CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 38 0000. ref SDS 35 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Sent letter to Doctor Massa, saying...
040902 -
040903 - 1. Subject: Re: Cause Stroke Symptoms Following EGD Dilation on June 17
040904 - Date: 2016-07-27 02:39
040913 - ..
040914 - 2. Thanks very much for taking a few moments this past Friday on
040915 - 160722 at 1304, to meet in the Module #2 lobby and explain
040916 - progress determining cause of stroke symptoms following EGD
040917 - dilation with conscious sedation performed at VA Medical Center
040918 - in Sacramento on 160617. This meeting responded to the letter
040919 - submitted to the Neurology team through Doctor Yoo, issued
040920 - earlier Friday, 160722 at 1020. ref SDS 34 W05I It was
040921 - especially helpful meeting you, since Doctor Yoo reported he
040922 - works at other facilities, and so has limited time for this
040923 - case. ref SDS 34 TF76
040925 - ..
040926 - 3. Please take a moment to review the record of the meeting, and
040927 - let me know of any additions or corrections. ref SDS 35 PR57
040929 - ..
040930 - 4. Thanks, as well, for asking about recovery of right knee injury
040931 - on 160715. Finally, today was able to do a full lap. Could
040932 - not do the last mile because of 103 degree heat. This is good
040933 - progress after not being able to hike for a week (see case
040934 - study on exercise, diet, medication and vitals - line 121630.
040935 - ref SDS 15 LC5J
040937 - ..
040938 - 5. Big decision will be next week meeting with Orthopedics to
040939 - review MRI findings pending on the knee for consideration of
040940 - arthroscopic surgery, or knee replacement. [...referencing
040941 - meeting in Orthopedics on 160720 1550. ref SDS 32 VQ4M...].
040942 - Hoping by then, knee issues will have healed up to avoid more
040943 - surgery. It's a complicated call.
040945 - ..
040946 - 6. Summarizing our discussion on 160722, ref SDS 35 6S5P, you
040947 - concurred with Doctor Yoo's letter on 160715, saying VA
040948 - Neurology has cleared the patient for repeat EGD dilation
040949 - procedure on 160909. ref SDS 28 MO6F This seems premature on
040950 - the current record. Accordingly, I am asking again, repeating
040951 - request in the letter to VA Neurology on 160717, ref SDS 29
040952 - GX38, to demonstrate evidence showing repeating the procedure
040953 - on 160909, will not repeat stroke symptoms with even more
040954 - serious consequences.
040956 - ..
040957 - 7. For example, VA Progress Notes for the prior procedure on
040958 - 151204, reports using "Olympus GIF-H180J video gastroscope"
040959 - advanced into the esophagus. Assuming the same equipment was
040960 - used on 160617, CNBC and Los Angeles Times reported yesterday
040961 - on 160726, Olympus gastroscopes have been found to cause
040962 - patient maladies all over the world, including death, since
040963 - 2013, by spreading infection due to design flaw that prevents
040964 - thorough cleaning. Research on 160621, cites contaminated
040965 - endoscope equipment as common cause of complications from EGD
040966 - dilation procedures. The rate of incidence is low; however,
040967 - using equipment with a design flaw greatly increases the
040968 - frequency for this event, and thus the odds it was a factor in
040969 - the instant case on 160617.
040971 - ..
040972 - 8. The next day after EGD dilation procedure in Sacramento, Doctor
040973 - Yoo reported the MRI on 160618, found a large area of
040974 - inflammation above the [...brain...]. ref SDS 21 MX8L He
040975 - advised this can be caused by bacteria, virus infection, and
040976 - cancer. Since the MRI found no evidence of cancer, this
040977 - suggests virus infection may have occurred from a contaminated
040978 - Olympus gastroscope, as reported by Los Angeles Times.
040979 - ref SDS 38 WR8I
040981 - ..
040982 - 9. Hopefully, this problem is limited to a single model of Olympus
040983 - endoscopes, which is not used by the VA. Please investigate
040984 - and report findings on this potential cause of stroke symptoms
040985 - in this case. What virus infection could have caused symptoms?
040986 - Has the VA, like other hospitals, had other patients get sick
040987 - after EGD dilations, since this matter first arose in 2013?
040989 - ..
040990 - 10. Research on 160621 lists a great many ways EGD can cause
040991 - complications. ref SDS 25 0J4M They should be reviewed for
040992 - applicability here, as well toward clearing the patient for the
040993 - next procedure on 160909.
040995 - ..
040996 - 11. You, also, indicated in our meeting on 160722, that VA
040997 - Neurology separates conscious sedation from the EGD procedure,
040998 - as potentially causing post procedure stroke symptoms. Since
040999 - this conscious sedation issue has not been addressed in VA
041000 - Progress Notes, please review it to support clearing the
041001 - patient for repeat procedure on 160909. What problems can
041002 - conscious sedation cause that might produce stroke symptoms in
041003 - this case?
041005 - ..
041006 - 12. During the meeting on 160722, you advised that MRI findings on
041007 - 160618, the day after EGD dilation procedure on 160617, of...
041008 -
041009 - "left anterior choroidal artery infundibulum"
041010 -
041011 - ...could not have caused stroke symptoms of minor motor control
041012 - and vision impairment, because the location identified in the
041013 - MRI report would have caused more symptoms. Therefore,
041014 - Neurology reasons that since more symptoms were not identified
041015 - by ER and Neurology examination over 15 hours after the EGD
041016 - dilation on 160617, this MRI finding caused nothing, and that a
041017 - surmised blood vessel blockage occurred further upstream where
041018 - vision and motor control are managed in the brain, but which
041019 - was not found in the MRI nor any other of numerous studies
041020 - performed in this case.
