CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 17 0000. ref SDS 16 0000.
040502 -
040503 -
040504 -
040505 - [On 160624 1127 letter to Doctor Yoo confirms understanding
040506 - that current neurology symptoms occur from possible "leak"
040507 - of brain fluid from the brain resulting from lumbar
040508 - puncture procedures, ref SDS 19 4Y44; report symptoms have
040509 - worsened, and so request being admitted to the hospital for
040510 - care. ref SDS 19 4Y5I
040512 - ..
040513 - [On 160624 1228 met Doctor Yoo by chance in the lobby of
040514 - Building 200 near the Clinic Modules. Turned out that
040515 - neurology symptoms had dissipated. Felt okay totally
040516 - without symptoms while standing and talking to the doctor.
040517 - He explained this temporal recovery indicates adverse
040518 - neurology symptoms occur from lumbar puncture procedures,
040519 - rather than from a continuing "leak" of brain fluid, and so
040520 - are expected to fully resolved in a few more days; as a
040521 - result did not request being admitted to hospital for care.
040522 - ref SDS 20 WL8O
040523 -
040524 -
040525 -
040526 -
040527 -
040528 -
040530 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Yesterday on 160622, sent letter to Doctor Yoo and Doctor Simpson
040902 - reporting results of hike, and that another right knee MCL injury
040903 - occurred. ref SDS 17 5F6F Also reported head seems heavy, tired,
040904 - hurts a little, possibly from the 2 lumbar puncture procedures that
040905 - Doctor Yoo performed, ref SDS 17 ET98, on 160618, ref SDS 12 PR6J, and
040906 - on 160620. ref SDS 15 5F6F
040908 - ..
040909 - Doctor Yoo has not had time to report results of the meeting
040910 - yesterday. The meeting to review my case was scheduled for yesterday
040911 - on 160622, in Alex's letter on 160621 1024. ref SDS 16 5F6F
040912 -
040914 - ..
0410 -
0411 -
0412 - 1006
0413 -
041301 - Received letter from Doctor Yoo saying...
041302 -
041303 - 1. Subject: RE: Hiking Results
041304 - Date: 2016-06-23 09:47
041312 - ..
041313 - 2. Apologies for the belated reply. The interventional
041314 - neuroradiologists reviewed your case and they have low
041315 - suspicion for a vascular abnormality as we discussed while you
041316 - were in the hospital. However, they would like to perform a
041317 - conventional angiogram on a non-urgent basis. They will
041318 - schedule one for you in the next few months. I had the
041319 - pathologists review your spinal fluid to look for any evidence
041320 - of cancer and they were not able to see any unusual cells that
041321 - would be consistent with malignancy.
041323 - ..
041324 - 3. In summary, the work-up thus far has been completely normal
041325 - regarding that strange imaging finding we saw on your MRI.
041326 - It's possible that we may not find a clear explanation for it,
041327 - but will continue to follow you clinically to make sure that
041328 - nothing evolves in the wrong direction. I asked our clinic
041329 - scheduler to get you a clinic appointment in about a month
041330 - (unfortunately there isn't anything sooner, unless you'd like
041331 - to see another physician).
041333 - ..
041334 - 4. Regarding your question for repeat imaging for the stroke:
041335 - there is no utility to repeat imaging unless you are having
041336 - worsening symptoms (to look for recurrent stroke).
041337 - Hypothetically, if we DID get the imaging, it would not provide
041338 - any useful information in making new recommendations for your
041339 - management. The most important data is how you're doing on a
041340 - day to day basis and if you're experiencing any new symptoms.
041342 - ..
041343 - This responds to request for repeat MRi during meeting with Doctor
041344 - Massa and Doctor Yoo on 160620 0707. ref SDS 15 IU9K The request was
041345 - confirmed in a letter to the medical team the next day on 160621 1024.
041346 - ref SDS 16 D460
041348 - ..
041349 - 5. Best wishes,
041350 -
041351 - Alexander Yoo
041352 -
041353 -
041355 - ..
0414 -
0415 -
0416 - 1010
0417 -
041701 - Submitted letter to Doctor Yoo saying...
041702 -
041703 - 1. Subject: Work-up Normal - Ask About Examination Continuing Symptoms
041704 - Date: 2016-06-23 10:45
041713 - ..
