CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 5 0000, ref SDS 4 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Patient identification at Stanford Neuroscience...
040902 -
040909 - ..
040910 - Sent letter to Stanford Neuroscience Center saying...
040911 -
040912 - 1. Subject: Re: Neuroscience center
040913 - Date: 2016-07-30 11:37
040918 - ..
040919 - 2. Responding to your letter received yesterday [...on 160729
040920 - 1531, ref SDS 5 WF5I...], request 2nd opinion on MRI findings,
040921 - impressions, and assessment by UCSF Neurology team providing
040922 - services at VA Medical Center in San Francisco. Everyone has
040923 - done a great job. However, the case can benefit from 2nd
040924 - opinion process to clarify assessment.
040925 -
040926 - [On 160802 0917 Stanford Neuroscience called and scheduled
040927 - meeting same day at 1300; located near Stanford Medical
040928 - Center in Palo Alto. ref SDS 6 WF5I
040930 - ..
040931 - [On 160802 1404 Doctor Massa called while I was in
040932 - discussion with Stanford Neuroscience doctors on 2nd
040933 - opinion as requested in this letter. ref SDS 7 WF5I He
040934 - presented new perspective indicating stroke did not occur.
040935 - He plans to ordered another MRI of brain to assess
040936 - resolution of original symptoms. ref SDS 7 4C94
040938 - ..
040939 - 3. On 160617 (June 17) OA 0900 in GI Clinic at VA Medical Center
040940 - Sacramento, I had EGD Dilation procedure, continuing a series
040941 - of about 20 prior procedures since 2010.
040943 - ..
040944 - 4. At my request, the GI medical team in Sacramento let me sleep
040945 - an hour longer than normal recovery on 160617. I then met with
040946 - Doctor Lee, who performed the work, to review findings, adjust
040947 - medication, and schedule the next procedure on 160909 (Sep 9).
040948 - This was set to accommodate hiking Half Dome the following week
040949 - on Sep 14.
040951 - ..
040952 - 5. On entering the examination room, I felt chilled and so a
040953 - blanket was provided. About 2 weeks later I learned, that
040954 - after the meeting I walked out of the hospital with the blanket
040955 - wrapped around my shoulders, got into the car and drove home.
040956 - This was a complete blank to me at the time. Getting into the
040957 - car, I could not buckle the seat belt on the left side, so the
040958 - driver (Kathy) did this for me.
040960 - ..
040961 - 6. We drove from Sacramento to where I live in Concord, and went
040962 - to a restaurant. Getting out of the car, Kathy again helped
040963 - with the seat belt. I dropped the cellphone in the left hand.
040964 - On being seated, I dropped it again, and waiter picked it up.
040965 - I ordered a tall mug of Doctor Pepper. Kathy handed me a small
040966 - container of lemon juice, which I added to the glass. A few
040967 - minutes later, I asked...
040968 -
040969 - "Where is the Doctor Pepper?"
040971 - ..
040972 - 7. She said, "Rod, it is on the table right in front of you."
040974 - ..
040975 - 8. I asked her to point it out, and on doing so, I saw it.
040977 - ..
040978 - 9. On returning home, I could not see the computer screen enough
040979 - to enter my password by placing the cursor at the correct line
040980 - on the screen. Kathy handed me her cellphone, and I could not
040981 - see the numbers on the screen to enter her password.
040983 - ..
040984 - 10. Went to bed and thought about all this. Then got up and drove
040985 - to the VA Medical Center in San Francisco, where I get most of
040986 - my care. Was examined immediately for a stroke. Care was
040987 - timely, thorough, and excellent in all respects.
040989 - ..
040990 - 11. The record of all this, including ER neurology examination
040991 - beginning at 2229 (10:29pm), is shown at [...the record on
040992 - 160617 1637. ref SDS 1 5F6F...]
040994 - ..
040995 - 12. You will see, Doctor Abrams, Chief of Neurology was consulted
040996 - and ordered a CT. This was done after midnight. Doctor Abrams
040997 - was notified of results, and ordered an MRA study. This was
040998 - done OA 0300 the next day.
