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: December 9, 2005 11:30 AM Friday;
Rod Welch
VA GI clinic endoscopy due diligence to diagnose achalasia. .
1...Summary/Objective
2...Flue Shot Primary Care Clinic
3...Lump on Back Found Teresa Orders Examination in Primary Care
4...Meeting Gastrointestinal Department Evaluate Digestion Problem
5...Cancer Not Indicated Endoscopy Examination
6...Endoscopy Images Examination Do Not Indicate Cancer
7...Discussion with Doctor Examination Does Not Indicate Cancer
8...Pictures Esophagus Do Not Indicate Cancer Endoscopy Examination
9...Throat Stomach No Evidence Affliction Cancer Endoscopy Examination
10...Achalasia Diagnosis Supported by Endoscopy Imaging Esophagus Sphincter
11...Gastroesophageal Junction Achalasia Supported by Endoscopy Pictures
12...Esophagus Sphincter Valve Constricted Achalasia Supported by Endoscopy
13...Achalasia Schedule Esophageal Sphincter Dilation Treatment
14...Schedule Esophageal Sphincter Dilation Treatment for Primary Achalasia
15...Esophageal Sphincter Dilation Treatment for Primary Achalasia Schedule
..............
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CONTACTS
SUBJECTS
Lump on Upper Left Back Observed by Teresa Calls Kim to Schedule Exa
Endoscopy Gastrointestinal (GI) Clinic Meeting Evaluate Digestion Pr
Flu Shot at VA Hospital in Martinez Ethyl
1405 -
1405 - ..
1406 - Summary/Objective
1407 -
140701 - Follow up ref SDS 28 0000. ref SDS 26 0000.
140702 -
140703 - The doctor performed endoscopy test, ref SDS 0 CY5M, and reported
140704 - there was no evident cancer, nor other affliction except achalasia
140705 - caused by constricted esophageal sphincter valve. ref SDS 0 PRRT
140706 - There was no evidence of problems to the stomach nor to the duodenum.
140707 - Biopsy results will be reported a few weeks, ref SDS 0 5B5K, and if
140708 - these tests do not show cancer, then an operation will be scheduled
140709 - for next month to treat achalasia with dilation of the exophageal
140710 - sphincter valve. ref SDS 0 NZ5H Millie noticed a bump on the back,
140711 - and this was reported to the primary care physician. The nurse also
140712 - asked a nurse in the Primary Care Department to schedule a meeting for
140713 - examination. ref SDS 0 3X5F Got a flu shot before meeting for the
140714 - endoscopy procedure. ref SDS 0 HP9H
140715 -
140716 - [On 051212 Irene called for due diligence on endoscopy procedure;
140717 - reported no adverse after affects. ref SDS 30 0001
140719 - ..
140720 - [On 051222 cancer negative findings pathology report on biopsies
140721 - taken today consistant with achalasia. ref SDS 32 FT6M
140723 - ..
140724 - [On 060111 received letter from Doctor in the Gastrointestinal
140725 - (GI) Clinic reporting that the biopsy was negative for cancer and
140726 - infection; next step is another test, then treatment for
140727 - achalasia. ref SDS 33 4Q3R
140729 - ..
140730 - [On 060125 manometry test scheduled for 060209 0800. ref SDS 34
140731 - GG9I
140733 - ..
140734 - [On 060209 meeting at VA Mather AFB in Sacramento, test was
140735 - postponed until 060223 due to equipment failure. ref SDS 36 OW6M
140737 - ..
140738 - [On 060330 0712 another endoscopy performed at VA in Sacramento to
140739 - supplement endoscopy test finding no evidence of throat nor
140740 - stomach cancer, performed at VA in Martinez today by Doctor Lee.
140741 - ref SDS 39 MC6H
140742 -
140743 -
140744 -
140745 -
140747 - ..
