CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 7 0000. ref SDS 6 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - On 090916 VA performed stress test, which indicated possible heart
040902 - and circulation problems.
040904 - ..
040905 - On 091002 met with Doctor Egan, Cardiologist at the VA. The doctor
040906 - advised that 10 of 11 test points in the stress test showed positive
040907 - for circulation problems, and so the doctor ordered angiogram.
040908 - ref SDS 4 1W5I
040910 - ..
040911 - On 091006 0843 Karen called and scheduled angiogram test on 091020 at
040912 - the VA in San Francisco. ref SDS 5 1W5I Received a letter from Karen
040913 - on 091006 at 1045 confirming schedule for the test which requires
040914 - arriving at the VA on 091019 to do prep for the test on 091020.
040915 - ref SDS 5 GK8L
040917 - ..
040918 - On 091007 0021 sent a letter notifying the medical team that Doctor
040919 - Egan's treatment plan is being implemented, and asked a question about
040920 - the cause of pain based on level of effort. ref SDS 6 4Z75
040922 - ..
040923 - On 091007 0818 received letter from Karen at VA in San Francisco
040924 - responding to the letter this morning asking the medical team for
040925 - cause of chest pain that correlates to level of effort. Doctor Egan
040926 - has not had time to respond. Karen attributes pain to possible
040927 - angina, but does not explain what causes pain. ref SDS 7 A68H
040929 - ..
040930 - 091019 1300 meeting in Cardiology for blood test to prepare for
040931 - angiogram test tomorrow, ref SDS 0 X59F, per Karen's letter on 091007
040932 - 0818. ref SDS 7 A68H
040934 - ..
040935 - Directions...
040936 -
040937 - Take Highway 24 across Bay Bridge, and take turn-off to
040938 - Gold2n Gate Bridge.
040939 -
040940 - Follow route to UCSF until Geary Street.
040942 - ..
040943 - West on Gear to 42nd street turn right onto 42nd.
040945 - ..
040946 - 42nd Street North to Clement; cross Clement into the VA
040947 - facility.
040949 - ..
040950 - Go to building 203 second floor and go to the EKG department around
040951 - 1pm. ref SDS 5 4P40
040952 -
040954 - ..
0410 -
0411 -
0412 - 1322
0413 -
041301 - Went to Cardiology on 2nd floor in Building 203, per plan. ref SDS 5
041302 - 4P40
041304 - ..
041305 - Was sent to the lab.
041306 -
041308 - ..
0414 -
0415 -
0416 - 1353
0417 -
041701 - Checked in at the lab to follow up prior lab at VA in Martinez on
041702 - 090813 1500. ref SDS 2 075H
041703 -
041705 - ..
0418 -
0419 -
0420 - 1426
0421 -
042101 - Called into the lab for blood draw. This took 5 minutes.
042103 - ..
042104 - Patient Provider Category View FR Date To Date
042113 - ..
042114 - VA Medical Center
042115 - San Francisco, CA
042117 - ..
042118 - Log#: 091019 13:42
042119 - <--------------------VETERANS ADMINISTRATION----------------->
042120 - Type Results Units Normal
042121 - WBC COUNT H 12.60 K/cmm 4.80 - 10.80
042122 - RBC COUNT 5.69 M/cmm 4.70 - 6.10
042123 - HEMOGLOBIN 17.3 g/dL 14.00 - 18.00
042124 - HEMATOCRIT 51.9 % 42.00 - 52.00
042125 - MCV 91.2 fL 80.00 - 100.00
042126 - MCH 30.4 uug 27.00 - 32.00
042127 - MCHC 33.3 gm/dL 32.00 - 36.00
042128 - RDW [Not Reported] % 11.50 - 14.50
042129 - PLATELETS 370.0 K/cmm 140.00 - 400.00
042130 - MPV [Not Reported] fL 7.00 - 10.40
042132 - ..
042133 - CPK 80.00 U/l 30.00 - 235.00
042134 - CPKMB 1.40 mcg/L 0.00 - 7.00
042135 -
042136 - Eval: CKMB also found in skeletal muscle; interpret results in
042137 - clinical context.
042139 - ..
