CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 13 0000. ref SDS 12 0000.
040502 -
040503 -
040504 -
040505 - [On 160622 1428 letter notified Doctor Yoo and Doctor
040506 - Simpson that hiking to support line of care for stroke-like
040507 - symptoms went well; reported minor neurapathy in left
040508 - fingers of left hand occurred and subsided for short
040509 - periods throughout the hike.; also reported new MCL injury
040510 - right knee will prevent hiking for 10 days or more.
040511 - ref SDS 14 5F6F
040513 - ..
040514 - [On 160622 1802 Doctor Simpson called to follow up this
040515 - letter on work plan in relation to stroke symptoms; he was
040516 - pleased Zio XT heart monitor was installed the day before
040517 - stroke symptoms occurred, so affect on heart rythms can be
040518 - evaluated. ref SDS 15 LK5I
040519 -
040520 -
040521 -
040523 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Received letter from Doctor Yoo, saying...
040902 -
040903 - 1. Subject: Plan of Care from SFVA neurology
040904 - Date: 2016-06-21 09:08
040908 - ..
040909 - 2. Dear Mr. Welch,
040911 - ..
040912 - 3. I just wanted to follow-up and let you know the plan moving
040913 - forward. We consulted the neurointerventional radiologists to
040914 - evaluate your case and they will be holding a conference on
040915 - Wednesday and take a look at your imaging.
040917 - ..
040918 - This letter updates planning discussed during the meeting yesterday at
040919 - the VA hospital in San Francisco, on performing further tests to
040920 - verify current preliminary diagnosis of stroke, reported on 160620
040921 - 0707. ref SDS 13 4344
040923 - ..
040924 - 4. I will contact you again after Wednesday to let you know if any
040925 - procedure will be done and when it will be scheduled, but in
040926 - the mean time I don't anticipate that you will need to come
040927 - back to the hospital this week. Please let me know if you have
040928 - any questions.
040929 -
040930 - [...below on 160621 1024 at 1618 letter thanks Doctor Yoo
040931 - for following up, ref SDS 0 T84J, and requests notice of
040932 - need for additional testing. ref SDS 0 D472
040934 - ..
040935 - 5. Best wishes,
040937 - ..
040938 - 6. Alexander Yoo
040939 -
040940 -
040942 - ..
0410 -
0411 -
0412 - 1618
0413 -
041301 - Sent letter to Doctor Yoo, with copies to medical team saying...
041302 -
041303 - 1. Subject: Work Plan from SFVA neurology for possible stroke
041304 - Date: 2016-06-21 20:07
041310 - ..
041311 - 2. Dear Doctor Yoo,
041313 - ..
041314 - 3. Thanks very much for your letter today, shown below, advising
041315 - that a neurointerventional radiology team will consider my case
041316 - tomorrow with further review of MRI imaging you ordered, and
041317 - which was performed on Saturday, 160618. This followed
041318 - examination Friday night in the ER for possible stroke
041319 - symptoms, reported on 160617 (see line 0408. ref SDS 10 5F6F
041321 - ..
041322 - This responds to the letter from Alex received earlier today, shown
041323 - above. ref SDS 0 5F6F
041325 - ..
041326 - Letter to Doctor Yoo and medical team continues...
041327 -
041328 - 4. I am grateful for timely, thorough care in the ER and by
041329 - Neurology, beginning with your examination the next day on
041330 - 160618 line 0408. ref SDS 11 5F6F
041332 - ..
041333 - 5. During the meeting yesterday on Monday, Doctor Massa advised
041334 - that the medical team will be searching for conditions that may
041335 - have caused stroke symptoms in this case. He seemed to say at
041336 - one point that age is typically not a factor. [...reported on
041337 - 160620 0707. ref SDS 13 CO6K...]. Hope so, of course, because
041338 - age cannot be assuaged. In considering potential for drug side
041339 - effects, please rely on the actual list of medications taken
041340 - day-to-day, as set in case study of daily exercise, diet, drugs
041341 - and vitals, shown on 140101. ref SDS 2 AD6J
041343 - ..
041344 - 6. Note the addition of aspirin, as you requested yesterday.
041346 - ..
041347 - 7. Of course each separate prescription is helpful, but what is
041348 - the effect combining all of these drugs in the cumulative
041349 - amounts shown in the record? Recall as well, that yesterday,
041350 - Doctor Massa cited several public reports the past year of
041351 - adverse effects taking PPI, here Omeprazole. [...shown in the
041352 - record on 160620 0707, ref SDS 13 644I...]. See for example
041353 - review on 150611 line 2512. ref SDS 3 5N3O
041355 - ..
041356 - 8. This report states in part...
041357 -
041358 - Our earlier work identified that the PPIs can adversely affect
041359 - the endothelium, the Teflon-like lining of the blood vessels,"
041360 - said John Cooke, M.D., Ph.D., a senior author of the PLOS ONE
041361 - report. "That observation led us to hypothesize that anyone
041362 - taking PPIs may be at greater risk for heart attack."
041364 - ..