1408 -
1409 -
1410 - Progress
1411 -
141101 - Flue Shot Primary Care Clinic
141102 - Lump on Back Found Teresa Orders Examination in Primary Care
141103 - Meeting Gastrointestinal Department Evaluate Digestion Problem
141104 -
141105 - Follow up ref SDS 28 HP9H.
141106 -
141107 - Flue shot treatment prior to endoscopy test. Checked in at the
141108 - Primary Care Clinic, and got a flu shot from Ethyl. She said there
141109 - are no side effects.
141111 - ..
141112 - While changing into a hospital gown, Millie observed swollen tissue
141113 - that appears tumor-like on the upper left side of the back. The
141114 - nurse, Teresa, took a look, and decided to notify the primary care
141115 - physician. She, also, called Kim in Primary Care. Kim was out to
141116 - lunch, so Teresa left a message about scheduling a meeting to examine
141117 - the lump for possible diagnosis. About 15 years ago, Millie had a
141118 - similar bulge removed, and indicated this was an uncomfortable
141119 - procedure.
141120 -
141121 - [On 051219 followed up contacted Primary Care about scheduling a
141122 - meeting on the lump. ref SDS 31 0001
141124 - ..
141125 - [On 051222 examination by primary care physician indicates lump on
141126 - back is not cancer, and looks like lipoma. ref SDS 32 P18O
141128 - ..
141129 - After changing into hospital gown for setup, entered the record of
141130 - work in progress, while waiting for the doctor's schedule to clear and
141131 - begin treatment. This was about 30 minutes.
141133 - ..
141134 - Meeting today was ordered by doctor in GI clinic during examination on
141135 - 051202. ref SDS 28 H25N
141137 - ..
141138 - This referral complements prior testing....
141139 -
141140 - Endoscopy scope................. 051202, ref SDS 28 IA5I
141141 - Ultrasound report............... 050906, ref SDS 24 BM6R
141142 - Barium test report.............. 050830, ref SDS 23 UR3M
141144 - ..
141145 - Vitals taken...
141146 -
141147 - Blood pressure 115 73
141148 - Pulse 89
141149 - EKG 77
141150 - Temperature 98.1
141151 - Resp 13 RPM
141152 -
141153 -
141155 - ..
141156 - Nurse: Judith, and Teresa.
141157 -
141158 - Connected an IV
141159 -
141160 - Teresa used a stethescope to listen to heart, lungs, and stomach;
141161 - nothing reported.
141163 - ..
141164 - Discharge papers signed.
141166 - ..
141167 - Consent for procedure signed.
141168 -
141170 - ..
1412 -
1413 -
1414 - 1339
1415 -
141501 - Talked to Irene.
141502 -
141503 - She configured an IV, and with an assistant wheeled the gurney into
141504 - an operating room.
141506 - ..
141507 - Irene installed oxygene for breathing support. The other nurse
141508 - sprayed the back of the throat with an antiseptic, which had a slight
141509 - cherry taste, but was somewhat unpleasant.
141510 -
141511 - [On 051212 Irene called for due diligence on endoscopy procedure;
141512 - reported no adverse after affects. ref SDS 30 0001
141514 - ..
141515 - Irene reviewed the consent form.
141517 - ..
141518 - The other nurse asked about loosening the belt to avoid becoming
141519 - uncomfortable when the procedure forces air into the stomach for the
141520 - test.
141521 -
141522 -
141524 - ..
1416 -
1417 -
1418 - 1408
1419 -
141901 - Meeting Doctor...
141902 -
141905 - ..
141906 - The doctor came into the room and discussed the procedure.
141908 - ..
141909 - The doctor said he has not had enough time to reivew the record for
141910 - the meeting on 051202, ref SDS 28 0001, which was submitted two days
141911 - ago through Kimberley on 051207. ref SDS 29 0001
141913 - ..
