CONTACTS 

SUBJECTS
Afib Diagnose Coronary Heart Disease Schedule 110310 24 Hour Heart M

6603 -
6603 -    ..
6604 - Summary/Objective
6605 -
660501 - Follow up ref SDS 75 0000. ref SDS 74 0000.
660502 -
660503 -
660504 -
660506 -  ..
6606 -
6607 -
6608 - Progress
6609 -
660901 - Cardiology Meeting Scheduled Review Recovery Heart Surgery
660902 -
660903 - Follow up ref SDS 75 OF8F, ref SDS 74 OF8F.
660904 -
660905 -    1.  Subject: Coordinate meeting Doctor Egan and Doctor Lee
660906 -        Date: Tue, 29 Mar 2011 22:46:28 -0700
660915 -         ..
660916 -    2.  Doctor Egan in Cardiology has scheduled a treadmill test next
660917 -        week on 110406, to follow up stress test you ordered on 090908,
660918 -        ref SDS 9 H27N, leading to CABG on 091022. ref SDS 12 LO3G
660919 -        Testing next week sets a baseline to assess future cardiology
660920 -        issues, and supplements a Helter monitor test for afib
660921 -        performed a few weeks ago on 110310. ref SDS 76 OF8F  Thanks to
660922 -        excellent VA care, expect tests to show strong cardiovascular
660923 -        function, unlike the test in 2009, which found 11 problem nodes
660924 -        and required 4 bypass grafts [...noted in Doctor Egan's medical
660925 -        chart on 091002, ref SDS 10 1W5I, Patient history on 101010
660926 -        shows hiking has increased to between 30 - 40 miles per week,
660927 -        and lap time has reduced.  BP is consistently below 120 and
660928 -        heart rate in the morning is below 60, sometimes below 50,
660929 -        e.g., 46 on 110311. ref SDS 47 964N
660931 -         ..
660932 -    3.  You can see, as well, vomiting has been nearly eliminated,
660933 -        achieved with your dilation procedures, and from eating a
660934 -        "soft" diet to prevent stiff food from clogging the esophagus.
660935 -        Eating slowly and drinking plenty of liquid with meals further
660936 -        aids swallowing.  Since meat seems to congest swallowing, have
660937 -        mostly eliminated this from daily diet.  On 110327, this past
660938 -        Sunday, tried some hamburger and had no vomiting. ref SDS 47
660939 -        WP6F
660940 -
660941 -            [On 110429 1230 Doctor Lee's Discharge document following
660942 -            EGD and dilating esophageal stricture to size of "ring
660943 -            finger," recommends eating "small bites" to aid swallowing.
660944 -            ref SDS 80 316N
660946 -             ..
660947 -            [On 101010 0744 case study for 110504, vomitting 90% likely
660948 -            due to eating too fast, with big bites - big mistake,
660949 -            despite report that esophageal stricture was dilated on
660950 -            110429, larger than expected. ref SDS 47 L68L
660952 -         ..
660953 -    4.  This shows progress since 101218, recovering from achalasia.
660955 -         ..
660956 -    5.  In a meeting on 110309, Doctor Egan recommended aspirin for
660957 -        risk management to avoid recurrence of heart disease.  Studies
660958 -        present mixed findings on conflicts with Omeprazole at 20 mg
660959 -        per day.  Have not found studies taking aspirin with Omeprazole
660960 -        80 mg per day, currently prescribed. [...reported during
660961 -        meeting at VA on 101210 0930. ref SDS 63 HW8H...]  In the
660962 -        meeting on 110218, we discussed reducing the dose to prior
660963 -        prescribed levels (i.e., 40 or 20 mg per day -, ref SDS 70
660964 -        SR64).  Following EGD examination you continued an 80 mg dose,
660965 -        perhaps related to the stricture contracting back to 11 mm.
660966 -        ...[reported on 110218 0730. ref SDS 70 SS8I...]
660967 -
660968 -            [On 110406 1230 Gesila seemed aware of published studies
660969 -            reporting possible conflicts between aspirin and low dose
660970 -            Omeprazole 20 mg. ref SDS 77 IW5Y
660972 -             ..
660973 -            [On 110415 0900 Doctor Egan seemed aware of studies
660974 -            reporting conflicts between aspirin and low dose Omeprazole
660975 -            20 mg; he discussed consideration to reduce prescription
660976 -            for high dose Omeprazole 80 mg. ref SDS 78 UR7L
660978 -         ..
660979 -    6.  Hopefully, EGD and biopsy on 110429, will support reducing
660980 -        Omeprazole, and find that steroid injection you added has
660981 -        helped prevent esophageal stricture from contracting again from
660982 -        14 back to 11 mm, as found on 110218. ref SDS 70 SS5N
660984 -         ..
660985 -    7.  Hoping, as well, Cardiology can schedule meeting Doctor Egan on
660986 -        110429 AM to review findings from Helter monitor and the stress
660987 -        test, and then do the EGD and dilation procedure scheduled with
660988 -        you for 1230 that day.  My sister-in-law, Kathy, is driving
660989 -        over from Sacramento to be the designated driver required for
660990 -        EGD with sedation.  Would like her to join meeting with Doctor
660991 -        Egan on 110429 in the morning, if this can be coordinated.
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6611 -