CONTACTS
SUBJECTS
Treadmill Heart Stress Test Schedule 200103 0700 Chest Pain Elevated
2403 -
2403 - ..
2404 - Summary/Objective
2405 -
240501 - Follow up ref SDS B6 0000. ref SDS B2 0000.
240502 -
240503 -
240504 -
240505 -
240506 -
240507 -
240509 - ..
2406 -
2407 -
2408 - Background
2409 -
240901 - On 191206 1425 letter to VAMCSF Cardiology Doctor Simpson, ref SDS A3
240902 - NE9N, notify possible afib symptoms. ref SDS A3 N874
240904 - ..
240905 - On 191207 0927 Doctor Simpson to order ECG [...electrocariogram...]
240906 - Zio test for AFib, after he returns to work following several weeks
240907 - out of the office. ref SDS A4 NE9N
240909 - ..
240910 - On 191213 0849 call from Tina - scheduled install Zio equipment for
240911 - heart monitoring test; meeting room 2A16 on 191216 1230. ref SDS A5
240912 - NE9N
240914 - ..
240915 - On 191216 1220 Exmeralda in Cardiology at VAMCSF installed Zio XT
240916 - heart monitor on left chest; she added 2 plastic tapes to secure the
240917 - unit against fall off in shower and perspiration during hiking.
240918 - ref SDS A9 AO7H
240920 - ..
240921 - On 191214 1138 letter to Doctor Simpson in Cardiology at VAMCSF,
240922 - ref SDS A7 NE9N, reports 8 weeks ago increased hiking route with steep
240923 - hills from 11 to 15 miles per day. ref SDS A7 MX58 About a week ago
240924 - increased hiking to 20+ miles per day in order to improve weight
240925 - control and to raise lipids toward HDL 80. ref SDS A7 MX61 Weight
240926 - increased after pausing hiking due to orthopedic pain left knee and
240927 - both feet, which was solved after receiving oxycodone and gabapentin,
240928 - and applying elastic bandage to left knee. ref SDS A7 MX64 Today,
240929 - before hiking felt chest swaying indicating afib. ref SDS A7 MY30
240930 - Research indicates walking can aid recovery from afib; during hike
240931 - today, will reduce level of effort back to 15 miles per day, and avoid
240932 - steeper hills. ref SDS A7 368M Ask about medication to treat afib.
240933 - ref SDS A7 MY38 Offer to walk with Doctor Simpson to assist recovery
240934 - from hip surgery. ref SDS A7 MY41
240936 - ..
240937 - On 191214 1138 at 1324 letter from Doctor Simpson in Cardiology at
240938 - VAMCSF says to do hiking that has led to symptoms. ref SDS A8 0K4L
240940 - ..
240941 - On 191228 1416 letter to Doctor Simpson notify Zio log reports chest
240942 - pain hiking with elastic bandage on left knee. ref SDS B0 NE9N 1st
240943 - episode hiking 12 miles through Golden Gate Park on 191220, chest pain
240944 - mild lasted on ly .25 miles. Occurred again next day hiking 20 miles
240945 - up Crystal Ranch Road. ref SDS B0 B652 Occurred next day on 191222, so
240946 - stopped at mile .75 and removed elastic bandage from left leg, pain
240947 - ended for rest of 20 mile hike and on subsequent hikes 20 mile past 6
240948 - days. ref SDS B0 B655 Today on 191228, chest pain occurred hiking up
240949 - mild hills without elastic bandage on left leg, so ended hike at 7
240950 - miles. ref SDS B0 B658 HR 150 - should be 45 - 55. ref SDS B0 B662
240951 - Seems like bypass saphenous graft failed under elevated load wearing
240952 - elastic bandage on left knee. ref SDS B0 B665 Pause hiking until hear
240953 - from the doctor. ref SDS B0 B668
240955 - ..
240956 - On 191228 1416 at 1534 letter from Doctor Simpson notifies he will
240957 - order treadmill stress test. ref SDS B0 RK6L
240959 - ..
