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SUBJECTS
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0403 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0403 -    ..
0404 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040501 - Follow up ref SDS 10 0000. ref SDS 9 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
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040508 -  ..
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0407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0408 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040901 - Sent letter to Lana at Wound Care Clinic VA Medical Center San Francisco                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040902 - and saying...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040903 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040904 -    1.  Subject:  Wound Dressing Changed Ahead of Schedule Increased Bleeding                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040905 -        Date:  2015-10-16 11:11                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040912 -         ..
040913 -    2.  This morning, dressing seemed to be slipping after 15 mile hike                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040914 -        yesterday, so removed gauze wrapping to replace with tighter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040915 -        wrapping [...reported in case study on 140101 0600. ref SDS 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040916 -        BB6G...], as we have been doing.  This showed moisture through                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040917 -        Enluxtra bandage, so removed it.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040919 -         ..
040920 -    3.  As shown in attached pictures, there was quite a bit more                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040921 -        bleeding than when Enluxtra has been changed the past few                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040922 -        weeks, most recently 2 days ago in your office on Wednesday.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040923 -        As a result, changed dressing today, instead of waiting until                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040924 -        tomorrow, as set out in the work plan on Wednesday, 151014.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040925 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040926 -            [...below on 151016 1053 at 0815 Lana recommends hikng 11                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040927 -            miles per day, and explains new tissue created by healing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040928 -            process tends to bleed more because it creates new blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040929 -            vessels. ref SDS 0 GH3L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040931 -         ..
040932 -    4.  Also shown in the pictures, wound bed now seems nearly even                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040933 -        with skin, indicating full recovery seems imminent with your                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040934 -        care.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040936 -         ..
040937 -    5.  Unless you instruct differently, will check dressing Sunday,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040938 -        and if needed, change it again, or wait until Monday according                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040939 -        to conditions observed.  I have Enluxtra bandages to make 2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040940 -        more changes after that, toward meeting with you scheduled                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040941 -        Friday 151023 0800.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040943 -         ..
040944 -    6.  I will be at the VA on Monday 0930 for a coronary CT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040945 -        angiography test, which the team has been trying to schedule                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040946 -        the past 2 years.  If you feel it necessary, you could take a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040947 -        look at the wound before 0800.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040948 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040949 -            [...below on 151016 1053 at 0815 Lana will examine the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040950 -            wound and change the dressing on Monday, 151019 0800.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040951 -            ref SDS 0 9A5M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040953 -         ..
040954 -    7.  Have a good weekend.  Maybe you will see me out there making                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040955 -        the turn from Oak Grove to Treat.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040956 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040965 -         ..
040966 -        Attachments...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040967 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
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040978 -  ..
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0411 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0412 - 0815                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0413 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041301 - Received letter from Lana at Wound Clinic VA Medical Center in San                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041302 - Francisco and saying...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041303 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041304 -    1.  Subject:  RE: [EXTERNAL] Wound Dressing Changed Ahead of Schedule Increased Bleeding                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041305 -        Date:  2015-10-16 12:42                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041312 -         ..
041313 -    2.  Try not to hike 15 miles, go back to 11.  Wound looks good, new                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041314 -        tissue form a lot of vessels , that is why it is prone to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041315 -        bleed.  Change dressing as we discussed when drainage reaches                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041316 -        the margin and you start seen it on a gauze.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041318 -  ..
041319 - Lana responds to the report earlier today that wound dressing changed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041320 - a 1 earlier than planned, and seems to show increased bleeding, per                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041321 - above. ref SDS 0 NV5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041323 -  ..
041324 - Reference to hiking 11 miles per day aligns with the meeting at the VA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041325 - on 151008 1200. ref SDS 9 4T8F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041327 -  ..
041328 - Lana's letter continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041329 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041330 -    3.  Give me a call on Monday when you are here. My first patient is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041331 -        at 9 am.  I can look at your wound.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041333 -         ..
041334 -    4.  Have a good weekend, remember not more than 11 miles for now.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
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0414 -