CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 31 0000. ref SDS 30 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - After meeting with Doctor Massa, Attending Physician, in the Welch
040902 - Neurology case, went across the street to Building 203, and met with
040903 - Debbie in the GI Clinic.
040905 - ..
040906 - Initially, said hello to Kim at the front desk.
040908 - ..
040909 - Told Debbie about the letter to Doctor Stewart on 160720 2206.
040910 - ref SDS 28 W05I
040912 - ..
040913 - Debbie checked the computer and found Doctor Stewart has not yet filed
040914 - a referral for consult with the GI Clinic for considering a stent,
040915 - which was requested in a letter to Doctor Stewart on 160720 2206.
040916 - ref SDS 28 CS58
040918 - ..
040919 - Debbie will check this again on Monday, 160725. If there is no
040920 - referral filed, she will contact Stewart to follow up.
040921 -
040922 - [On 160726 1006 received call from someone in GI clinic at
040923 - VAMCSF on scheduling meeting; he will coordinate with
040924 - Isagana in Doctor Stewart's office about getting the
040925 - referral for the consult with GI. ref SDS 33 W05I
040927 - ..
040928 - Need guidance from GI at VAMCSF on switching to stent procedure that
040929 - avoids risk of stroke symptoms from EGD dilation that occurred on
040930 - 160617 1637. ref SDS 19 5F6F What is done during EGD that can cause
040931 - stroke symptoms, and has the patient in this case passed a threshold
040932 - that requires changing to less risky procedure?
040934 - ..
040935 - Debbie said she has no experience treating patients with EGD
040936 - dilations, who later suffer stroke symptoms. She is unaware this has
040937 - occurred in the GI Clinic while she has worked here.
040939 - ..
040940 - Debbie said to discuss this with the doctor.
040942 - ..
040943 - To guide discussionw with the doctor, Debbie showed on the computer
040944 - screen the material used for a stent that aids swallowing...
040945 -
040946 - Esopmageal Stent
040947 -
040948 - manufactured by Boston Scientific
040950 - ..
040951 - Asked Debbie how reflux is controlled, which is major problem in this
040952 - case, shown by rising ulceration of LESV reported by Doctor Lee after
040953 - EGD dilation on 160617?
040955 - ..
040956 - Debbie said patients with stent control reflux with PPI medication,
040957 - like Omeprazole.
040959 - ..
040960 - We reviewed the record of side effects with Omeprazole that cause
040961 - frequent urination, leading to dehydration which injures the feet,
040962 - thus preventing hiking. This causes HDL to drop with consequent
040963 - increased risk of coronary and cerebral events.
040965 - ..
040966 - Debbie said an alternative to Omeprazole is...
040967 -
040968 - Pantoprazole
040970 - ..
040971 - Explained Doctor Lee's plans to propose alternates to Omeprazole,
040972 - reported in telecon on 160714 0814. ref SDS 24 PW4P
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0410 -