CONTACTS
SUBJECTS
Stroke Symptoms After EGD Dilation Procedure VAMC Sacramento Left Si
0903 -
0903 - ..
0904 - Summary/Objective
0905 -
090501 - Follow up ref SDS 5 0000.
090502 -
090503 -
090504 -
090505 - [On 160621 1024 letter to Doctor Yoo notifies medical team
090506 - of progressing stroke-like symptoms following EGD Dilation
090507 - procedures today, on 160617. ref SDS 8 D961
090509 - ..
090510 - [On 161003 0628 letter notifies medical team that Doctor
090511 - Lee indicated administration of conscious sedation
090512 - medication was most likely the cause, ref SDS 13 WR69, of
090513 - post-procedure stroke symptoms on 160617. ref SDS 0 5F6F
090514 -
090515 -
090516 -
090517 -
090519 - ..
0906 -
0907 -
0908 - Progress
0909 -
090901 - After EGD dilation proceduration at VA Medical Center in Sacramento
090902 - with Doctor Lee, reported in another record on 160617 0800,
090903 - ref SDS 5 0001, on getting into the car at the VA in Sacramento, had
090904 - difficulty buckling the seat belt on the left side. Could not seem to
090905 - line up the fastening mechanisms. Kathy helped secure the seat belt.
090906 - She drove us from Sacramento, about 90 miles to Mudville Grill in
090907 - Clayton for late lunch/dinner.
090909 - ..
090910 - [On 160722 1304 report of memory loss following EGD
090911 - Dilation beginning during post procedure meeting with
090912 - Doctor Lee, walked out of hospital with blanket on
090913 - shoulders. ref SDS 10 UY6H
090915 - ..
090916 - [On 161004 0800 Doctor Lee explained sedation drugs, mainly
090917 - Versed, are administered 2 mL every 5 - 6 minutes; so
090918 - typical 15 minute procedure adds up to 4 - 5 mL; however,
090919 - on 160617 procedure took 30 minutes, and so total Versed
090920 - exceeded 5 mL. ref SDS 14 E46N
090922 - ..
090923 - Exiting the car on arrival, had difficulty unbuckling the seat belt on
090924 - the left side in the passenger seat, so Kathy again assisted. On
090925 - stepping out of the car reached over and grasped cellphone stored in
090926 - the cup holder between the 2 seats. Attempting to place the cellphone
090927 - in left pocket, it slipped from left hand. Picked it up and proceeded
090928 - into the restaraunt.
090930 - ..
090931 - In the restaraunt, thought we ordered usual meal splitting patty melt
090932 - and fries. Actually, Kathy said we ordered clam chowder. We had this
090933 - a month or so ago and planned to have it again; but, they serve clam
090934 - chowder only on Friday and Saturday, so today being a Friday, was the
090935 - first occassion to have it again.
090937 - ..
090938 - Ordered usual mug filled with ice and Doctor Pepper. Kathy brought
090939 - lemon juice to combine these ingredients, as usual.
090941 - ..
090942 - As well, dropped the cellphone again in left hand. The waiter noticed
090943 - and picked it up for me.
090945 - ..
090946 - I added the lemon juice to the Doctor Pepper.
090948 - ..
090949 - Moments/minutes later, while talking, I asked Kathy where the mug of
090950 - Doctor Pepper was.
090952 - ..
090953 - She said it is on the table in front of me.
090955 - ..
090956 - I still did not see it. Asked Kathy to point to the glass. She did
090957 - and then I saw it and was able to pick it up and sip some liquid
090958 - through a straw.
090960 - ..
090961 - Thus, there appears to have been a progression of symptoms.
090962 - Initially, saw the mug of Doctor Pepper on the table to add lemon
090963 - juice. Then a minute or so later, could not see it.
090964 -
090965 - [On 160621 1024 letter to Doctor Yoo notifies medical team
090966 - of progressing stroke-like symptoms following EGD Dilation
090967 - procedures today, on 160617. ref SDS 8 D961
090969 - ..
090970 - [On 160715 1630 meeting with Doctor Yoo - he advises
090971 - Neurology team has found no evidence in CT and MRI testing
090972 - of atherosclerosis in the brain that could have caused
090973 - stroke symptosm. ref SDS 9 NM6N
090975 - ..
090976 - [On 160715 1630 Doctor Yoo Neurology Progress Notes say in
090977 - part "given absence of vertebrobasilar disease..." which is
090978 - another way of saying there is no evidence of
090979 - atherosclerosis in the brain. ref SDS 9 TV4F
090981 - ..
090982 - [On 161003 0628 letter notifies medical team that Doctor
090983 - Lee indicated administration of conscious sedation
090984 - medication was most likely the cause, ref SDS 13 WR69, of
090985 - post-procedure stroke symptoms on 160617. ref SDS 0 5F6F
090987 - ..
