CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 20 0000. ref SDS 19 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 151019, VA Radiology performed CCTA. ref SDS 7 NV5I The report
040902 - interpreting the test merely states all bypass grafts are patent.
040903 - ref SDS 7 JW8O The VA also reported a finding that calcium score was
040904 - not calculated. ref SDS 7 8Q6I
040906 - ..
040907 - On 151203, met with Bret Elicker in the Radiology Department of the VA
040908 - Medical Center in San Francisco. Doctor Elicker advised that he read
040909 - the CCTA scan file created on 151019, and found no evidence of any
040910 - lesions or blockages in the active circulatory system. ref SDS 11 SZ5F
040911 - The doctor also reported that a calcium score was generated and the
040912 - result was about 1200, ref SDS 11 4S6M, and that all of this calcium
040913 - was found in the bypassed blood vessels, and so none is present in the
040914 - active circulatory system. As a result, calcium found in the bypassed
040915 - blood vessels presents no risk to patient health, longevity, nor to
040916 - quality of life. ref SDS 11 QW4K
040918 - ..
040919 - On 151204, ordered 2nd opinion from SLDC to obtain written
040920 - confirmation of findings from CCTA, ref SDS 12 644K, performed at the
040921 - VA Medical Center in San Francisco on 151019.
040923 - ..
040924 - On 151215 1642 received 2nd opinion from SLDC. ref SDS 14 RV5F For
040925 - some reason, the letter does not present detailed findings to clarify
040926 - the VA's original report that "All bypass grafts are patent."
040927 - ref SDS 14 A88O
040929 - ..
040930 - On 151215 1642 at 2156 sent letter to Doctor Vernacchia at SLDC
040931 - requesting clarification of 2nd opinion letter. ref SDS 14 MZ5L
040933 - ..
040934 - On 151216 0915 received letter from Doctor Vernacchia saying SLDC does
040935 - not have "equipment" to render a medical opinion of amount of
040936 - stenosis,lesions and blockages in active circulatory system.
040937 - ref SDS 15 5O4H
040939 - ..
040940 - On 151217 submitted letter to Doctor Elicker requesting amendment to
040941 - clarify findings for CCTA, 151217 2052, ref SDS 16 Y630, performed on
040942 - 151019 that says simply all bypass grafts are patent. ref SDS 7 8Q6I
040944 - ..
040945 - On 151223 0921 called Doctor Elicker, and he recommending meeting with
040946 - the attending physician, Doctor Priyanka Jha, to file an addendum that
040947 - clafifies the radiology report for CCTA on 151019. ref SDS 17 A46I
040949 - ..
040950 - On 160104 0855 meeting Doctor Jha in Radiology at VA Medical Center in
040951 - San Francisco, the doctor confirmed that CCTA on 151019 found
040952 - radiology policy and practice no plaque build up of any kind (other
040953 - than bypassed blood vessels) establishes none were evident from the
040954 - CCTA test on 151019. You also advised that plaque in bypassed blood
040955 - vessels presents no risk to patient health. ref SDS 19 054G
040956 -
040957 -
040958 -
040960 - ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Received letter from Doctor Jha saying...
041302 -
041303 - 1. Subject: RE: Addendum Clarify Findings CCTA Oct 19 2015
041304 - Date: 2016-01-08 15:35
041312 - ..
041313 - 2. Thank you for writing and explaining the situation again. I
041314 - will review your case with Dr Elicker and other chest imaging
041315 - experts as well. I will notify you of our discussion and
041316 - addend the report as appropriate.
041318 - ..
041319 - 3. I'm fully aware of your meticulous efforts to maintain your
041320 - health. However, as a radiologist- I can't practice beyond my
041321 - area of expertise.
041323 - ..
041324 - 4. I am able to comment on the findings on your CCTA including the
041325 - calcification within the native vessels and bypass grafts. I'm
041326 - unable to make claims as you requested such as "present no risk
041327 - to patient health" or that "indicating substantial recovery
041328 - from patient atherosclerosis profile that required CABG surgery
041329 - 6 years ago." These comments are beyond my specialization and
041330 - expertise. Also, there are multiple other clinical factors
041331 - beyond just imaging results which contribute towards your
041332 - health. Imaging results can not be applied in isolation from
041333 - clinical findings.
041335 - ..
041336 - Doctor Jha refers to proposed addendum language submitted to the
041337 - medical team on 160107 2042. ref SDS 20 8P70
041338 -
041339 - [...below on 160108 2106 at 0820 letter to Doctor Jha
041340 - approved proposed omissions, ref SDS 0 TE4U, with
041341 - explanation why omitted language is helpful. ref SDS 0 TE51
041343 - ..
