CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 2 SR6L.
040502 -
040503 -
040504 -
040506 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Letter to Doctor Lee at VA Medical Center in Sacramento saying...
040902 -
040903 - 1. EGD Dilation Dec 4th and PPI Options
040912 - ..
040913 - 2. Here is agenda for meeting on Friday at 0800 to perform another
040914 - EGD Dilation [...scheduled in the record on 150925 0336.
040915 - ref SDS 2 SR6L...].
040916 -
040917 - 1. You can see case study beginning 140101 reports daily
040918 - exercise, diet, medication, and vitals - vomiting has
040919 - suddenly increased markedly the past 2 weeks (scroll down
040920 - from line 108867...
040921 -
040922 - http://www.welchco.com/sd/08/00101/02/14/01/01/060002.HTM#6Q4G
040924 - ..
040925 - Yesterday, seemed to cough up 110% of dinner.
040927 - ..
040928 - Estimate LESV has contracted below 15. See as well,
040929 - analyst reports CCTA performed at VA Medical Center in San
040930 - Francisco on 151019, shows esophagus has again expanded
040931 - (see line 060588. ref SDS 3 YY4H
040932 -
040933 - http://www.welchco.com/sd/08/00101/02/15/10/19/093049.HTM#YY4H
040935 - ..
040936 - Recurrence of distorted esophagus aligns with increased
040937 - difficulty swallowing, indicating 7 months may be too long
040938 - between EGD dilation procedures. If you order the next EGD
040939 - dilation in 5 months, then may be able to schedule in 6
040940 - months, and this should solve the problem.
040942 - ..
040943 - Distorted esophagus in CT test on 151019, ref SDS 3 YY4H, conflicts
040944 - with findings from CT test ordered by Doctor Stewart on 150526, and
040945 - performed the next day showing esophagus was normal, without
040946 - distortion associated with achalasia, reported on 150527 0930.
040947 - ref SDS 1 TV5O
040949 - ..
040950 - Letter to Doctor Lee continues...
040951 -
040952 - 2. The letter to the team on 150624 (see below), cited new
040953 - study finding Omeprazole correlates with 16% - 21%
040954 - increased myocardial infarction, from damaging endothelial
040955 - lining of blood vessels...
040956 -
040957 - http://www.welchco.com/sd/08/00101/02/15/06/11/071336.HTM#5N3O
040959 - ..
040960 - The record is not clear on CCTA evaluating this issue,
040961 - performed on 151019, in Radiology at VAMCSF. The analyst
040962 - does not mention findings on damage to endothelial lining,
040963 - so may be okay; or, it may have been overlooked.
040965 - ..
040966 - We can consider this further during follow up meeting in
040967 - your office scheduled next week on 151210 0800.
040969 - ..
040970 - 3. Thanks very much for timely action lowering prescription on
040971 - Omeprazole back to 20 mg per month in order to reduce side
040972 - effects that increase urination, causing severe
040973 - dehydration, which in turn injures feet preventing hiking
040974 - required to maintain HDL 70, that regresses
040975 - atherosclerosis. Despite reducing Omeprazole to 20 mg, the
040976 - problem is at least stable and may be worse with current
040977 - medication protocols that combine Omeprazole PPI with
040978 - Atorvastatin 10 mg statin to manage cholesterol.
040980 - ..
040981 - Hoping collaboration can occur between GI and Cardiology to
040982 - manage both LESV stricture ulceration problem, and manage
040983 - cholesterol, without debilitating side effects.
040985 - ..
040986 - On 150623, Doctor Stewart, on considering ulceration of
040987 - LESV and Dor Fundoplication issues, was kind enough to
040988 - prescribe trial of H2 Blocker (Famotidine) see line
040989 - 351834...
040990 -
040991 - http://www.welchco.com/sd/08/00101/02/15/06/23/130003.HTM#WW65
040993 - ..
040994 - This supplements Omeprazole. Have only taken it a few
040995 - times - seems to help some and without evident side
040996 - effects, but have not taken enough to establish response to
040997 - this treatment. Have been waiting to meet with you for
040998 - developing comprehensive work plan applying VA
040999 - evidence-based practices.
041001 - ..
041002 - By copy thanking Doctor Stewart for this initiative. When
041003 - we meet next week on 151210, perhaps there will have been
041004 - time to develop a line of care to try going forward that
041005 - will be effective without difficult side effects. Will
041006 - coordinate with Doctor Stewart following week on 151215,
041007 - when we meet to review recovery from hematoma on lower left
041008 - leg.
041010 - ..
041011 - For example, if 2nd opinion on CCTA findings yields strong
041012 - evidence that atherosclerosis has fully regressed, then may
041013 - be able to pause statin treatment, or try Doctor Wisneski's
041014 - suggestion in Cardiology (VAMCSF) to reduce daily dose of
041015 - Atorvastatin 10 mg down to 5 mg. Another suggestion was to
041016 - take Atorvastatin every other day. Possibly something
041017 - along these lines might be tried with Omeprazole, or maybe
041018 - there is an alternative that can be combined with
041019 - Famotidine (H2 Blocker) that you feel is worth trying.
041021 - ..
041022 - 3. As always, looking forward to working with the team in the GI
041023 - Clinic for EGD dilation on Friday.
041025 - ..
041026 - 4. Very best regards,
041027 -
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0411 -