090988 - On leaving the restaraunt, needed Kathy's help to buckle the seatbelt
090989 - due to weakness and lack of feeling in left hand. Similiarly on
090990 - arriving home needed help to unbuckled seatbelt.
090992 - ..
090993 - ..
090994 - Finally recognized definite weakness and some numbness in left hand,
090995 - primarily in last three (3) fingers.
090997 - ..
090998 - Back at the house, I was unable to distinguish characters on the
090999 - computer screen in the bedroom. Kathy was sittging on the edge of the
091000 - bed. I could see her and interact normally. Kathy handed her cell
091001 - phone to me. I could not see the numbers on the screen to enter her
091002 - password. Looked at my cellphone and powered it up. Could not read
091003 - the 4-digit time posted in large letters on the screen.
091004 -
091005 - [...below on 160617 1637 at 2229 later in the evening at
091006 - the VA in ER could not see letter preceeding a string of
091007 - letters during vision test for possible stroke symptoms.
091008 - ref SDS 0 U95U
091010 - ..
091011 - Opening my records in the SDS Group Manager, I moved the pointer to
091012 - the line below my name. Did this several times even after Kathy told
091013 - me to move the pointer up 1 line to my name. Was unable to physically
091014 - move the pointer because was not seeing it correctly.
091016 - ..
091017 - Gave up on opening SDS.
091019 - ..
091020 - Had similar problem using remote control for Samsung 55" television.
091021 - Could press the up arrow, but could not see the down arrow to execute
091022 - a manauver switching between HDMI port 1 and 2, which switches between
091023 - using the display as a television and as a computer monitor. Kathy
091024 - pointed to the down arrow on the remote control. I then saw the down
091025 - arrow. When she removed her finger, could no longer see down arrow.
091026 - Tried and failed several times on this maneuver.
091027 -
091028 -
091030 - ..
0911 -
0912 -
0913 - 2106
0914 -
091401 - Gave up on doing anything constructive on the computer and watching
091402 - television.
091404 - ..
091405 - Went to bed.
091406 -
091408 - ..
0915 -
0916 -
0917 - 2136
0918 -
091801 - Vision issue did not resolve itself, so decided to request
091802 - examination at VA for possible stroke symptoms.
091804 - ..
091805 - Kathy drove us to VA Medical Center in San Francisco.
091806 -
091807 -
091809 - ..
0919 -
0920 -
0921 - 2229
0922 -
092201 - Reported to ER possible minor stroke.
092203 - ..
092204 - Triage occurred within a very few minutes.
092206 - ..
092207 - Then to an examination room.
092209 - ..
092210 - Nurse Megan did initial case review. Reported vision and left hand
092211 - weakness, per above. ref SDS 0 5F6F
092213 - ..
092214 - Megan placed her hand beneath a string of letters on a plackard
092215 - fastened to the wall similar to a vision test at the DMV. She asked
092216 - what letters are shown above her hand?
092218 - ..
092219 - Said the letters that could be seen.
092221 - ..
092222 - Megan was kind offering hints on some of the letters. Megan asked
092223 - several times about letters left of the letters recognized. These
092224 - mistakes correlate with not seeing all 4 digits for time on the
092225 - cellphone, per above. ref SDS 0 TI7T
092227 - ..
092228 - There is also correlation with not placing pointer (mouse) on computer
092229 - screen to correct line for logging into SDS, per above. ref SDS 0 BE9M
092231 - ..
092232 - Significance of left side vision deficit is unclear.
092233 -
092234 - [On 160618 1348 MRI findings for MRA present "Likely left
092235 - anterior choroidal artery infundibulum. Fetal type right
092236 - PCA." Research anterior choroidal artery (AChA) supplies
092237 - several crucial anatomical structures of the brain
092238 - important for vision and motor control. ref SDS 6 PB3O
092240 - ..
092241 - [On 160802 1404 at 2024 after returning home from Stanford
092242 - Neuroscience Health Center in Palo Alto, received letter
092243 - from Doctor Massa presenting more details explaining new
092244 - efforts of the VA Neurology Department to review this case,
092245 - ref SDS 11 UH5L, and then determining that the MRI on
092246 - 160618, does not support a diagnosis of stroke. ref SDS 11
092247 - 5K34
092248 -
092249 -
092250 -
092252 - ..
0923 -
0924 -
0925 - 2319
0926 -
092601 - Doctor Jeneen Smith made initial review of symptoms and patient
092602 - history of vision problems.
092604 - ..
092605 - Related that today, and only today vision and left side strength
092606 - problems occurred, as per above. ref SDS 0 5F6F
092608 - ..
092609 - Received timely, thorough care performing clinical, neurological
092610 - tests, similar to tests performed by Doctor Yoo earlier this month on
092611 - 160603 1430. ref SDS 2 2Y49
092613 - ..