041000 - ..
041001 - 13. Stroke symptoms resolved within 2 days. I was released from
041002 - the hospital on the 4th day and have suffered no recurrence of
041003 - symptoms. This seems to indicate something happened to the
041004 - patient during the EGD dilation procedure on 160617, and wore
041005 - off within 24 - 48 hours.
041007 - ..
041008 - 14. The day after EGD dilation on 160617, Doctor Yoo explained a
041009 - virus infection could have caused stroke symptoms shown in MRI
041010 - study of a large inflammation layer over the top of my brain.
041011 - The MRI lists an impression of "suspicious for leptomeningeal
041012 - enhancement," however 2 lumbar puncture procedures found no
041013 - evidence of this. The virus infection theory seems supported
041014 - by labs drawn initially in the ER showing WBC 15.2 - 50% high
041015 - drawn after midnight on 160618 0054. By the following morning,
041016 - on 160619 0700, daily lab in the hospital showed WBC 13.0. For
041017 - some reason, subsequent labs performed while in the hospital do
041018 - not report WBC. On July 17, an independent lab was drawn to
041019 - check HDL, and reported WBC 8, within normal range. This
041020 - indicates resolution of what caused elevated WBC 15.2 the night
041021 - after EGD Dilation on 160617.
041023 - ..
041024 - 15. VA Neurology maintains the MRI shows a "likely" stroke, but is
041025 - asymptomatic, and did not cause stroke symptoms manifest in
041026 - this case. VA Neurology further maintains the MRI was
041027 - re-reviewed a month later and on 2nd review, assumes the
041028 - "likely" stroke occurred a day or 2 before EGD dilation on
041029 - 160617, thus indicating no causal relationship, and so no
041030 - danger to the patient for repeating the same procedure without
041031 - changes nor corrections, currently scheduled on 160909.
041033 - ..
041034 - 16. Neurology makes no assessment on what caused the stroke
041035 - symptoms, but maintains I am cleared for the next EGD Dilation
041036 - procedure scheduled on 160909. Timing for this procedure is
041037 - becoming critical because LESV seems to be shutting down faster
041038 - this cycle [...reported yesterday to Doctor Stewart on 160729
041039 - 0119. ref SDS 3 DZ3Q...], which possibly is another stroke
041040 - symptom, since research indicates achalasia may be
041041 - neurologically driven. This presents a question of whether
041042 - whatever controls LESV was torqued by what happened during the
041043 - EGD dilation on 160617 that preceded stroke symptoms.
041045 - ..
041046 - 17. Undergoing a repeat EGD dilation procedure on 160909, even
041047 - though it is essential, requires confidence that neurology
041048 - events on 160617, will not repeat with more severe
041049 - consequences, and so seek 2nd opinion on these matters.
041051 - ..
041052 - 18. Last week on Wednesday, 160727, I wrote a letter citing
041053 - research indicating contaminated gastroscope equipment might
041054 - have caused virus infection that caused stroke symptoms, given
041055 - that this equipment has a history of causing patient maladies
041056 - all over the world, including death, attributed to a design
041057 - flaw that inhibits cleaning between uses, thus spreading
041058 - infection. This letter can be accessed on the Internet at (see
041059 - beginning at line 040945. ref SDS 2 SZ61
041061 - ..
041062 - 19. MRI gearview.exe and related image files have been uploaded to
041063 - the referralbox [...reported on
041064 - Additionally, I can bring case files,
041065 - including Progress Notes, on a notebook to a meeting, since the
041066 - purpose of the meeting is to identify which particular scan
041067 - files support VA findings, and related conclusions.
041069 - ..
041070 - 20. Several letters to the Neurology team requesting support for
041071 - current assessment, have not been answered, because everyone is
041072 - busy providing good care to other patients. VA does
041073 - outstanding work, including in this matter. 2nd opinions add
041074 - resources to ensure limited time does not prevent thorough
041075 - consideration of critical correlations, implications and
041076 - nuance. When my wife, Millie had cancer in 2002, we began
041077 - getting 2nd opinions in 2004, from Stanford, UCSF and others.