041365 - 9. Since heart attack and stroke are related circulatory events,
041366 - this may be an interesting line of inquiry, however, with a
041367 - dilemma. EGD dilation last Friday on 160617, found increased
041368 - ulceration of LESV, signalling need for increasing PPI dose.
041369 - This was discussed during the meeting after waking up from the
041370 - procedure. The recovery team was very kind to let me sleep an
041371 - hour or so longer, at my request. The new prescription to take
041372 - Omeprazole 20 mg daily doubles the prior dose taking 20 mg
041373 - every other day, which was prescribed last December to reduce
041374 - severe side effects of frequent urination. Nominally, doubling
041375 - the dose would seem to double the risk damaging endothelium
041376 - lining of blood vessels, and return to a level of urination
041377 - that caused severe dehydration. Will discuss with Doctor Lee
041378 - in GI Clinic VA Sacramento other possibilities, e.g.,
041379 - increasing Famotidine and/or Mylanta (Mintox). Copying Doctor
041380 - Stewart planning meeting next month on 160705, to consider
041381 - surgical solution for achalasia and reflux issues.
041383 - ..
041384 - 10. Generally, it seems that complete cognitive function has
041385 - restored. This may suggest something, likely subtle, happened
041386 - on 160617, that caused stroke symptoms, and those symptoms got
041387 - worse, then subsided as causative conditions wore off. That's
041388 - the happy scenario.
041390 - ..
041391 - 11. Could another MRI in a week or 2 see if adverse stroke
041392 - conditions still present?
041394 - ..
041395 - 12. In any case, as you requested, I will come to the VA for follow
041396 - up care if stroke symptoms recur.
041398 - ..
041399 - Responding to Doctor Yoo's comments during the meeting yesterday on
041400 - 160620 0707. ref SDS 13 OW5L
041402 - ..
041403 - Letter to Doctor Yoo and medical team continues...
041404 -
041405 - 13. Yesterday, on returning home from the hospital, there was a
041406 - telephone message from GI Clinic in Sacramento asking if
041407 - anything adverse occurred after the EGD Dilation procedure on
041408 - Friday. I called and left a message with Lapria that
041409 - stroke-like symptoms were treated at VAMCSF the next 4 days.
041410 - She plans to notify Doctor Lee on his return from vacation. By
041411 - copy to Doctor Lee and to Jessica, who coordinates
041412 - administration, this confirms notice on this matter.
041414 - ..
041415 - 14. Responding to Doctor Simpson's letter on 160616, advising of
041416 - urgency to follow Zio XT protocol for 2-week heart monitoring.
041417 - ref SDS 9 EW6F In the morning on 160616 at 0500, did 3-hour
041418 - hike from VA through the Golden Gate Park and back. After
041419 - returning, Zio XT device was installed at 0930 in Cardiology.
041420 - 160616 0930, ref SDS 9 SX67 Over the next 4 days, could not
041421 - hike to execute objectives to evaluate normal activities. Was
041422 - fortunate the lab ordered by the ER team late in the evening on
041423 - 160617, reported that hiking the prior 7 days raised HDL to 63,
041424 - i.e., back above 60 again, and lowered TG to 66, suggesting
041425 - favorable LDL large particle size. Tomorrow will begin hiking
041426 - again to fulfill requirements for Zio XT test.
041428 - ..
041429 - This record should have reported hiking half lap on returning home
041430 - from VA on 160616, as shown in case study on 140101 0600. ref SDS 2
041431 - WVPY Since this was after the VA installed Zio XT heart monitor, this
041432 - 6 mile hike will be recorded on the Zio device,
041433 -
041434 - [On 160622 1428 letter notified Doctor Yoo and Doctor
041435 - Simpson that hiking to support line of care for stroke-like
041436 - symptoms went well; reported minor neurapathy in left
041437 - fingers of left hand occurred and subsided for short
041438 - periods throughout the hike.; also reported new MCL injury
041439 - right knee will prevent hiking for 10 days or more.
041440 - ref SDS 14 5F6F
041442 - ..
041443 - [On 160622 1802 Doctor Simpson called to follow up this
041444 - letter on work plan in relation to stroke symptoms; he was
041445 - pleased Zio XT heart monitor was installed the day before
041446 - stroke symptoms occurred, so affect on heart rythms can be
041447 - evaluated. ref SDS 15 LK5I
041449 - ..
041450 - Letter to Doctor Yoo and medical team continues...
041451 -
041452 - 15. Please keep me posted on any new evidence or theories from the
041453 - radiology review meeting tomorrow that may suggest the need for
041454 - sonogram/angiogram testing discussed with you and Doctor Massa
041455 - yesterday.
041457 - ..
041458 - Citing meeting with Doctor Yoo and Doctor Massa yesterday considering
041459 - sonogram and/or angiogram testing of the brain, reported on 160620
041460 - 0707. ref SDS 13 5J9J
041462 - ..
041463 - Letter to Doctor Yoo and medical team continues...
041464 -
041465 - 16. Thanks again very much for outstanding care.
041467 - ..
041468 - 17. Very best regards,
041469 -
041474 -
041475 -
041476 -
041477 -
041478 -
041479 -