042140 - LYMPHS % [Not Reported] % 20.00 - 51.00
042141 - MONOS % [Not Reported] % 2.00 - 13.00
042142 - ..
042143 - (NEUTS x 1000 = ANC for Kaiser)
042144 - Neutrophils % [Not Reported] % 40.00 - 80.00
042146 - ..
042147 - EOS % [Not Reported] % 0.50 - 7.00
042148 - BASO % [Not Reported] % 0.00 - 2.00
042150 - ..
042151 - Log#: 091019 13:42
042152 - <--------------------VETERANS ADMINISTRATION----------------->
042153 - Type Results Units Normal
042154 - NEUTS # [Not Reported] K/cmm 1.50 - 7.90
042155 -
042156 - NEUTS (also absolute neutrophils count - ANC) is calculated
042157 - according to the formula on 060810 1330. ref SDS 1 GL4M
042158 -
042159 - ANC = WBC x 1000 x (Neutrophils + Bands)
042160 -
042161 - = 10.5 x (.77 + 0) x 1000 = 8085
042163 - ..
042164 - Log#: 091019 13:42
042165 - <--------------------VETERANS ADMINISTRATION----------------->
042166 - Type Results Units Normal
042167 - ELECTROLYTE PANEL
042168 - GLUCOSE 115 mg/dL 65.00 - 115.00
042169 - SODIUM 138 mmol/L 135.00 - 145.00
042170 - POTASSIUM 3.8 mmol/L 3.30 - 4.80
042171 - CHLORIDE L 100 mmol/L 101.00 - 112.00
042172 - CO2 30 mmol/L 24.00 - 32.00
042173 - ANION GAP 8 mmol/L 5.00 - 20.00
042175 - ..
042176 - UREA NITROGEN 16 mg/dL 10.00 - 24.00
042178 - ..
042179 - CREAT with eGFR
042180 - CREATININE 1.04 mg/dL 0.60 - 1.30
042182 - ..
042183 - eGFR 72 mL/min ref: >=60.00
042184 -
042185 - eGFR Units = mL/min/1.73 square meters
042187 - ..
042188 - Log#: 091019 13:42
042189 - <--------------------VETERANS ADMINISTRATION----------------->
042190 - Type Results Units Normal
042191 - PROTHROMBIN TIME 13.50 secs 10.30 - 13.90
042192 -
042193 - Eval: Please note change in reference range effective 090313.
042195 - ..
042196 - INR 1.10 0.80 - 1.20
042197 -
042198 - Eval: recommended recommended therapy range for coagulation control
042199 - Eval: treatment of DVT and PE: INR = 2.0 - 3.0
042200 - Eval: atrial fibrillation: INR = 2.0 - 3.0
042201 - Eval: prosthetic heart valves: INR = 2.5 - 3.5
042203 - ..
042204 - PTT 31.90 24.90 - 36.10
042205 -
042206 - Eval: effective 090316 Heparin theraputic range 70 - 95 secs
042207 - Eval: 080304 - 090316 @ 1100 heparin theraputic range: 45.4 - 77.2 secs
042208 - Eval: This new range corresponds to plasma heparin level of 0.3 - 0.7 U/mL
042209 - Eval: as determined by the beparin Anti-Xz assay. Hospira-
042210 - Eval: manufactured beparin was used for the evaluation.
042211 -
042213 - ..
042214 - Log#: 091019 13:42
042215 - <--------------------VETERANS ADMINISTRATION----------------->
042216 - Type Results Units Normal
042217 - CALCIUM [Not Reported] mg/dL 8.70 - 10.20
042219 - ..
042220 - MAGNESIUM [Not Reported] mg/dL 1.80 - 2.30
042222 - ..
042223 - AST [Not Reported] IntUnits/L 8.00 - 42.00
042224 - ALT [Not Reported] IntUnits/L 5.00 - 55.00
042225 - ALKALINE PHOSP [Not Reported] IntUnits/L 37.00 - 107.00
042226 - BILIRUBIN TOTAL[Not Reported] mg/dL 0.30 - 1.20
042227 - BILIRUBIN DIRE [Not Reported] mg/dL 0.10 - 0.40
042228 - PROTEIN [Not Reported] g/dL 6.50 - 8.10
042229 - ALBUMIN [Not Reported] g/dL 3.30 - 4.80
042230 -
042232 - ..