041344 - [On 160113 2234 received letter from Doctor Jha saying the
041345 - radiology faculty approved issuing an addendum. ref SDS 21
041346 - A85F
041348 - ..
041349 - [On 160114 0022 letter commends Doctor Jha and faculty
041350 - colleagues at UCSF for good faith review to clarify CCTA on
041351 - 151019, that demonstrates CCTA evaluating response to
041352 - treatment (hiking 10K miles raising HDL 30 to 70) for
041353 - regressing atherosclerosis to 0. ref SDS 22 N760
041355 - ..
041356 - 5. Again, I will review your case and issue an addendum if
041357 - necessary.
041359 - ..
041360 - 6. I wish you all the best of health.
041362 - ..
041363 - 7. Regards,
041364 - Priyanka
041365 -
041367 - ..
0414 -
0415 -
0416 - 0820
0417 -
041701 - Sent letter to Doctor Jha saying...
041702 -
041703 - 1. Subject: Re: Addendum Clarify Findings CCTA Oct 19 2015
041704 - Date: 2016-01-08 23:05
041715 - ..
041716 - 2. Thanks for timely response to the letter yesterday, shown
041717 - below. ref SDS 0 A85F Your point on limiting the addendum to
041718 - radiology standard of practice is essential.
041720 - ..
041721 - 3. Your preference to omit at the end of the 1st para "...present
041722 - no risk to patient health" is fine. [...responding to Doctor
041723 - Jha's letter earlier today, per above. ref SDS 0 QQ6L...].
041725 - ..
041726 - 4. On the 2nd para, please feel free to end the sentence with a
041727 - period after "...or amount." And further to write the second
041728 - para as you feel appropriate to convey your finding no plaque
041729 - in the active circulatory system shown in the CT scan. [...
041730 - also responding to Doctor Jha's letter earlier today, per
041731 - above. ref SDS 0 QQ6L...]
041733 - ..
041734 - These para 3 and 4, reference letter to the doctor suggesting addendum
041735 - language, submitted on 160107 2042. ref SDS 20 8P70
041737 - ..
041738 - Letter to Doctor Jha continues...
041739 -
041740 - 5. Authorities say CCTA is an accurate method for both detection
041741 - and exclusion of coronary plaques. [...reported on 151119 2141.
041742 - ref SDS 10 7N6J and ref SDS 10 WP43...]. This case seems
041743 - appropriate for expressly stating absence of plaques, rather
041744 - than leave to mere conjecture, surmise or conclusion from
041745 - silence alone. For example, Doctor Simpson, who ordered the
041746 - CCTA test, called me on 151021, while I was out hiking. He
041747 - advised the test report seems vague to him. ref SDS 8 FU6N
041749 - ..
041750 - Example using radiology to find "exclusion" occurred when Doctor Tseng
041751 - and her cardiothoracic surgery team (Neil, KC, Paula), performed CABG
041752 - x4 on 091022. ref SDS 1 LO3G After surgical opening was closed, an
041753 - inventory discovered needle count was one short. The doctor ordered
041754 - an xray study to verify harmful needle was not inside the patient. In
041755 - addition to reporting what was found, the Radiology department
041756 - affirmatively reported a finding that anything even suspicious of a
041757 - needle was not found (see report in the record, shown in the record on
041758 - 100928 0706. ref SDS 3 0W4O
041759 -
041760 - [On 160113 2234 received letter from Doctor Jha saying the
041761 - UCSF radiology faculty approved issuing an addendum to
041762 - clarify CCTA test on 151019. ref SDS 21 A85F
041764 - ..
041765 - [On 160114 0022 letter commends Doctor Jha and faculty
041766 - colleagues at UCSF for good faith review to clarify CCTA on
041767 - 151019, that demonstrates CCTA evaluating response to
041768 - treatment (hiking 10K miles raising HDL 30 to 70) for
041769 - regressing atherosclerosis to 0. ref SDS 22 N760
041771 - ..
041772 - 6. On returning from the hike, and reading the report, it seemed
041773 - vague to me as well; but, of course, I am not an expert. Your
041774 - efforts and the Radiology team, are very helpful considering
041775 - addendum language to clarify the CT study on 151019, for
041776 - evaluating response to treatment. Raising HDL 30 to 70 is
041777 - difficult work [...hiking 10,000 miles the past 4 years...].
041778 - Clear reporting that there is no plaque in the active
041779 - circulatory system is powerful motivation to continue line of
041780 - care.
041782 - ..
041783 - 7. Thanks again for giving this matter thoughtful attention.
041784 -
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