CONTACTS
SUBJECTS
CT Barium Swallow Test Radiology Preliminary Results Favorable No Re
2803 -
2803 - ..
2804 - Summary/Objective
2805 -
280501 - Follow up ref SDS D3 0000. ref SDS D1 0000.
280502 -
280503 - CT barium swallow test, ref SDS 0 K37G; seems to have favorable
280504 - results, similar to prior test on 130117. ref SDS 0 QB3I This
280505 - resolves recent concern that swallowing problems reported on 141107,
280506 - due to omitting triamcinalone steriod injections to LESV have not
280507 - distorted esophagus causing recurrent achalasia "bird beak" problem.
280508 - ref SDS 0 UO9K After the test, visited Isagani's office, ref SDS 0
280509 - GU5O, and developed work plan to submit with email photographs Doctor
280510 - Stewart requested yesterday showing Dor fundoplication has loosened.
280511 - ref SDS 0 2X5N
280512 -
280513 -
280514 -
280516 - ..
2806 -
2807 -
2808 - Progress
280901 - ..
280902 - CT Barium Swallow Assess Redo Fundoplication Fix Hiatal Hernia and Ulceration
280903 -
280904 - Follow up ref SDS D3 NU8L, ref SDS D1 NU8L.
280905 -
280906 - This morninng visited Radiology on 2nd Floor Building 200, scheduled
280907 - with Mike yesterday on 150526 1300. ref SDS D3 WY3O
280909 - ..
280910 - Mike did check-in administration, and provided patient medical
280911 - identification braclet.
280912 -
280914 - ..
2810 -
2811 -
2812 - 0938
2813 -
281301 - Another Mike came and led the way to the radiation work room. This
281302 - avoided having to stand around in the Waiting Room, and so was
281303 - appreciated.
281305 - ..
281306 - Changed to a hospital patient gown.
281307 -
281309 - ..
2814 -
2815 -
2816 - 0952
2817 -
281701 - Mike completes equipment setup. The doctor arrives. Could not
281702 - remember his name.
281704 - ..
281705 - CT barium swallow test was performed, similar to prior test on 130117
281706 - 0900, ref SDS 95 HR9K, except today, no supplemental xray test was
281707 - done.
281709 - ..
281710 - After multiple images were again taken today, was able to view the
281711 - last screen, similar to the test on 130117. It seemed to show...
281713 - ..
281714 - Live imaging on the monitor showed swollowing seems significantly
281715 - improved from the original study on 050714 1000. ref SDS 2 6136 The
281716 - esophagus seems much less distorted. There is slight distoration
281717 - above LESV, but there is no big bulge nor long string-like structure
281718 - that was in the original study nearly 8 years ago, 050714 1000,
281719 - ref SDS 2 B94J, and shown again by Doctor Lee in a meeting at the VA
281720 - on 051202 1430. ref SDS 6 5B5K Images today look relatively normal...
281721 -
281722 -
281723 - | |
281724 - | |
281725 - | |
281726 - | | Esophagus
281727 - | |
281728 - | |
281729 - | |
281730 - | |
281731 - | |
281732 - | |
281733 - | |
281734 - | |
281735 - \ | Lower Esophageal Spincter Valve (LESV)
281736 - \ \
281737 - / -----------\
281738 - / \
281739 - | \ Stomach
281740 - | |
281741 - | |
281742 - / /
281743 - / ------------ /
281744 - | /
281745 - \ \
281746 - \ --------------
281747 - -- ----------------
281748 -
281750 - ..
281751 - The attending physician said the imaging today looks better than prior
281752 - test for the patient. He likely was referring to the test on 091218,
281753 - reported in the record a year later on 100928 0706, ref SDS 56 1357,
281754 - because that is the only test on the VA Medical Center server in San
281755 - Francisco, where the study is being performed. If he did not know
281756 - there were other tests, he would not have known to look for them.
281758 - ..
281759 - Reminded the doctor 2 other prior studies were done. The original on
281760 - 050714 1000, ref SDS 2 B94J, shows significant distortion in the
281761 - esophagus above LESV, commonly called "bird beak." This condition
281762 - would be similar to the condition of the esophagus on 091218, after
281763 - Heller Myotomy surgery, and which the doctor likely saw in his
281764 - preliminary research preparing for this study today. The most recent
281765 - test was on 130117, and looked similar to the test today, with the
281766 - esophagus significantly largely recovered to normal configuration,
281767 - discussed above. ref SDS 0 QB3I
281769 - ..
281770 - This result will be clarified on receipt of the doctor's analysis.
281772 - ..
281773 - In the meantime, preliminary indications resolve concerns that recent
281774 - swallowing problems from omitting triamcinalone injections, reported
281775 - on 141107 0800, ref SDS C2 VV6N, have not caused recurrence of
281776 - achalasia distorted esophagus from food and liquid backing up due to
281777 - constricted LESV, and as discussed with Doctor Lee in planning
281778 - investigations with Doctor Stewart on 150319 0800. ref SDS C7 J24M
281779 - This was discussed again more recently on 150521 0800. ref SDS D2 OG6L
281780 -
281781 -
281782 -
281783 -
2818 -
SUBJECTS
Photographs Submit Email Best Evidence EGD Dilations Assess Severity
4103 -
4104 - 1028
410501 - ..
410502 - Meeting Isagani's Office Assistant to Doctor Stewart Building 202 2nd Floor
410503 -
410504 - Follow up ref SDS D3 RV3G.
410505 -
410506 - After completing the CT test in Radiology on the 2nd floor in building
410507 - 200, walked down the hall taking the elevated enclosed walkway to
410508 - building 202.
410510 - ..
410511 - At the end of the hall on entering building 202, there is an unmarked
410512 - door across the hallway diagonally to the left. Someone had earlier
410513 - advised that Doctor Stewart's staff works in that small room.
410515 - ..
410516 - Knocked on the door. A woman opened the door. Inside was a singel
410517 - cubical dividing wall. On the far side is Isagani's workstation, and
410518 - on the near side was the woman's workstation.
410520 - ..
410521 - Asked for Isagani. The woman said he has a phone call, and asked if
410522 - she could help? Could hear Isagani talking in the next cubicle.
410524 - ..
410525 - Explained meeting yesterday, that Doctor Stewart could not access
410526 - photographs from VA MC server in Sacramento (Mather), needed to
410527 - evaluate requirements for redo Dor fundoplication, reported on 150526
410528 - 1300. ref SDS D3 RV3G
410530 - ..
410531 - Advised I have the pictures and can submit with email, if needed.
410533 - ..
410534 - The woman was very helpful. She tried to access the photographs from
410535 - the server for the VA Medical Center in Sacramento (Mather). This was
410536 - again unsuccessful, as occurred when Doctor Stewart tried yesterday.
410537 - ref SDS D3 F65O
410539 - ..
410540 - By this time, Isagani completed his call. He said they will continue
410541 - to try accessing the photogrpahs to support Doctor Stewart. In the
410542 - meantime, he requested the patient submit with email available files
410543 - with the photographs she needs.
410544 -
410545 - [On 150529 1202 letter to Isagani submits the record
410546 - meeting with Doctor Stewart the day before on 150526, and
410547 - transmits photographs she requested, as planned meeting
410548 - with Isagani the next day on 150527. ref SDS D4 SQ50
410550 - ..
410551 - Thanked Isagani and his colleague for timely attention to assist the
410552 - doctor.
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