CONTACTS
SUBJECTS
VA Notify Injury Hematoma Left Leg Symptoms Worsening Pain Need Crut
1403 -
1403 - ..
1404 - Summary/Objective
1405 -
140501 - Follow up ref SDS 36 0000. ref SDS 31 0000.
140502 -
140503 -
140504 -
140505 -
140506 - [On 160625 2057 received Patient Satisfaction Questionaire
140507 - for NP Rettberg. ref SDS 39 WM5F
140508 -
140509 -
140510 -
140512 - ..
1406 -
1407 -
1408 - Background
1409 -
140901 - On 160504, met Lauren Rettberg, NP PA, in Primary Care. Reported loss
140902 - of balance that caused fall on 160501, ref SDS 28 JN3J, shown in case
140903 - study on 140101 0600. ref SDS 4 O85F Lauren performed a neurological
140904 - test, passed this including Romberg's balance test. ref SDS 28 WZ50
140906 - ..
140907 - On 160513 Lauren called and discussed referral to Wound Care for
140908 - treatment of new injury to left leg Achilles' tendon. ref SDS 31 FG5O
140909 - Lauren also planned to consult with Neurology about balance problem,
140910 - ref SDS 31 YK6J; she may make referral to Physical Therapy to evaluate
140911 - and assist with recovery balance problem. ref SDS 31 YK68 Lauren will
140912 - schedule visit for performing care to recover from calcified crystals
140913 - breaking loose from vestibular chamber and falling into semicircular
140914 - canals that cause loss of balance. ref SDS 31 YK72
140916 - ..
140917 - On 160523 visited Rose (Marie) in Medical Practice, scheduled call
140918 - from Lauren for Primary Care support on 160525 1130. ref SDS 33 PG6N
140919 - Rose on the Appointment care 5/23, so called back and got correction
140920 - from Bridget. ref SDS 33 8M9M
140922 - ..
140923 - On 160525 1130 Lauren called - she scheduled meeting on 160603 1030,
140924 - to maneuver head for resolving balance problem by dislodging calcified
140925 - crystals from semicircle balance canals near the hears. ref SDS 37 SY6N
140926 - Maneta called later and changed this to 1100. ref SDS 37 GT5G Lauren
140927 - also contacted Neurology and advised they want to meet with patient
140928 - immediately. She asked if a meeting has been scheduled. Since this
140929 - has not happened, she will call them again. She said that if
140930 - Neurology has not scheduled a meeting by this Friday, on 160527, to
140931 - call and request a meeting.
140932 -
140933 -
140935 - ..
1410 -
1411 -
1412 - Progress
1413 -
141301 - Epley Maneuver Resolve Balance Problem Meeting Primary Care VA
141302 - Meeting Primary Care VA Epley Maneuver Resolve Balance Problem
141303 -
141304 - Follow up ref SDS 36 JN3J, ref SDS 31 JN3J.
141305 -
141306 - During telecon on 160513, Lauren planned to perform care to
141307 - recover from calcified crystals breaking loose from vestibular
141308 - chamber and falling into semicircular canals that cause loss of
141309 - balance. ref SDS 31 YK72
141311 - ..
141312 - Went to Medical Practice on the the 1st floor. Met with Rose at the
141313 - front counter. She checked me in and ordered vitals. Gail did the
141314 - vitals.
141316 - ..
141317 - Few minutes later, Lauren called me into the patient examination area.
141319 - ..
141320 - On arrival in the examination room, Lauren said she would perform the
141321 - Dix Hallpike maneuver to resolve balance problems. This head
141322 - maneuvering procedure is explained in the record on 160513 1100.
141323 - ref SDS 31 4W62
141325 - ..
141326 - Lauren checked the record and found that Mike performed the Dix
141327 - Halpike maneuver to diagnose BPPV during the meeting on 160523 0830.
141328 - ref SDS 34 R657
141330 - ..
141331 - Lauren decided to perform the Epley maneuver, also explained on 160513
141332 - 1100. ref SDS 31 M15O
141334 - ..
141335 - Lauren advised she needs assistance from the attending or another
141336 - resident to do the Epley maneuver. She has done this a few times,
141337 - but not enough to feel proficient. Lauren left the room to get
141338 - assistance.
141340 - ..
141341 - She returned 5 minutes later, and said no one is availabe to provide
141342 - assistance. Lauren said we could skip the balance maneuver process,
141343 - or she could attempt to perform the procedure herself without
141344 - assistance.
141346 - ..
141347 - Decided to go ahead and do the Epley maneuver.
141349 - ..
141350 - Lauren said this would be good training for her. She had a set of
141351 - instructions explaining each step for this procedure.
141353 - ..
141354 - Laid on the examination table with rolled up towel under my head.
141356 - ..
