CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 19 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 091103 Paula reported the VA has scheduled a meeting today with
040902 - Doctor Stewart for planning Heller Myotomy surgery to correct
040903 - achalasia problem. ref SDS 14 PS60
040905 -  ..
040906 - On 091104 0718 Medical Chart discharge guidance lists meeting with
040907 - Doctor Stewart 091117 1300, which conflicts with patient history
040908 - today. ref SDS 15 Q03J
040910 -  ..
040911 - On 091119 1000 Erick confirmed visit with Doctor Stewart on 091208,
040912 - and is reviewing date of surgery scheduled for 091217. ref SDS 17 935H
040914 -  ..
040915 - On 091208 1300 met with Doctor Stewart and Doctor Tabrizi and advanced
040916 - schedule for surgery to resolve achalasia one day to 091216.
040917 - ref SDS 19 QB41  At that time, Mike scheduled pre-op visit today for
040918 - labs, and then orientations with General Surgery, Anesthesia, and with
040919 - the ASU nurse. ref SDS 19 PUQT
040921 -  ..
040922 - On 091211 1523 letter notifies medical team confirming understandings
040923 - from meeting with Doctor Stewart on 091208, ref SDS 20 PPXY, including
040924 - that Coumadin is ended based on sonogram test finding no evidence of
040925 - DVT nor blood clot problems of any kind, ref SDS 20 445Y; by copy
040926 - notify Diana that meeting scheduled for 091214 to check INR and adjust
040927 - Coumadin is no longer needed, and so can be cancelled. ref SDS 20 446W
040929 -  ..
040930 - On 091214 visited VA in San Francisco and performed pre-op tasks for
040931 - surgery to resovle achalasia. ref SDS 0 5R5H
040932 -
040933 -
040935 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Pre-op schedule received on 091208, ref SDS 19 PUQT, and cited in
041302 - letter to medical team on 091211 1523. ref SDS 20 PPXY
041304 -         ..
041305 -        Preparing for Your Operation or Procedure
041306 -
041307 -        Follow up ref SDS 19 CG5S.
041309 -             ..
041310 -        1.  Laboratory blood draw.
041311 -
041312 -            091214 1400................. Building 200 2nd floor 2B-113A
041314 -  ..
041315 - When we arrived in the lab, Edwin was behind the counter.  He had done
041316 - blood draws a number of times during recovery from heart surgery,
041317 - e.g., on 091103. ref SDS 14 4Z7C
041319 -  ..
041320 - Edwin drew blood ordered by Doctor Stewart on 091208. ref SDS 19 6F6F
041321 - and scheduled by Mike for today. ref SDS 19 PUTW
041323 -  ..
041324 - After getting a blood draw, went to the cafeteria for lunch, until
041325 - meeting in module 2 at 1300.
041326 -
041328 -  ..
0414 -
0415 -
0416 - 1300
0417 -
041701 - Isagani came into the Module 2 patient waiting area and introduced
041702 - himself...
041704 -             ..
041705 -        2.  Patient history and physical examination, that supplments
041706 -            the work done by Doctor Tabrizi and Doctor Stewart,
041707 -            reported on 091208 1300. ref SDS 19 QB7H
041709 -             ..
041710 -            091214 1300................. Building 200 Clinic Module 2
041712 -  ..
041713 - In the examination room, Isagani asked about doing an xray and EKG?
041715 -  ..
041716 - Reviewed Doctor Stewart's determination on 091208 that these tests
041717 - performed at the VA in Martinez on 091117 are sufficient for the
041718 - current Heller Myotomy procedure scheduled on 091216. ref SDS 19 0P4N
041720 -  ..
041721 - Isagani asked for patient history on achalasia, which is scheduled for
041722 - surgical treatment in 2-days on 091216.
041724 -  ..
041725 - Reviewed background presenting patient history to Doctor Stewart and
041726 - Doctor Tabrizi last week on 091208.  Today, submitted printed reports
041727 - on following patient history, previosuly requested numerous times by
041728 - the medical team....
041729 -
041730 -            1.  Meeting with Doctor Stewart and Doctor Tabrizi on
041731 -                091208. ref SDS 19 PQ4Y
041733 -                 ..
041734 -            2.  Meeting with Doctor Lee at VA in Martinez showing
041735 -                patient history on achalasia and chest pains leading to
041736 -                heart surgery, reported on 090908 1130, ref SDS 7 FT6M
041738 -                 ..
041739 -            3.  Meeting with Doctor Lee at VA in Sacramento showing
041740 -                performance of endoscopy test, reported on 060330 0712.
041741 -                ref SDS 5 VX4G; and also manometry test, also, reported
041742 -                on 060330 0712. ref SDS 5 MC7P
041744 -  ..
041745 - During the meeting, Isagani used the case study on patient history
041746 - listed for the meeting with Doctor Lee on 090908, ref SDS 7 FT6M, to
041747 - find records on the VA computer reporting the manemotry test on
041748 - 060330, and which supported diagnosis of achalasia; however, the VA
041749 - records do not show the numerical findings from the test, as reported
041750 - by Doctor Lee in his record for meeting on 090908.  Doctor Lee's
041751 - report does confirm that the manemotry test established achalasia.