0423 -
0424 -
0425 - 1338
0426 -
042601 - Returned to Cardiology Department.
042602 -
042603 -
042605 - ..
0427 -
0428 -
0429 - 1410
0430 -
043001 - EKG test.
043002 -
043003 - This took 10 minutes.
043004 -
043006 - ..
0431 -
0432 -
0433 - 1417
0434 -
043401 - We met with Doctor Kurt Hoffman.
043402 -
043403 - He seems to be a young physician under 30, and may have indicated he
043404 - is serving his residency.
043406 - ..
043407 - Kurt asked about patient history on chest pains leading to angiogram
043408 - test at the VA in San Francisco?
043410 - ..
043411 - Presented the record meeting with Doctor Lee at the VA in Martinez to
043412 - schedule a procedure to resolve achalasia, reported on 090908 1130,
043413 - ref SDS 3 MY4N
043415 - ..
043416 - Also presented explanation made during the stress test on why a heart
043417 - attack did not occur, because heavy exercise expanded small
043418 - capillaries to make up for some loss of blood flow due to blockages in
043419 - main arteries to the heart, discussed with Doctor Egan at the VA in
043420 - Martinez on 091002 0900. ref SDS 4 789N
043422 - ..
043423 - The doctor asked if this is the first time the patient has had this
043424 - procedure?
043426 - ..
043427 - Advised this will be the first time.
043428 -
043429 - [On 091020 0700 Doctor Quinn asked again about prior
043430 - angiogram/stent procedures. ref SDS 8 C46L
043432 - ..
043433 - Kurt advised that he or a colleague will assist Doctor Kendrick Shunk
043434 - who will lead the 2-man team performing the test, and perform any
043435 - procedures that seem appropriate, per below.
043437 - ..
043438 - Angiogram Test Orientation Issues...
043439 -
043440 - 1. Explain achalasia problem prevents laying flat which causes
043441 - vomitting. choking, and drowning.
043443 - ..
043444 - Kurt had read the medical chart showing the only medical problem is
043445 - achalasia.
043447 - ..
043448 - Kurt advised that the angiogram test requires laying flat. The only
043449 - solution is to avoid eating for 24 hours to prevent vomiting during
043450 - the test, which might take 20 minutes to 3 or 4 hours.
043451 -
043452 - [On 091021 0716 Cath Lab team not aware of achalasia
043453 - causing problems while laying flat for angiogram test.
043454 - ref SDS 10 KH32
043456 - ..
043457 - [On 091021 0716 Dennis provided folded towel to
043458 - slightly elevate the head, and suction aparatus to
043459 - prevent chocking from achalasia while lying flat for
043460 - the angiogram test. ref SDS 10 7L87
043462 - ..
043463 - [On 091021 0716 at 1429 explained background of
043464 - achalasia leading to stress test, and then angiogram
043465 - that showed need for heart surgery. ref SDS 10 P34P
043467 - ..
043468 - [On 091021 0716 at 1429 CT team planning remedies to
043469 - prevent achalasia problems of vomitting and breathing
043470 - during heart surgery. ref SDS 10 NX6M
043472 - ..
043473 - Angiogram Test Orientation Issues continues...
043474 -
043475 - 2. Cholesterol was not included with blood test today to
043476 - evaluate effectiveness of medication.
043478 - ..
043479 - 3. EKG test results...
043481 - ..
043482 - Kurt reviewed the EKG test report and said it looks good.
043484 - ..
043485 - Angiogram Test Orientation Issues continues...
043486 -
043487 - 4. Chest pain, as set out in the record on
043488 - 091007 0021. ref SDS 6 VM4Y
043490 - ..
043491 - Kurt drew a diagram showing the heart is supported by three main
043492 - arteries. He seemed to indicate that the heart pumps blood to itself
043493 - through these arteries. The angiogram test will investigate each of
043494 - these arteries for blockages.
043496 - ..