240960 - On 191228 1416 at 1537 letter to Doctor Simpson notifies will submit
240961 - Zio XT device with afib data on Monday, 191230. ref SDS B0 WO6F
240963 - ..
240964 - On 191229 1243 received letter from Doctor Simpson notifies need to
240965 - get ECG test at VAMCSF before they can schedule treadmill stress test.
240966 - ref SDS B1 NE9N Further says to get care in the ER if chest pain
240967 - recurs at rest. ref SDS B1 NH77
240969 - ..
240970 - On 191229 1243 at 1256 letter to Doctor Simpson asks where and when to
240971 - get ECG test. ref SDS B1 YH8N Notifies so far chest pain has not
240972 - occurred at rest; has only occurred when hiking. ref SDS B1 YA48
240973 - Notifies of EGD procedure in GI Clinic at VAMC Sacramento on 200107,
240974 - and getting MRI studies on feet and knees at VAMCSF on 200109.
240975 - ref SDS B1 YA51
240977 - ..
240978 - On 191229 1243 at 1420 received letter from Doctor Simpson advising
240979 - ECG is done on 2nd floor building 203, and to arrive about 1000.
240980 - ref SDS B1 LG4J Recommends notifying GI Clinic to delay EGD until
240981 - after resolution of current Cardiology issue. ref SDS B1 6H6G
240983 - ..
240984 - On 191229 1243 at 1538 received letter from Doctor Simpson advising
240985 - ECG was done in this case at the end of Oct, so do not need a new one;
240986 - next step is for VA to schedule stress test. ref SDS B1 E17N
240988 - ..
240989 - On 191229 1243 at 1619 sent letter to Jessica on notifying Doctor Lee
240990 - to delay next EGD scheduled on 200107 0730 for a month until 200204
240991 - 0730. ref SDS B1 4R7J
240993 - ..
240994 - On 191229 1243 at 1700 letter thanks Doctor Simpson for advising ECG
240995 - not needed. ref SDS B1 M48J
240997 - ..
240998 - On 191229 1243 at 1946 letter notifies Doctor Simpson that feet
240999 - elevated on footrest seem swelled. Cellphone reports HR 38. That is
241000 - low for me. Don't feel dizzy or light headed; seems like afib event,
241001 - with chest swaying back and forth. ref SDS B1 MH6N
241003 - ..
241004 - On 191229 1243 at 1946 letter notifies Doctor Simpson Zio device was
241005 - mailed to company a day early on 191229. ref SDS B1 UA47
241007 - ..
241008 - On 191230 0930 received call from Tina in Cardiology at VAMCSF
241009 - scheduled treadmill stress test on 200103, ref SDS B2 NE9N, report
241010 - first at 0700 to ASU on 3rd floor Building 200 for IV, then go to
241011 - Neuclear Medicine on ground floor building 203. ref SDS B2 GE5K
241013 - ..
241014 - On 191230 0930 at 0938 received letter from Doctor Simpson in
241015 - Cardiology explaining symptoms reported last night are okay, since not
241016 - dizzy, until after stress test. ref SDS B2 GF3G
241018 - ..
241019 - On 191230 0930 at 0949 received letter Tina in Cardiology confirming
241020 - schedule for stress test on 200103 0700, and submitting instructions
241021 - to prepare for the test. ref SDS B2 Q76I
241023 - ..
241024 - On 191230 0930 at 1021 letter to Doctor Simpson in Cardiology at
241025 - VAMCSF reporting stress test has been scheduled on 200301 0700.
241026 - ref SDS B2 9W6F Reported mild chest pain at rest for 10 minutes, but
241027 - it resolved while writing the letter. ref SDS B2 JY39
241029 - ..
241030 - On 191230 0930 at 1114 received letter from Lauren, NP and PCP in this
241031 - case; she concurs patient should go to ER if chest pain persists at
241032 - rest, and should have a driver. ref SDS B2 2S4N
241034 - ..
