CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 19 0000, ref SDS 16 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
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 11 PS60  On 091104 0718 Medical Chart
040904 - discharge guidance lists meeting with Doctor Stewart 091117 1300,
040905 - which conflicts with patient history today. ref SDS 12 Q03J  On 091119
040906 - 1000 Erick confirmed visit with Doctor Stewart on 091208, and is
040907 - reviewing date of surgery scheduled for 091217. ref SDS 14 935H
040909 -  ..
040910 - On 091208 Doctor Stewart advanced the schedule for surgery one day to
040911 - 091216. ref SDS 16 6E41
040913 -  ..
040914 - On 091216 0600 meeting Doctor Stewart for Heller Myotomy surger to
040915 - correct achalasia; check in at ASU. ref SDS 19 PP8W
040916 -
040917 -
040918 -
040920 -  ..
0410 -
0411 -
0412 - Progess
0413 -
041301 - There is condiderable pain today in the stomach and upper chest.
041302 -
041303 - Medication everu 2 hours helps control pain.  Needed two treatments
041304 - within an hour twice this morning.
041305 -
041306 -     [On 091218 0541 found that hiking helps relieve surgical pain; so
041307 -     ended pain medication at 0300; still having difficulty getting in
041308 -     and out of bed. ref SDS 20 PP8W
041309 -
041310 -
041312 -  ..
0414 -
0415 -
0416 - 0942
0417 -
041701 - Joe and Jon visited.
041702 -
041703 - They advised that Heller Myotomy surgery was successful yesterday on
041704 - 091216, so Doctor Stewart expects complete recovery from achalasia, as
041705 - planned in the meeting on 091030. ref SDS 9 GM5I  Report seems to
041706 - resolve swallowing problem which has been pending for four years,
041707 - reported in the meeting with Doctor Lee on 090908 1130. ref SDS 7
041708 - FT6M
041710 -  ..
041711 - Joe advised there was a complication during surgery, which caused a
041712 - small tear in the lining of the esophagus.  This was repaired during
041713 - the operation.  Doctor Stewart has ordered an xray study tomorrow to
041714 - evaluate the repair.  The test will use Gastrogafin contrast medium,
041715 - similar to Millie's CT tests that evaluate progression of cancer,
041716 - reported on 080718 1030. ref SDS 6 2U6L
041717 -
041718 -        [On 091218 0541 xray study performed, ref SDS 20 PQ5Q; results
041719 -        seem to show repair was effective, indicating successful Heller
041720 -        Myotomy surgery to recover from achalasia. ref SDS 20 ES5H
041722 -  ..
041723 - As a result, the patient will remain NPO (nothing by mouth) for
041724 - another day (ordered yesterday on 091216 0600. ref SDS 19 HQ5M), and
041725 - if the test tomorrow is successful, there will be a transition toward
041726 - solid food and drink, beginning with liquid diet.
041727 -
041728 -        [On 091218 0541 at 1647 Doctor Stewart advises that Heller
041729 -        Myotomy surgery successful; patient NPO status ends, can
041730 -        begin eating and drinking, and go home tomorrow or Sunday.
041731 -        ref SDS 20 ER4F
041733 -  ..
041734 - Jon emphasized during the meeting that hiking several times a day is
041735 - a major theraputic treatment for recovery.
041737 -  ..
041738 - Joe noticed the stomach is still bloated; he expects hiking will help
041739 - resolve this problem.
041741 -  ..
041742 - Actually, there is considerable pain in the stomach and across the
041743 - chest.  Will try to dissipate this with hiking.  However, getting in
041744 - and out of bed, sitting and getting up from a chair that all involve
041745 - bending the stomach causes acute pain.
041747 -  ..
041748 - Jon said that he will sign an order to increase pain medication to
041749 - every hour, and if that doesn't work he will prescribe stronger
041750 - treatment.
041751 -
041753 -  ..
0418 -
0419 -
0420 - 1033
0421 -
042101 - Asked the nurse, Rose, for additional pain medication, prescribed by
042102 - the doctor earlier, per above. ref SDS 0 OG57
042104 -  ..
042105 - Rose checked the medical chart, and said that pain medication is
042106 - still only prescribed every 2 hours.  She feels the doctor forgot to
042107 - enter the new order.
042109 -  ..
042110 - Rose left to call the doctor.
042111 -
042113 -  ..
0422 -
0423 -
0424 - 1051
0425 -
042501 - Rose returned and advised that everything is squared away.  The
042502 - medical team was contacted and posted the doctor's order to the
042503 - medical chart to give pain medication every hour, rather than every 2
042504 - hours.
042506 -  ..