043497 - Pain occurs from the heart not getting sufficient blood due a blockage
043498 - in one or more of these arteries.
043500 - ..
043501 - Kurt said that sometimes stress tests produce false positive findings
043502 - for blockages in the arteries. The angiogram test provides a direct
043503 - examination for blockages, and enables immediate repair in many cases.
043505 - ..
043506 - Angiogram Test Orientation Issues continues...
043507 -
043508 - 5. Surgery risks for angiogram.
043510 - ..
043511 - Kurt advised that he has done 600 angiogram tests over the past 2
043512 - years, and has never had a problem, including injury to an artery, the
043513 - heart, nor of infection.
043515 - ..
043516 - Angiogram Test Orientation Issues continues...
043517 -
043518 - 6. Test schedule...
043520 - ..
043521 - Two patients are scheduled for tests starting at 0800 tomorrow
043522 - morning. Patients must arrive in the Surgery Department by 0700.
043524 - ..
043525 - Between 0700 and 0800 when tests start, a nurse will provide further
043526 - orientation.
043528 - ..
043529 - Kurt advised that Rod will either be the first or second test. If Rod
043530 - is the second test, then there may be a wait from 20 minutes to
043531 - possibly 4 hours for the test, depending on findings and procedures in
043532 - the first test.
043534 - ..
043535 - Angiogram Test Orientation Issues continues...
043536 -
043537 - 7. Test process....
043538 -
043539 - a. Patient is conscious during the procedure.
043541 - ..
043542 - b. Local anesthetic will be given at the groin on the
043543 - right leg.
043545 - ..
043546 - c. Probe will be fed into the main artery from the right
043547 - groin, and into the heart. There is a camera that can
043548 - display the condition within the arteries.
043550 - ..
043551 - Kurt described a contrast medium that will be injected
043552 - to facilitate seeing the condition of the arterie,
043553 - similar to Millie's CT tests.
043555 - ..
043556 - d. Test may find no blockages. In that case the test
043557 - could be completed in 20 minutes.
043559 - ..
043560 - e. Test may find minimal to moderate blockages, which
043561 - might be treated with stints or with medication,
043562 - including for high cholesterol.
043564 - ..
043565 - f. Test may find some moderate to severe blockages, and in
043566 - that case the team will immediately perform a procedure
043567 - to apply stints that repair the blockages in 1 to 3
043568 - arteries.
043570 - ..
043571 - This might take another 20 minutes or several hours,
043572 - depending on how many stints are needed.
043574 - ..
043575 - g. Test may find very severe blockage that requires a
043576 - special stint that must be ordered and delivered. In
043577 - that case, work will be stopped and the patient will
043578 - return after the specialized stint has been delivered.
043580 - ..
043581 - h. Test may find widespread blockages which cannot be
043582 - repaired with stints. In this case, the test will be
043583 - ended and the medical team will evaluate the case for a
043584 - heart by-pass procedure to rearrange arteries and
043585 - remove damaged material. The patient will return at a
043586 - later date for the procedure.
043587 -
043589 - ..
0436 -
0437 -
0438 - 1527
0439 -
043901 - Mil left hopefully in time to miss traffic getting across the bridge
043902 - to get home.
043903 -
043905 - ..
0440 -
0441 -
0442 - 1530
0443 -
044301 - Checked into Hoptel as instructed in Karen's letter reported in the
044302 - record on 091006 0843. ref SDS 5 VN5F
044304 - ..
044305 - After getting a room, when to the cafeteria to use a table for
044306 - working.
044307 -
044309 - ..
0444 -
0445 -
0446 - 1700
0447 -
044701 - Cafeteria closed.
044702 -
044703 - Since cannot eat anything due to achalasia so that vomitting is
044704 - avoided during angiogram test tomorrow, went to the ward next to the
044705 - Emergency Department and worked there until about midnight.
044706 -
044708 - ..
0448 -
0449 -
0450 - 0228
0451 -
045101 - Walked to Hoptel, and got to bed avoiding eating anything, until
045102 - after the angiogram test tomorrow.
045103 -
045104 -
045105 -
045106 -
045107 -
045108 -
045109 -
0452 -