041714 - 2. Thanks very much for reporting "good news" from the radiology
041715 - review yesterday, shown in your letter earlier today (see
041716 - below). The team finding "completely normal" work-up seems
041717 - encouraging in that no blood clots have been identified to have
041718 - occurred, which was a concern during the meeting on Monday,
041719 - 160620.
041721 - ..
041722 - 3. Yesterday and today, there is definitely a heaviness in my
041723 - forehead and eyes. Hoping this results from removing fluid
041724 - from the brain in the 2 lumbar puncture procedures the team
041725 - performed over the weekend. The concern is that symptoms occur
041726 - when working, as now crafting this letter. Symptoms subside
041727 - when I step away from the computer. This could indicate either
041728 - or both the brightness of the screen and concentrating on
041729 - characters are problematic, which was an issue last Friday,
041730 - reported on 160617. ref SDS 11 TI7T
041732 - ..
041733 - 4. Of course I can see perfectly, and fully distinguish
041734 - characters, which were core deficits last Friday, and are not
041735 - present now.
041737 - ..
041738 - 5. This seems more like a fatigue issue, i.e., the effort to write
041739 - this letter) quickly fatigues mental resources, or something
041740 - like that. A day or so ago the head hurt on sneezing.
041741 - Currently, turning my head left or right presents pain level 2
041742 - - 3 and makes a little noise. Would be great if all this
041743 - results from the lumbar puncture procedures, and so will
041744 - resolve as the system restores the liquid back to a normal
041745 - brain condition.
041747 - ..
041748 - 6. I am coming into the hospital to get Progress Notes and
041749 - radiology scans. I realize your schedule is booked, but will
041750 - see if someone might be available to do a quick examination of
041751 - these new issues. If time permits, please call to advise if
041752 - you feel an examination is unnecessary, or to coordinate where
041753 - I should go to see someone. Should arrive OA 1300.
041755 - ..
041756 - 7. Thanks again for the update today, and to the entire Neurology
041757 - team for outstanding work.
041758 -
041767 -
041768 -
041770 - ..
0418 -
0419 -
0420 - 1037
0421 -
042101 - Doctor Yoo called. He had received the letter reporting continuing
042102 - head issues, per above. ref SDS 0 6Q59
042104 - ..
042105 - The doctor concurred that symptoms of heaviness and fatigue on the
042106 - face about the eyes, likely result from the 2 lumbar puncture
042107 - procedures performed, the first on 160618 0800 at 1140, ref SDS 12
042108 - PR6J, and the second performed on Monday, 160620 0707. ref SDS 15
042109 - 5F6F
042111 - ..
042112 - Asked how long it takes the body to replenish fluid, as removed in the
042113 - 2 lumbar puncture tests?
042115 - ..
042116 - Doctor Yoo explained that is what makes this situation odd, because
042117 - normally the brain replaces all such fluid 3 times a day. He said
042118 - that sometimes a "leak" can occur with lumbar puncture process, that
042119 - causes brain fluid to decline. He feels this may account for
042120 - continuing symptoms. Doctor Yoo seemed to say that such "leaks" can
042121 - be easily repaired.
042122 -
042123 - [On 160624 1127 letter to Doctor Yoo confirms understanding
042124 - that current neurology symptoms occur from possible "leak"
042125 - of brain fluid from the brain resulting from lumbar
042126 - puncture procedures, ref SDS 19 4Y44; report symptoms have
042127 - worsened, and so request being admitted to the hospital for
042128 - care. ref SDS 19 4Y5I
042130 - ..
042131 - [On 160624 1228 met Doctor Yoo by chance in the lobby of
042132 - Building 200 near the Clinic Modules. Turned out that
042133 - neurology symptoms had dissipated. Felt okay totally
042134 - without symptoms while standing and talking to the doctor.
042135 - He explained this temporal recovery indicates adverse
042136 - neurology symptoms occur from lumbar puncture procedures,
042137 - rather than from a continuing "leak" of brain fluid, and so
042138 - are expected to fully resolved in a few more days; as a
042139 - result did not request being admitted to hospital for care.
042140 - ref SDS 20 WL8O
042142 - ..