141357 - Lauren only tested the left side, since Mike determined dizziness
141358 - occurs in the left vestibular chamber doing the Dix-Hallpike maneuver
141359 - in Physical Therapy on 160523 0830. ref SDS 34 I769
141361 - ..
141362 - Today, there was at most only slight dizziness experienced with the
141363 - maneuver Lauren did. It is not clear why, except explained that
141364 - dizziness does not occur all the time.
141365 -
141366 - [On 160616 1000 Mike advised that rapid eye movement was
141367 - observed with severe dizziness after assisting with Epley
141368 - manauver again, establishes diagnosis of BPPV in this case.
141369 - ref SDS 38 JQ4O
141371 - ..
141372 - Lauren said she may leave her position in a month, when she completes
141373 - her residency training. She has had discussions about continuing in
141374 - Primary Care at the VA, but nothing is certain.
141376 - ..
141377 - This record suggests that in a month, Lauren will no longer be the
141378 - Primary Care provider in this case.
141380 - ..
141381 - Thanked Lauren for providing primary care the past few months,
141382 - beginning on 160504 1030. ref SDS 28 JN3J She took over from Doctor
141383 - Rao, who provided care and made referrals on 150923 1530, ref SDS 15
141384 - 499K, to recover from falling during Half Dome hike a week earlier on
141385 - 150916 0535. ref SDS 9 O87H
141387 - ..
141388 - Lauren said that if she is invited to continue in Primary Care, she
141389 - will retain her patient list, so there is continuity of care.
141391 - ..
141392 - Fast turn over of personnel in Primary Care with Lauren aligns with
141393 - similar experience with Doctor Rao, who commented that she wanted to
141394 - leave Medical Practice, during the meeting on
141395 -
141396 - [On 160625 2057 received Patient Satisfaction Questionaire
141397 - for NP Rettberg. ref SDS 39 WM5F
141398 -
141399 -
141401 - ..
1415 -
1416 -
1417 - 1141
1418 -
141801 - After leaving the meeting with Lauren, went to the Pharmacy on the
141802 - Ground floor. Asked if the VA Pharmacy in San Francisco, can provide
141803 - supplemental medicaiton in this case Mylanta (Mintox) for the period
141804 - until the VA Pharmacy in Sacramento is scheduled to fill a request for
141805 - additional medication on 160612?
141807 - ..
141808 - The lady at the counter said the VA Pharmacy here in San Francisco,
141809 - cannot provide additional medication for a prescription on file at the
141810 - VA Pharmacy in Sacramento. She said the Pharmacy requires a
141811 - prescription ordered by a doctor.
141812 -
141814 - ..
1419 -
1420 -
1421 - 1158
1422 -
142201 - Went back to Medical Practice on the 1st floor. Asked Rose to
142202 - notify Lauren the patient requests additional time of 1 minute.
142204 - ..
142205 - Rose sent a message to Lauren.
142206 -
142208 - ..
1423 -
1424 -
1425 - 1207
1426 -
142601 - Lauren had not responded to the message Rose sent. Asked Rose to
142602 - request that Lauren call and gave her the cell phone number.
142604 - ..
142605 - Went to the cafateria to work until 1430 meeting with Neurology.
142607 - ..
142608 - While walking out to the car to get the computer, received call from
142609 - Lauren.
142611 - ..
142612 - Explained mixup on getting refill for Mylanta digestion medication,
142613 - which is pending refill at VA Pharmacy in Sacramento.
142615 - ..
142616 - Lauren said she will order prescription for 2 bottles of Mylanta
142617 - (Mintox), which will be sufficient until the VA Pharmacy in Sacramento
142618 - fills the pending refill request on 160612. Thanked Lauren for
142619 - assistance on this matter.
142620 -
142621 - [On 160625 2057 received Patient Satisfaction Questionaire
142622 - for NP Rettberg. ref SDS 39 WM5F
142623 -
142624 -
142626 - ..
1427 -
1428 -
1429 - 1404
1430 -
143001 - While workng in the cafeteria, noticed the display screen on the wall
143002 - showed that the Phamacy has filled the prescription which Lauren
143003 - entered, and it is ready for pickup.
143005 - ..
143006 - Left the cafateria and went to check in at Module 2 for meeting with
143007 - Neurology at 1430.
143009 - ..
143010 - Told the clerk that have to pickup a prescription in the Pharmacy,
143011 - which is located just down the all from the clinic modules. The
143012 - clerk said that if the doctor comes out and calls for me, she will
143013 - let him know I will be back shortly.
143015 - ..
143016 - Went to the Pharmacy. Had to wait 10 minutes or so to get to the
143017 - head of the line. Another veteran was king in letting me advance
143018 - ahead of him in order to return in time for meeting with Neurology
143019 - for meeting at 1430.
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