092614 - Some of these tests included...
092615 -
092616 - 1. Grasping and squeezing 2 fingers on each of the doctor's
092617 - hands to compare strength differentials.
092618 -
092619 - 2. Recognizing fingers being moved by the doctor when held 18"
092620 - away, and at peripheral end points.
092622 - ..
092623 - 3. Recognizing number of fingers being held steady by the
092624 - doctor when held 18" and at peripheral points.
092626 - ..
092627 - 4. Merely following movement of the doctor's finger across the
092628 - field of vision and up and down covering a distance of 3'
092629 - or so up and across.
092631 - ..
092632 - 5. Touching the doctor's finger held up about 18" away, and
092633 - then touching my own nose, i.e., going back and forth.
092634 - Then alternating hands and repeating this exercise.
092636 - ..
092637 - 6. Doing same exercises with eyes closed.
092639 - ..
092640 - Jeneen contacted Doctor Abrams. He ordered a lab and CT test of head.
092642 - ..
092643 - Tech came from the lab to perform a blood draw.
092645 - ..
092646 - Nurse took me in a wheel chair to Radiology on 2nd floor.
092648 - ..
092649 - CT test on head will address part of review planned to be performed in
092650 - Audiology and Balance examination scheduled on 160707, reported in
092651 - telecon on 160606 1409. ref SDS 3 6H9I
092652 -
092653 -
092655 - ..
0927 -
0928 -
0929 - 0140
0930 -
093001 - Jeneen reported results of CT test to Doctor Abrams. He ordered
093002 - MRI test of head.
093003 -
093005 - ..
0931 -
0932 -
0933 - 0251 on 160618
0934 -
093401 - Kathy went home.
093403 - ..
093404 - Went for MRI test in Radiology Department.
093406 - ..
093407 - Met Bella who came into the facility as an "on call" tech just to
093408 - perform this cerebral MRI.
093409 -
093410 - [On 160618 1348 neuroradiologist report received and
093411 - entered in the record. ref SDS 7 W67N
093412 -
093413 - [On 160817 0800 Bella was technician for 3rd MRI to test
093414 - for stroke symptoms following next EGD on 160816.
093415 - ref SDS 12 MX82
093417 - ..
093418 - There was an issue with the Zio XT heart monitoring device. Bella
093419 - said the MRI cannot be performed with this device attached. She found
093420 - a doctor to get assistance. There was brief discussion about what to
093421 - do. Explained Zio XT test was ordered and installed to investigate
093422 - causes of occasional dizziness that may cause loss of balance and
093423 - falls, reported on 160616 0930. ref SDS 4 PU50
093425 - ..
093426 - Finally, decided the doctor would remove the device, since determining
093427 - scope of issues that may have caused stroke symptoms has priority at
093428 - the moment to evaluating heart performance that may be causing
093429 - dizziness, even though both may be related.
093431 - ..
093432 - The doctor removed the Zio XT device. He used a cloth soaked with
093433 - alcohol to loosen the adhesive that connects the straps the skin.
093435 - ..
093436 - This was much more extensive than MRI test on knee performed on 160504
093437 - 0800. ref SDS 1 PP8O The prior test took only 40 minutes. The test
093438 - today seemed to take over an hour, maybe 90 minutes. The prior test
093439 - seemed like the body was moved on a gurney up and down through the
093440 - large radiation ring. This test was not aware of the body moving.
093441 - The body was moved on a gurney into the rings and then seemed to be
093442 - stable for the entire test. Gurney could have been moving, and just
093443 - was not aware. Most prominent aspect of the test was very loud noise
093444 - and the range of different noises indicating different phases of the
093445 - MRI test process.
093447 - ..
093448 - Bella was the technician who ran the equipment. She was very nice.
093449 - Enjoyed working with her.
093450 -
093451 - [On 160618 1348 neuroradiologist report received and
093452 - entered in the record. ref SDS 7 W67N
093453 -
093454 - [On 160817 0800 Bella was technician for 3rd MRI to test
093455 - for stroke symptoms following next EGD on 160816.
093456 - ref SDS 12 MX82
093458 - ..
093459 - After the test, the doctor pressed the Zio XT devce back to the
093460 - chest. Not sure if additional adhesive was applied. The device
093461 - seemed to remain in place though possibly looser.
093462 -
093464 - ..
0935 -
0936 -
0937 - 0410
0938 -
093801 - Returned on gurney to ER.
093802 -
093804 - ..
0939 -
0940 -
0941 - 0427
0942 -
094201 - Jeneen advised that Doctor Abrams recommends patient remain in ER
094202 - overnight for further examination in the morning.
094204 - ..
094205 - Sleeping for few hours.
094206 -
094207 -
094208 -
094209 -
094210 -
094211 -
094212 -
094213 -
094214 -
0943 -