042507 - Effective doctor/patient partnership correcting the medical chart in
042508 - time to avoid pain and suffering aligns with prior experience
042509 - following heart surgery on 091103 0347. ref SDS 11 A346
042511 -  ..
042512 - Rose provided additional pain medication.
042514 -  ..
042515 - This was very helpful throughout the day.
042516 -
042517 -        [On 091218 0541 at 1647 Doctor Stewart approves ending NPO
042518 -        status, so patient can eat and drink normally, including taking
042519 -        oral medications, which will reduce pain getting drugs through
042520 -        IV catheters. ref SDS 20 FU5O
042522 -         ..
042523 -        [On 091219 0600 pain also controlled with hiking. ref SDS 21
042524 -        PP8W
042526 -         ..
042527 -        [On 091219 0600 coordinate with nurse on transitioning from IV
042528 -        to oral medication treatments, and to reduce pain from using IV
042529 -        catheters which have expired and now cause pain getting
042530 -        medication. ref SDS 21 PQPX
042532 -         ..
042533 -        [On 100301 0313 Ed had problems at the VA in Sacramento,
042534 -        because doctor's order for pain medication was not posted to
042535 -        medical chart. ref SDS 22 YL9J
042536 -
042537 -
042538 -
042540 -  ..
0426 -
0427 -
0428 - 1053
0429 -
042901 - Belongings delivered.  Ellen helped setup the computer.
042902 -
042903 - Could not find the mouse.
042905 -  ..
042906 - Ellen called ASU and Kimberly came to TCU.  She found the mouse in
042907 - the computer case on the back side.
042908 -
042909 -
042911 -  ..
0430 -
0431 -
0432 - 1146
0433 -
043301 - Went hiking again, another 10 laps, which is about a mile.
043302 -
043303 - Did this 3 times today.
043304 -
043306 -  ..
0434 -
0435 -
0436 - 1451
0437 -
043701 - Pain in the chest seems to be subsiding.  Stomach still hurts,
043702 - actually seems worse than this morning, but difficult to guage.
043704 -  ..
043705 - Ellen has been very good providing additional pain medication,
043706 - prescribed per above. ref SDS 0 O45H
043708 -  ..
043709 - Very painful to get in and out of bed, because this requires bending
043710 - at the waist.
043712 -  ..
043713 - Voice began to decline due to lack of using the chest, and salivary
043714 - glands that makes the entire digestion system very dry.
043716 -  ..
043717 - Ellen suggested taking more water with the sponge system.
043719 -  ..
043720 - Voice got better.
043721 -
043722 -
043724 -  ..
0438 -
0439 -
0440 - 1651
0441 -
044101 - Doctor Stewart visited.
044102 -
044103 - Sounds like this hospital stay may extend another 3 or 4 days, in
044104 - order to resolve swelled stomach, and transition to eating solid
044105 - food.
044107 -  ..
044108 - The doctor mentioned benefits of hiking again to advance recovery.
044110 -  ..
044111 - Doctor Stewart explained complications during surgery yesterday, cited
044112 - by Jon and Joe, earlier this morning, per above. ref SDS 0 0042  She
044113 - feels can start eating solid food in a day or so if test tomorrow is
044114 - favorable.
044115 -
044116 -
044118 -  ..
0442 -
0443 -
0444 - 1729
0445 -
044501 - Molly visited about social issues of some kind.  Was not sure what
044502 - this is about.
044504 -  ..
044505 - Was pleased to commend VA health care.
044507 -  ..
044508 - Molly will get the ball rolling on transportation home in the event
044509 - that Millie is not feeling well enough to drive.
044511 -  ..
044512 - Molly said that the VA has prepared documents to award a disability
044513 - pension as a result of heart surgery on 091022, and Heller Myotomy
044514 - surgery yesterday to enable swallowing.  Asked how this relates to
044515 - social security?  Molly said VA medical disability supplements Social
044516 - Security, and someone will visit tomorrow with the documents to sign.
044517 -
044518 -        [On 091218 0541 Molly's colleague presented VA filing for
044519 -        disability benefits. ref SDS 20 X44J
044521 -         ..
044522 -        [On 101008 1251 Karen explained Social Security retirement
044523 -        benefits cannot include disability because VA has awarded
044524 -        medical disability payments. ref SDS 23 K755
044525 -
044526 -
044528 -  ..
0446 -
0447 -
0448 - 1744
0449 -
044901 - After Molly left, Ellen visited on pain management.
044902 -
044903 - Not very productive on computer, because hard to write up the record
044904 - when pain is a problem.
044906 -  ..
044907 - Ellen provided pain medication under the 2-hour rule, per above.
044908 - ref SDS 0 O45H
044910 -  ..
044911 - Fell asleep.
044912 -
044913 -
044914 -
044915 -
044916 -
044917 -
0450 -