041752 - This aligns with Doctor Ratcliff's determination on 091030, also,
041753 - relying on patient history. ref SDS 11 V15O
041755 -  ..
041756 - Isagani feels patient records can help the medical team maintain
041757 - understandings on discovery, testing, and treatment for achalasia, and
041758 - chest pains leading to heart surgery, and which have been presented
041759 - over 10 times the past few months, reported on 091021 0716.
041760 - ref SDS 9 LJ7L
041762 -  ..
041763 - Isagani made copies of these reports and took them for processing by
041764 - the VA.  He explained these documents will be attached to his report
041765 - on the meeting today, and can be accessed for future reference under a
041766 - heading...
041767 -
041768 -                           Vista Imaging
041770 -  ..
041771 - Isagani showed results of the lab earlier this morning, per above,
041772 - ref SDS 0 PUTW, on the computer screen.  Since the VA restricts
041773 - distribution of communications to patients, the record does not yet
041774 - show the precise findings from the lab.  From memory, these results
041775 - were reported favorably today...
041776 -
041777 -        INR 1.1,
041779 -  ..
041780 - Meets requirements for surgery on Wednesday.
041782 -  ..
041783 - Isagani was aware that Doctor Stewart ordered ending Coumadin
041784 - (warfarin) on 091208, based on sonogram test showing DVT is resolved.
041785 - ref SDS 19 YE59
041786 -
041787 -        Albumin 4.2
041789 -  ..
041790 - Rising albumin shows continued improvement in nutrition, discussed
041791 - with the CT surgery team on 091030, ref SDS 11 1O58, including
041792 - discussion wth KC, ref SDS 11 ZN9O, saying the team wants albumin
041793 - increased to 3.6. ref SDS 11 MU5N
041794 -
041795 -        WBC 11.6
041797 -  ..
041798 - Isagani asked about patient history that reconciles WBC elevated
041799 - above VA stantards of 3.? - 10.
041801 -  ..
041802 - Reviewed background showing WBC elevated consistently in all labs
041803 - beginning in 2005.  Isagani checked the record and noticed this
041804 - condition is shown in the VA computer.  Thus, "normal" in this case
041805 - is WBC 12 + or -
041807 -  ..
041808 - Reviewed concerns about aspiration pneumonia because WBC spiked to 22
041809 - and CT test showed possible fluid on the lungs, reported on 091102.
041810 - ref SDS 13 PQ5P, and leading to treatment with antibiotics,
041811 - ref SDS 13 PB6Y, and which were found unnecessary the next day by
041812 - Doctor Penn, reported on 091103 0347. ref SDS 14 ER3K  WBC elevated to
041813 - 22 dropped back to 12 (normal), after infection declined from heart
041814 - surgery incision on the right leg, reported on 091104, ref SDS 15
041815 - PRPV, and from implementing Jan's advice in TCU the day before on
041816 - 091103 0347. ref SDS 14 G46G
041818 -  ..
041819 - On 090813 lab showed that cholesterol was still too high, ref SDS 6
041820 - 4N5H, as follows...
041821 -
041822 -        Cholesterol       H   233      mg/dL ref: <= 200.00
041823 -        Triglyceride          118      mg/dL ref: <= 150.00
041824 -        HDL Cholesterol   L    30      mg/dL ref: >=  40.00
041825 -        LDL Cholesterol   H   179      mg/dL ref: <= 160.00
041827 -  ..
041828 - Cholesterol is related to coronary health; problems are reflected in
041829 - findings from angiogram test on 091021 0716, ref SDS 9 7L43, and
041830 - leading to heart bypass surgery the next day on 091022 0700.
041831 - ref SDS 10 PQWU
041833 -  ..
041834 - Isagani seemed to say today during the meeting that cholesterol, and
041835 - HDL cholesterol are now within the target range, and that LDL
041836 - cholesterol is still slightly high.
041838 -  ..
041839 - Isagani advised that rest of the lab also shows the patient is healthy
041840 - enough for surgery on Wednesday, i.e., patient is "good to go" for
041841 - Heller Myotomy surgery on 091216, ordered by Doctor Stewart last week
041842 - on 091208. ref SDS 19 PQVQ
041844 -  ..
041845 - Isagani asked about patient history for possible conflicts and
041846 - adjustments required to perform surgery on Wednesday.  These questions
041847 - are similar to questions asked by Doctor Tabrizi during the meeting
041848 - with Doctor Stewart on 091028. ref SDS 19 KU8I
041850 -  ..
041851 - Isagani asked about exercise.
041853 -  ..
041854 - Reviewed the record the past 2 months, hiking several miles per day at
041855 - the hospital until discharge on 091104, shown for example on 091103.
041856 - ref SDS 14 I15I  More recently, have been hiking from 3 - 9 miles per
041857 - day 4 - 5 days per week at Lafayette Reservoir.  This is the same
041858 - route where chest pains led to discovering angina, reported on 090908,
041859 - ref SDS 7 MY4N, which required heart surgery to correct.  The past
041860 - week severe inclement weather has prevented hiking at Lafayette
041861 - Reservoir.