041022 - ..
041023 - 13. Accordingly, I urge Neurology to reconsider MRI express finding
041024 - in relation to the absence of any other finding that explains
041025 - patient symptoms in this case.
041027 - ..
041028 - 14. For example, since disruption of vision and motor control was
041029 - minor, a broader array of less prominent symptoms could also
041030 - have occurred, but with such minor effects as to go unnoticed,
041031 - and then resolved by the time professional care made an
041032 - examination 18 hours later, in the same way that the 2 major
041033 - symptoms of vision and motor control resolved within a day or
041034 - so.
041036 - ..
041037 - 15. In fact a broader array of symptoms did occur, set out in the
041038 - record on 160722 (line 040994. ref SDS 35 UY6H
041040 - ..
041041 - 16. Of course, even if true that the MRI finding reconciles stroke
041042 - symptoms in this case, there is still the question of what
041043 - caused it? Is there a medical connection that reasonably
041044 - justifies blaming the Olympic Company in Japan for a design
041045 - flaw that caused virus infection, as set out in the Los Angeles
041046 - Times article? Can we simply switch to another vendor, and
041047 - steam clean the equipment? This would be a comprehensive
041048 - solution, if supported by the record.
041049 -
041050 - [On 160907 1420 letter notifies medical team that
041051 - Triamcinolone may have caused stroke symptoms on 160617,
041052 - because dose over 3 month period accumulated to
041053 - significantly more than commonly given in this case.
041054 - ref SDS 43 BI60
041056 - ..
041057 - 17. In the meantime, patient will agree to undergo another 2-weeks
041058 - of Zio XT heart monitoring [...proposed during meeting with
041059 - Neruology Doctor Yoo on 160715 1630. ref SDS 28 8Q6I...], to
041060 - support Neurology testing the theory that a seemingly healthy
041061 - patient experienced afib that caused a blood clot or 2 or 3,
041062 - none of which were found in the MRI study the day after
041063 - symptoms occurred following the EGD dilation on 160617. I am
041064 - interested to see if stressing the body with extended endurance
041065 - exercise, required to raise HDL that resolves atherosclerosis,
041066 - causes any adverse coronary issues.
041067 -
041068 - [On 160727 0930 scheduled MRI on knees to evaluate injury
041069 - on 160715; Radiology department cannot perform MRI with Zio
041070 - XT device installed, so will have Zio XT device installed
041071 - in Cardiology right after MRI is completed on 160805.
041072 - ref SDS 40 0J47
041074 - ..
041075 - [On 160731 1532 notified Cardiology that Zio XT device will
041076 - be installed on 160805, after MRI on knees. ref SDS 41 ST75
041078 - ..
041079 - [On 160801 0923 notify Doctor Yoo in Neurology that Zio XT
041080 - device will be installed on 160805 OA 1000. ref SDS 42 WF5I
041082 - ..
041083 - 18. For Doctor Lee, please schedule the meeting to review the prior
041084 - procedure, and consider adjustments. Hopefully, this can be
041085 - done this week or next, at your convenience. We can meet
041086 - before or after normal hours in order to avoid disruption of
041087 - your schedule. Just let me know. This meeting was requested
041088 - in the letter on 160714. But, with everything going on,
041089 - understandably have not heard from you.
041091 - ..
041092 - 19. Would like your views on stent option, which will be considered
041093 - with GI Clinic at VAMCSF, as well. Also review diet (e.g.,
041094 - orange juice, lemon juice, onions, etc) for reducing acid
041095 - reflux which causes ulceration of stricture. You proposed
041096 - considering alternate PPI. Need a list. Would like to discuss
041097 - Pantorazole mentioned by Debbie here in San Francisco last
041098 - week. Has the Mylanta prescription been updated? How is the
041099 - independent review going, which you ordered on 160714?
041101 - ..
041102 - 20. Yesterday morning, received a call from someone in the GI
041103 - Department at VAMCSF, asking why there was a note on his desk
041104 - to schedule a meeting? [...reported on 160726 1006. ref SDS 37
041105 - W05I...]. He explained the GI clinic needs a referral to
041106 - schedule a meeting. Cited the record on 160705, when Doctor
041107 - Stewart suggested making a referral to consider a stent
041108 - procedure. On 160720 I sent a letter asking the doctor to make
041109 - the referral. The caller said he would contact Isagani, Doctor
041110 - Stewart's admin assistant, about the referral. There was no
041111 - call back to follow up on return from the hike today. This
041112 - will remind the GI team to try and touch base with Doctor
041113 - Stewart to execute a referral.
041115 - ..
041116 - 21. Doctor Simpson, received your voice mail on 160722, saying you
041117 - looked at the MRI and concur a stroke may have occurred,
041118 - ref SDS 36 509K, as presented by Neurology, albeit without
041119 - symptoms nor causation. You also talked to someone in GI
041120 - Clinic on this matter. Would like to meet with you later
041121 - today, to take a look at the radiology study on the stroke and
041122 - review the intensity issue, which Doctor Yoo mentions helps
041123 - date occurrence. As noted above, he is often off site, so an
041124 - objective look would be helpful. Your support is appreciated.
041125 -
041126 - [On 160727 0930 at 1121 Doctor Simpson unavailable to meet
041127 - today; recommended scheduling meeting. Scheduling clerk
041128 - said Doctor Simpson can meet on 161019; since meeting is
041129 - needed within 2 weeks, did not schedule a meeting.
041130 - ref SDS 39 HE6N
041132 - ..
041133 - 22. Thanks very much for continued support on complex issues.
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041144 -
041145 -
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041149 -