141914 - The doctor explained the endoscopy procedure, which aligned with the
141915 - record on 051202, ref SDS 28 IA5I, and showed the equipment that would
141916 - be used for the endoscopy, and which is forced down the throat,
141917 - through the esophagael sphincter, which is the problem area, and into
141918 - the stomach to the duodenum, per planning on 051202. ref SDS 28 NZ5H
141919 -
141920 - [On 060330 0712 another endoscopy performed at VA in Sacramento
141921 - to supplement endoscopy test finding no evidence of throat nor
141922 - stomach cancer, performed at VA in Martinez today by Doctor
141923 - Lee. ref SDS 39 MC6H
141925 - ..
141926 - This is a flexible tube about .25" in diameter, with a camera and
141927 - lights on either side.
141929 - ..
141930 - We reviewed the primary purpose of the examination today is to look
141931 - for cancer or other abnormality that may be causing the esophageal
141932 - sphincter valve to function incorrectly. toward confirming initial
141933 - diagnosis of achalasia, discussed on 051202. ref SDS 28 5B5K
141935 - ..
141936 - The consent form was signed at this time.
141937 -
141939 - ..
1420 -
1421 -
1422 - 1313
1423 -
142301 - The doctor left the room, and Irene then connected an anesthetic drug
142302 - through the IV.
142303 -
142304 -
142305 -
142307 - ..
1424 -
1425 -
1426 - 1530
1427 -
142701 - Woke up in the recovery room. Millie had gone to lunch, and
142702 - returned.
142704 - ..
142705 - The nurse, Judith, brought some orange juice to drink.
142707 - ..
142708 - She asked about a sore throat or bloating feeling, which sometimes
142709 - occur after endoscopy.
142711 - ..
142712 - None of these symptoms occurred.
142713 -
142715 - ..
1428 -
1429 -
1430 - 1540
1431 -
143101 - Got up and dressed.
143102 -
143103 -
143104 -
143105 -
143106 -
143107 -
143108 -
1432 -
SUBJECTS
Endoscopy Images Examination Discussion with Doctor Pictures Esophag
1603 -
1604 - 1557
160501 - ..
160502 - Cancer Not Indicated Endoscopy Examination
160503 - Endoscopy Images Examination Do Not Indicate Cancer
160504 - Discussion with Doctor Examination Does Not Indicate Cancer
160505 - Pictures Esophagus Do Not Indicate Cancer Endoscopy Examination
160506 -
160508 - ..
160509 - After recovering from anesthesia, Doctor Lee visited to explain
160510 - preliminary findings.
160512 - ..
160513 - The doctor advised there was nothing that looked like cancer. He took
160514 - some biopsies from the esophagus, the stomach and the duodenum.
160515 - Results will be reported in about two (2) weeks.
160516 -
160517 - [On 051212 Irene called for due diligence on endoscopy procedure;
160518 - reported no adverse after affects. ref SDS 30 0001
160520 - ..
160521 - [On 051222 cancer negative findings pathology report on biopsies
160522 - taken today consistant with achalasia. ref SDS 32 FT6M
160524 - ..
160525 - [On 060111 received letter from Doctor in the Gastrointestinal
160526 - (GI) Clinic reporting that the biopsy was negative for cancer and
160527 - infection; doctor proposes next step is another test; a manometry
160528 - test will further establish achalasia to prepare for treating
160529 - achalasia. ref SDS 33 4Q3R
160531 - ..
160532 - [On 060202 confirmed understandings from the meeting, and notified
160533 - of plan to have lipoma removed. ref SDS 35 G49P
160535 - ..
160536 - [On 060209 meeting at VA Mather AFB in Sacramento, test was
160537 - postponed until 060223 due to equipment failure. ref SDS 36 OW6M
160539 - ..
160540 - [On 060220 letter asks to confirm meeting on 060223, if equipment
160541 - has been repaired, or is there another delay. ref SDS 37 GG9I
160543 - ..
160544 - [On 060221 Jimmy says manometry equipment still broken; has been
160545 - sent out for repairs and there is no date at this time on when the
160546 - equipment will be available for use at the VA. ref SDS 38 ND7M
160548 - ..
160549 - [On 060221 letter to Doctor asks about alternatives to manometry
160550 - testing, and whether treatment for achalasia can proceed.