041863 -  ..
041864 - Isagani asked if there are stairs at home.  Millie related the stairs
041865 - have 16 steps, rising 10 feet.  Further reported there is no shortness
041866 - of breath going up and down stairs 10+ times per day.
041868 -  ..
041869 - Isagani performed physicial exam testing range of motion, and strength
041870 - based on resisting pressure he supplied to ourstretched arms.  He
041871 - tested vision following movement of his finger up and down, side to
041872 - side.
041874 -  ..
041875 - Reported significant recovery from heart surgery, CABG, on 091022
041876 - 0700, ref SDS 10 PQWU, evidenced in the past week by increased range
041877 - of motion without discomfort stretching incision adhesions, and
041878 - further with significantly reduced pain from coughing and sneezing,
041879 - which initially caused very severe pain in Ocober and early November.
041881 -  ..
041882 - Vitals were taken, and reported within normal range.
041883 -
041884 -            Weight,,,,,,,,,,,,,,,,, 175
041885 -            Blood pressure......... 119 63
041886 -            Pulse.................. 77
041887 -            Oxygen................. 98%
041888 -            Temperature............ 97.7
041890 -  ..
041891 - Isagani feels patient ready for surgery on 091216.
041892 -
041893 -        [On 091216 0600 meeting at VA for Heller Myotomy surgery to
041894 -        recover fro achalasia. ref SDS 21 4M5T
041895 -
041896 -
041898 -  ..
0419 -
0420 -
0421 - 1400
0422 -
042201 - Visited Karen in the ASU unit on 3rd floor...
042203 -             ..
042204 -        3.  Anesthesia pre-op clinic examination and orientation.
042205 -
042206 -            091214 1400................. Building 200 3rd floor 3A-122
042208 -  ..
042209 - Karen asked about patient history for possible conflicts with general
042210 - anesthesia required on Wednesday for surgery.   These are similar
042211 - questions asked by Doctor Tabrizi on 091208 during examination with
042212 - Doctor Stewart, ref SDS 19 KU8I, and, asked again today by Iszgani,
042213 - per above. ref SDS 0 5W9J
042215 -  ..
042216 - Karen recommended resuming medication with Metoprolol listed in the
042217 - medical chart on 091104 0718. ref SDS 15 UN6L  She advised that if
042218 - blood pressure drops below 100 again, then take a half pill once a
042219 - day, rather than twice per day.
042221 -  ..
042222 - Karen said to discontinue taking aspirin until after surgery, also,
042223 - prescribed on 091104 0718. ref SDS 15 414R
042225 -  ..
042226 - Vitals were taken again...
042227 -
042228 -            Blood pressure......... 112 67
042229 -            Pulse.................. 64
042230 -            Oxygen................. 98%
042232 -  ..
042233 - Karen noted requirement for suction during surgery to prevent
042234 - aspiration into the lungs from food in the lower esophagus, which was
042235 - configured by Doctor Brzezinski, reported on 091022. ref SDS 10 3W6L
042237 -  ..
042238 - Would be helpful for Doctor Brzezinski to support anesthesia for
042239 - laparoscopic surgery on Wedensday, 091216.  Karen seemed to say nobody
042240 - has been assigned for this yet.
042242 -  ..
042243 - Karen feels patient ready for surgery on 091216.
042244 -
042245 -        [On 091216 0600 meeting at VA for Heller Myotomy surgery to
042246 -        recover fro achalasia. ref SDS 21 4M5T
042247 -
042248 -
042249 -
042250 -
042252 -  ..
0423 -
0424 -
0425 - 1438
0426 -
042601 - Visited Rene in ASU Department...
042602 -
042603 -        4.  Ambulatory Surgical Unit (ASU) meeting for orientation
042604 -            with nurses.
042606 -             ..
042607 -            091214 1400................. Building 200 3rd floor 3A-122
042608 -            (included with Anesthesia pre-op clinic visit)
042610 -  ..
042611 - Renee recalled work on 091020 waiting for angiogram test, including
042612 - using the computer. ref SDS 8 PPYW  Getting ready for surgery on
042613 - 091216, will be similar to the process on 091020.
042615 -  ..
042616 - She explained that after checking in at 0600 for surgery preparation,
042617 - there may be a wait for several hours.  Can work on the computer while
042618 - waiting for surgery team to peform the work.
042620 -  ..
042621 - Renee feels patient ready for surgery on 091216.
042623 -  ..
042624 - Renee said someone will call tomorrow, Tuesday afternoon, confirming
042625 - schedule for surgery on Wedensday morning.
042627 -  ..
042628 - She expects this case will be the first surgery on Wednesday.
042629 -
042630 -        [On 091216 0600 meeting at VA for Heller Myotomy surgery to
042631 -        recover fro achalasia. ref SDS 21 4M5T
042632 -
042633 -
042634 -
042635 -
042636 -
042637 -
042638 -
042639 -
042640 -
042641 -
0427 -