - ref SDS 2 P18O
071368 - ..
071369 - 4. On 060131 Plastic Surgeon confirms diagnosis is lipoma, and
071370 - that no immediate treatment is required. ref SDS 3 K85O The
071371 - doctor said that since the lump is not causing pain, which is
071372 - the most common condition, i.e., lipoma is usually benign, and
071373 - since the lump is fairly small, then there is no urgency about
071374 - removing it, and no risk to health by not removing it at this
071375 - time. ref SDS 3 JK34
071377 - ..
071378 - 5. On 060202 0932 letter asks VA to schedule surgery for removing
071379 - the lump after Doctor Lee completes work on the achalasia
071380 - matter. ref SDS 4 G46P
071382 - ..
071383 - Achalasia has been in continual treament to the present day,
071384 - beginning with Doctor Stewart performing Heller Myotomy surgery
071385 - on 091216 0600. ref SDS 8 KE9U
071387 - ..
071388 - 6. On 190102 1025 sent letter to Doctor Stewart advising that lump
071389 - on the back has suddenly gotten bigger, so need to evaluate
071390 - removal again.
071392 - ..
071393 - Research seems to indicate that removal may be considered,
071394 - when lump gets bigger.
071396 - ..
071397 - Sarah said the lump may not need removal at this time.
071399 - ..
071400 - She consulted Doctor Stewart in hallway.
071402 - ..
071403 - Doctor Stewart joined the meeting. She examined the lump. The doctor
071404 - indicated the lump seems most likely benign lipoma tumor.
071406 - ..
071407 - Doctor Stewart scheduled surgery to remove the lump on 190204, per
071408 - agenda above. ref SDS 0 VT6N
071409 -
071410 - [On 190204 1200 Doctor Stewart performed surgery that
071411 - removed lipoma tumor on back. ref SDS 29 B46I
071412 -
071413 - [On 190206 1143 letter thanks Doctor Stewart for surgery to
071414 - remove lipoma tumor on back performed on 190204 1200, and
071415 - commends support crew, including Doctor Choukalas
071416 - coordinating anesthesia issues, ref SDS 30 XT59; advises no
071417 - pain Monday after surgery, swelled upper lip and minor
071418 - stomach and rib pain on 190205, and 190206, unexpected for
071419 - surgery on back, took pain pill on 190205. ref SDS 30 XT62
071420 - Asks about checking surgery wound post-surgery. ref SDS 30
071421 - XT6U
071423 - ..
071424 - She has two other minor procedures that day, and so feels this
071425 - additional minor surgery can be accomplished the same day.
071427 - ..
071428 - Sarah prepared consent form on the computer.
071430 - ..
071431 - Signed consent for the surgery based on Sarah's explanation.
071432 -
071434 - ..
071435 - 7. About 30 years ago, Millie had a similar bulge removed, and
071436 - indicated this was an uncomfortable procedure. Hopefully,
071437 - surgical improvements have reduced pain performing this
071438 - procedure?
071440 - ..
071441 - Research today found...
071443 - ..
071444 - Drugs.com
071445 - Lipoma Removal
071446 -
071447 - https://www.drugs.com/cg/lipoma-removal.html
071449 - ..
071450 - You will be given local anesthesia to numb the surgery area.
071451 - With local anesthesia, you may still feel pressure or pushing,
071452 - but you should not feel any pain. If your lipoma is large or
071453 - deep, you may be given general anesthesia. General anesthesia
071454 - will keep you asleep and free from pain during surgery.
071456 - ..
071457 - Your healthcare provider will make an incision in your skin and
071458 - remove the lipoma. The removed lipoma may be sent to a lab and
071459 - tested for cancer. Your provider may use stitches or medical
071460 - glue to close your skin. A pressure bandage will be placed
071461 - over your incision to prevent bleeding.
071463 - ..
071464 - Doctor Stewart said the surgery will be performed with general
071465 - anesthesia or conscious sedation, like EGD procedure, so the patient
071466 - will feel no pain.
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