241035 - On 191230 0930 at 1117 received call from Aladin who is Lauren's
241036 - assistent in Medical Practice; he indicated Lauren asked him to call
241037 - and get background on chest pain issue. ref SDS B2 578G Explained
241038 - background is reported in correspondence with Doctor Simpson in
241039 - Cardiology, and this has been copied to Lauren. ref SDS B2 5W6J
241041 - ..
241042 - On 191230 0930 at 1135 responded to Lauren citing call from her
241043 - assistent, Aladin, and reporting background on current issue is
241044 - reported in correspondence with Doctor Simpson in Cardiology, who is
241045 - directing the work, and that Lauren has been copied on all
241046 - correspondence. ref SDS B2 659K
241047 -
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241050 -
241052 - ..
2411 -
2412 -
2413 - Progress
2414 -
241401 - Lauren called this morning, following up call from Aladin on 200218
241402 - 1415. ref SDS B6 NE9N
241404 - ..
241405 - Need naproxen and Tramadol. She will order Tramadol in a week, so a
241406 - month will have expired since she ordered oxycodone.
241407 -
241408 - [On 200306 1028 received tramadol pain medication delivered
241409 - by US postal service. Signed showing receipt. ref SDS C2
241410 - 4G4N
241412 - ..
241413 - Before ordering naproxen, Lauren wants to try diclofenac. It is
241414 - topical, rather than systemic. She feels this presents less risks for
241415 - preventing apixaban and clopedogrel from thinning blood, and so
241416 - reduces exposure to strokes, which is the purpose of apixaban. Lauren
241417 - said she used diclofenac years ago in high school for back pain, and
241418 - remembers it was effective. She has reports from other patients, who
241419 - she recalls report effective pain management with diclofenac.
241420 -
241421 - [On 200305 1435 received from VA Diclofenac medication
241422 - delivered by UPS. ref SDS C0 L74M
241424 - ..
241425 - We tried this previously, ordered by Doctor Tang in Podiatry on 161220
241426 - 0927. ref SDS 34 0657 It was ponderous applying to feet (did not need
241427 - for knees at that time), and so discouraged hiking, reported on
241428 - 170201, as shown in case study on 160101 0700. ref SDS 26 574G Was
241429 - not effective; had to cut off hike due to feet and knee pain on
241430 - 170203, also in same case study. ref SDS 26 PWWU Worse experience on
241431 - 170204, record describes "terrible" hike. ref SDS 26 QPUR Same again
241432 - on 170210. ref SDS 26 YF5K Next day considered callig cab for ride
241433 - home - cut off hike at 6 miles. ref SDS 26 QSVT On 170219 good
241434 - experience with dicolphenac. ref SDS 26 QXXP On 170226 another good
241435 - hike with diclophenac. ref SDS 26 RRXQ This record is inconclusive,
241436 - so will try it again.
241438 - ..
241439 - Lauren will call back in 2 weeks on 200312 0800. If dicolfenac is
241440 - not working well, she will order naproxen.
241442 - ..
241443 - Advised have not received Famotidine, calcium carbonate, and Mylanta
241444 - nor metoprolol tartrate and clopidogrel, all ordered on 200222 1021.
241445 - ref SDS B7 4G4N
241447 - ..
241448 - Lauren checked the VA computer. She said it shows metoprolol tartrate
241449 - and clopidogrel were shipped on 200225, and so should be delivered
241450 - today. If they are not delivered, call back, and she will arrange for
241451 - these medications to be shipped for next day delivery, i.e., tomorrow.
241452 -
241453 -
241455 - ..
2415 -
2416 -
2417 - 0852
2418 -
241801 - Lauren called back. She said the medications will be delivered
241802 - today, or tomorrow.
241803 -
241804 - [On 200228 1614 on returning from hike there were 2
241805 - packages on front porch: 1 was a box with 5 bottles
241806 - Mylatna; the 2nd package contained metoprolol tartrate 25
241807 - mg, and also clopidogrel. ref SDS B8 4G4N
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