160551 - ref SDS 38 7U8H
160553 - ..
160554 - [On 060330 0800 another endoscopy test was performed, ref SDS 39
160555 - VX4G, and again found no evidence of cancer. ref SDS 39 MD4N
160557 - ..
160558 - [On 091030 0810 Doctor Sawhney at the VA in San Francisco examined
160559 - throat (esophagus) and stomach in connection with plading a feeder
160560 - tube, and reported finding no evidence of cancer. ref SDS 40 AS7N
160562 - ..
160563 - [On 091208 1300 Doctor Stewart considers delaying surgery for
160564 - Heller Myotemy to correct achalasia, and in order to perform
160565 - endoscopy, because results from testing at VA in Martinez on
160566 - 051209 cannot be found in VA computer, due in part to not
160567 - remembering the year 2005 when the test was performed. ref SDS 41
160568 - BJ3H
160569 -
160571 - ..
160572 - Four (4) pictures were presented during the meeting, and are
160573 - identified by date and time.
160574 -
160577 -
160578 -
160579 - 1. 051209 143629
160580 -
160581 - This shows the condition from the mouth leading to the throat
160582 - (esophagus).
160584 - ..
160585 - The doctor said there is nothing remarkable shown in this
160586 - picture.
160588 - ..
160589 - 2. 051209 143730
160590 -
160591 - This picture shows the exophagus (throat), and is heavily
160592 - coated with debris from food and drink. It has a white, cream
160593 - to gray coloration, rather than pink-like appearance in the
160594 - other pictures.
160595 -
160596 - [On 051222 cancer negative findings pathology report on
160597 - biopsies taken today consistant with achalasia.
160598 - ref SDS 32 FT6M
160600 - ..
160601 - [On 060111 received letter from Doctor Lee in the
160602 - Gastrointestinal (GI) Clinic reporting that the biopsy was
160603 - negative for cancer and infection; doctor proposes next
160604 - step is another test; a manometry test will further
160605 - establish achalasia to prepare for treating achalasia.
160606 - ref SDS 33 4Q3R
160608 - ..
160609 - [On 091030 0810 Doctor Sawhney used a camera in the throat
160610 - and stomach in order to place a feeder tube; he reported
160611 - finding no evidence of cancer or disease of any kind.
160612 - ref SDS 40 AS6M
160614 - ..
160615 - The doctor said this is normal coloration expected for
160616 - achalasia. He found some fluid was still in this area, and
160617 - removed it with suction equipment.
160619 - ..
160620 - 3. 051209 144002
160621 -
160622 - The doctor said this picture shows the stomach. It seems
160623 - empty, somewhat smaller in diameter than expected. It has a
160624 - near pristine appearance, indicating minimal use, since with
160625 - achalasia food only seeps through the esophageal sphincter
160626 - after being reduced to a near liquid state.
160628 - ..
160629 - The doctor said there is nothing remarkable shown in this
160630 - picture.
160632 - ..
160633 - 4. 051209 144042
160634 -
160635 - The doctor described this picture showing the duodenum leading
160636 - to the upper intestine. It looks bigger than the stomach.
160638 - ..
160639 - The doctor said there is nothing remarkable shown in this
160640 - picture.
160642 - ..
160643 - There is a considerable amount of white streaking in this
160644 - picture, more than in pictures 1 and 3, and none in picture 2.
160646 - ..
160647 - The doctor explained that this appearance of "streaking"
160648 - occurs from reflections of the lights configured with the
160649 - camera. The duodenum tissue is more wrinkled than the other
160650 - areas, so there are more reflections of light. The doctor
160651 - said this condition is normal and so was expected.
160652 -
160653 -
160654 -
160655 -
160656 -
160657 -
1607 -
SUBJECTS
Achalasia Diagnosis Supported by Endoscopy Imaging Esophagus Sphinct
2103 -
210401 - ..