042143 - The doctor proposed allowing another 3 days or so for these symptoms
042144 - to resolve. If they do not, or if they worsen then come in for
042145 - immediate care. He suggested going to the ER in the lobby across from
042146 - the Clinic Modules.
042148 - ..
042149 - Asked Doctor Yoo to write a Progress Note to document this discussion
042150 - on a work plan for addressing continuing symptoms.
042152 - ..
042153 - Thanked Doctor Yoo for calling to clarify the record. Advised should
042154 - arrive on campus close to 1300, to get the report on the meeting
042155 - yesterday, and the new Progress Note on this call.
042156 -
042157 -
042158 -
042160 - ..
0422 -
0423 -
0424 - 1125
0425 -
042501 - Drove to the VA Medical Center in San Francisco, on Clement Street.
042502 -
042504 - ..
0426 -
0427 -
0428 - 1245
0429 -
042901 - Arrived at VA Medical Center. Traffic was heavy crossing the bridge,
042902 - and taking Goff out to Fell Street, then to the park. John F Kennedy
042903 - Drive through the park was normal.
042905 - ..
042906 - Went to ROI on the 1st Floor of Building 200.
042908 - ..
042909 - Dave was at the front desk.
042911 - ..
042912 - Requested Progress Notes on meeting of interventional
042913 - neuroradiologists, who reviewed this case yesterday, reported in
042914 - Doctor Yoo's letter on Tuesday, 160621 1024, ref SDS 16 5F6F, and
042915 - cited in the doctor's letter again today, shown above. ref SDS 0 8L8L
042917 - ..
042918 - Dave said that he mailed the CD with the record of Progress Notes
042919 - meeting with Doctor Yoo and Doctor Massa on 160620. He appologized,
042920 - saying there was nothing indicating I would come by to pick them up
042921 - personally.
042923 - ..
042924 - Dave offered to burn another CD with the records on 160620, and all
042925 - subsequent activity through today. He checked the computer record
042926 - and found the Progress Notes Doctor Yoo entered for the telephone
042927 - call earlier today, per above.
042929 - ..
042930 - He could not find any records on the meeting of the interventional
042931 - neuroradiologists team yesterday. Dave speculated the Progress Notes
042932 - may have been dictated, but have not been signed off by the author,
042933 - and so they do not show up in the ROI system.
042935 - ..
042936 - Told Dave I would come back in an hour, to see if the record has been
042937 - released.
042938 -
042939 -
042941 - ..
0430 -
0431 -
0432 - 1250
0433 -
043301 - Went to Prosthetics and Orthotics also on the 1st Floor of Building
043302 - 200.
043304 - ..
043305 - Waited a few minutes until 1300, for the staff to return from lunch.
043307 - ..
043308 - While was first to arrive, just before 1300 3 or 4 other patients
043309 - arrived.
043311 - ..
043312 - Wanted to ask Natallie if the knee brace received on 160614 0800.
043313 - ref SDS 9 GB5K, would protect against MCL injury from suddenly
043314 - sprinting while walking briskly along the roadside.
043316 - ..
043317 - Talked to Natallie. She was busy in a meeting. Told her I would
043318 - drop by another day, rather than take time from other patients.
043319 -
043320 -
043322 - ..
0434 -
0435 -
0436 - 1311
0437 -
043701 - Went to Telemetry on 2nd Floor for Medical Surgery patients.
043702 -
043703 - Alona is off today. Charlette was there, and said hello, but she was
043704 - with another patient.
043706 - ..
043707 - Another nurse checked and said the wound in the middle of the back
043708 - near the spine from Lumbar Puncture procedures looks okay. Getting
043709 - into and out the car on the drive over felt some scratchiness, so
043710 - thought a bandage might have failed.
043711 -
043712 -
043713 -
043715 - ..
0438 -
0439 -
0440 - 1330
0441 -
044101 - Went to Module 2 in the Clinics on the ground floor.
044102 -
044103 - Asked the clerk at the check-in desk to see if Doctor Yoo can meet for
044104 - a minute?
044106 - ..
044107 - After about 2 minutes Doctor Yoo came out into the waiting area.
044109 - ..
044110 - Advised could not get Progress Notes on the meeting yesterday of
044111 - interventional neuroradiologists.
044113 - ..