041078 - Kaiser implemented all 2nd opinion recommendations, with the
041079 - result that Millie survived with an active life worth living
041080 - even with stage IV cancer (IBC) for nearly 10 years. This
041081 - record provides great confidence in Stanford and UCSF (who
041082 - incidentally provide my care at VAMCSF).
041084 - ..
041085 - 21. On 160714, Doctor Lee, who has always done excellent work, and
041086 - performed EGD Dilation on 160617, called and advised he ordered
041087 - independent review of that work toward determining any
041088 - corrections to prevent repeating stroke symptoms. Nothing has
041089 - been submitted on results of this review.
041091 - ..
041092 - 22. Thus, I will pay to hire others to develop a record that
041093 - justifies repeating the EGD dilation procedure with GI Clinic
041094 - at VA Medical Center in Sacramento on 160909.
041096 - ..
041097 - 23. Attached is the MRI report. The VA included it with other
041098 - records, which may be of interest, but the MRI report is the
041099 - focus in this 2nd opinion study.
041101 - ..
041102 - 24. Patient background...
041104 - ..
041105 - 25. Six (6) years ago, on 091022, with HDL 30, I had CABG x4,
041106 - Doctor Elaine Tseng, attending. Two (2) months later, on
041107 - 091216, I had Heller Myotomy surgery with Dor fundoplication to
041108 - relieve symptoms of achalasia, performed by Doctor Lygia
041109 - Stewart. Three (3) months later on 100305, began getting
041110 - periodic EGD dilation procedures to expand LESV for normal
041111 - swallowing, performed by Doctor Randall Lee.
041113 - ..
041114 - 26. From 2003 to 2009, patient was hiking 3 - 6 miles per day,
041115 - which yielded HDL 30, leading to CABG x4. Following CABG,
041116 - patient increased hiking to 4 - 8 miles per day. This
041117 - increased HDL to only 45, not enough to make a difference.
041119 - ..
041120 - 27. In 2011, patient increased daily hiking to 11 - 15 miles per
041121 - day, hiking nearly 12,000 miles the past 5 years. This yielded
041122 - HDL 73 on 160202. Most recent HDL 67 was reported 2 weeks ago
041123 - by Labcorp, reflecting significant decline in hiking due to
041124 - injuries the past 6 months.
041126 - ..
041127 - 28. CCTA was performed last year on 151019, and showed patient
041128 - clear of atherosclerosis, i.e., raising HDL to 73 has
041129 - completely regressed plaque to 0. MRI on 160618, shows no
041130 - evidence of atherosclerosis nor blood clots in the brain.
041132 - ..
041133 - 29. A week ago had EEG and Echo tests. They showed nothing that
041134 - indicates the patient has continuing cardiovascular issues nor
041135 - other maladies that explain stroke symptoms on 160617.
041137 - ..
041138 - 30. Nominally, this is a very healthy patient. So, what evidence
041139 - explains stroke symptoms?
041141 - ..
041142 - 31. At the time of the EGD Dilation on 160617, patient was wearing
041143 - Zio XT heart monitor installed the day before to evaluate a
041144 - dizziness issue. The dizziness was independently diagnosed as
041145 - BPPV and resolved on 160707 by Bethany in Audiology and Balance
041146 - using Dix-Hallpike, Epley, and Semont maneuvers, albeit this
041147 - took a lot of effort (20 attempts). Important to the stroke
041148 - issue, Zio XT 2 week monitoring showed no instance of afib, nor
041149 - anything else that could cause blood clots or stroke symptoms.
041151 - ..
041152 - 32. VA Neurology proposes doing another 2 weeks Zio XT heart
041153 - monitoring test looking for evidence of afib as an alternate
041154 - theory for causing a possible asymptomatic infarct. I have
041155 - agreed, and this will begin after an MRI is performed scheduled
041156 - on 160805 (next Friday).
041158 - ..
041159 - 33. Please advise the cost to review MRI scan and provide 2nd
041160 - opinion on evidence of stroke and cause of symptoms, including
041161 - meeting with the patient.
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