210402 - Throat Stomach No Evidence Affliction Cancer Endoscopy Examination
210403 - Achalasia Diagnosis Supported by Endoscopy Imaging Esophagus Sphincter
210404 - Gastroesophageal Junction Achalasia Supported by Endoscopy Pictures
210405 - Esophagus Sphincter Valve Constricted Achalasia Supported by Endoscopy
210406 -
210407 - Follow up ref SDS 28 5B5K, ref SDS 21 DG8G.
210408 -
210409 - The doctor indicated that examination today, ref SDS 0 PRRT, supports
210410 - initial diagnosis of achalasia on 051202. ref SDS 28 DX8K
210412 - ..
210413 - The doctor saw no evidence of cancer nor of any affliction in the
210414 - throat, the stomach and duodenum, per pictures above. ref SDS 0 Y69K
210416 - ..
210417 - After the pathology reports are available in about two (2) weeks, he
210418 - can confirm status of findings on cancer.
210419 -
210420 - [On 060111 received letter from Doctor in the Gastrointestinal
210421 - (GI) Clinic reporting that the biopsy was negative for cancer and
210422 - infection; doctor proposes next step is another test; a manometry
210423 - test will further establish achalasia to prepare for treating
210424 - achalasia. ref SDS 33 4Q3R
210426 - ..
210427 - [On 060125 manometer test scheduled for 060209 0800. ref SDS 34
210428 - GG9I
210429 -
210430 -
210431 -
2105 -
SUBJECTS
Achalasia Schedule Esophageal Sphincter Dilation Treatment
2503 -
250401 - ..
250402 - Achalasia Schedule Esophageal Sphincter Dilation Treatment
250403 - Schedule Esophageal Sphincter Dilation Treatment for Primary Achalasia
250404 - Esophageal Sphincter Dilation Treatment for Primary Achalasia Schedule
250405 -
250406 - Follow up ref SDS 28 NZ5H, ref SDS 21 0G7M.
250408 - ..
250409 - The doctor expects to schedule dilation treatment for the espophageal
250410 - sphincter sometime next month, provided the biopsy reports are
250411 - favorable as expected, based on preliminary results of endoscopy test
250412 - today, per above. ref SDS 0 PRRT
250413 -
250414 - [On 051212 Irene called for due diligence on endoscopy procedure;
250415 - reported no adverse after affects. ref SDS 30 0001
250417 - ..
250418 - [On 051222 cancer negative findings pathology report on biopsies
250419 - taken today consistant with achalasia. ref SDS 32 FT6M
250421 - ..
250422 - [On 060111 received letter from Doctor in the Gastrointestinal
250423 - (GI) Clinic reporting that the biopsy was negative for cancer and
250424 - infection; doctor proposes next step is another test; a manometry
250425 - test will further establish achalasia to prepare for treating
250426 - achalasia. ref SDS 33 4Q3R
250428 - ..
250429 - [On 060125 manometry test scheduled for 060209 0800. ref SDS 34
250430 - GG9I
250432 - ..
250433 - [On 060202 confirmed understandings from the meeting, and notified
250434 - of plan to have lipoma removed. ref SDS 35 G49P
250436 - ..
250437 - [On 060209 meeting at VA Mather AFB in Sacramento, manometry test
250438 - postponed until 060223 due to manometry equipment failure.
250439 - ref SDS 36 OW6M
250441 - ..
250442 - [On 060220 letter asks to confirm meeting on 060223, if equipment
250443 - has been repaired, or is there another delay. ref SDS 37 GG9I
250445 - ..
250446 - [On 060221 Jimmy says manometry equipment still broken; has been
250447 - sent out for repairs and there is no date at this time on when the
250448 - equipment will be available for use at the VA. ref SDS 38 ND7M
250450 - ..
250451 - [On 060221 letter to Doctor asks about alternatives to manometry
250452 - testing, and whether treatment for achalasia can proceed.
250453 - ref SDS 38 7U8H
250454 -
250455 -
250456 -
250457 -
250458 -
250459 -
250460 -
250461 -
250462 -
2505 -