044114 - Doctor Yoo will remind the interventional neuroradiologist doctor who
044115 - wrote the Progress Notes to sign them, so they can be released to
044116 - manage the work.
044118 - ..
044119 - Discussed the medical team finding a completely normal work-up,
044120 - reported in the doctor's letter earlier this morning, per above,
044121 - ref SDS 0 UL45, suggests something caused the symptoms last Friday on
044122 - 160617 1637, ref SDS 11 5F6F, rather than a stroke due to blood clots,
044123 - as discussed with the doctor and Doctor Massa a few days later this
044124 - past Monday on 160620 0707. ref SDS 15 RY8O
044126 - ..
044127 - Doctor Yoo said there was a stroke.
044129 - ..
044130 - He used a pink 3x5 card from his pocket to draw a diagram of the
044131 - heart, with aorta leading to the brain.
044133 - ..
044134 - The doctor drew a small, uneven circle as the stroke location, and
044135 - said this is clearly visible in the scans for the MRI test on 160618,
044136 - which is entered in the record on 160617 1637. ref SDS 11 027K He
044137 - further said this is another "odd situation", like the current
044138 - symptoms eminating from drawing fluid from the brain in the lumbar
044139 - punctures, and despite the brain replacing this fluid 3 times per day,
044140 - per above. ref SDS 0 Y46N
044142 - ..
044143 - Doctor Yoo clarified that there is clear evidence of stroke in the
044144 - MRI, but the location of the stroke in this case would not be expected
044145 - to cause any of the symptoms found on 160617 1637. ref SDS 11 5F6F At
044146 - this time there are no evident symptoms of stroke, but the medical
044147 - team interprets the MRI scans as showing a stroke occurred.
044149 - ..
044150 - The neurology team's current working theory is that a clot formed in
044151 - the heart and advanced through the aorta to the base of the brain,
044152 - where it encountered atherosclerotic plaque. This caused an
044153 - obstruction to blood blow, which then denied oxygen to an area of the
044154 - brain thereby causing the evident stroke visible in the MRi scan, but
044155 - is and was asymptomatic, i.e., none of the stroke symptoms diagnosed
044156 - by the medical team could have been caused by this 1st condition.
044157 - This blood clot further split in two, with the 2nd part advancing
044158 - further up the blood stream, where it encountered another
044159 - atherosclerotic plaque and so caused a 2nd obstruction to blood flow.
044160 - This 2nd blood flow obstruction caused stroke symptoms of impaired
044161 - vision and left side weakness, however there is no evidence of a
044162 - stroke area that could have caused the symptoms.
044163 -
044164 - [On 160722 1314 Doctor Massa endorsed blood clot
044165 - originating from afib in the heart and created blood flow
044166 - blockage encountering atherosclerosis in blood vessels of
044167 - the brain as the only working hypothesis to explain stroke
044168 - symptoms of vision and motor control impairment following
044169 - EGD dilation. ref SDS 21 EF4K
044171 - ..
044172 - Doctor Yoo emphasized that the MRI cerebral angiogram study shows no
044173 - evidence of blood clots nor atherosclerotic plaques anywhere in the
044174 - patient's brain. The medical team believes plaques and blood clots
044175 - existed on the day of the EGD Dilation procedure, but completely
044176 - resolved 2 days later when the Bella performed the MRI study, reported
044177 - in the record on 160617 1637. ref SDS 11 027K
044179 - ..
044180 - The record is not clear why the body would produce atherosclerotic
044181 - plaque at 2 specific locations, then just disappear 2 days later
044182 - leaving no trace of leasions, and further why atherosclerosis plaque
044183 - would not occur somewhere else in the brain?
044185 - ..
044186 - It is interesting there has been no discussion on the "large mass
044187 - across the brain" shown by the MRI test on 160617 1637. ref SDS 11
044188 - 027K The next morning, Doctor Yoo reported this "large mass" shows a
044189 - stroke occurred. 160618 0800, ref SDS 12 MX8L
044191 - ..
044192 - What has become of the "large mass" theory of the case??
044194 - ..
044195 - Turned out this is another way of describing leptomeningeal
044196 - enhancement set out in findings of MRI on 160618 1348. ref SDS 13 VQ6F
044197 -
044198 -
044199 -
044200 -
044201 -
044202 -
044203 -
044204 -
044205 -
0443 -