CONTACTS
SUBJECTS
Stroke Symptoms After EGD Dilation Pocedure VAMC Sacramento Left Si
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 38 0000. ref SDS 37 0000.
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040509 -
040511 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Sent letter to medical team saying...
040902 -
040903 - 1. Subject: EGD Triamcinolone Injection on 160617, May Correlate Stroke Symptoms MRI 160168
040904 - Date: 2016-09-07 16:02
040913 - ..
040914 - 2. On 160811, you wrote noting significant possibility of stroke
040915 - symptoms related to the EGD on 160617, but no mechanism was
040916 - evident. 160811 1546, ref SDS 27 3K9J
040918 - ..
040919 - 3. About 2 weeks later on 160823, you called and asked if Doctor
040920 - Lee injected Triamcinolone for EGD procedure the week before on
040921 - 160816? At that time, I demurred on grounds that Doctor Lee's
040922 - Progress Notes had not been posted. ref SDS 38 SA5I
040924 - ..
040925 - 4. Subsequent review of patient history indicates Triamcinolone
040926 - injection on 160816, likely was not performed, in that prior
040927 - injection 2 months earlier on 160617, of 5.0 mL was aggressive,
040928 - where as little as 2.0 mL has been effective for 6 months (see
040929 - case study. ref SDS 4 V48Y
040931 - ..
040932 - 5. Since research indicates Triamcinolone can cause vision loss,
040933 - involved in this case [...ref SDS 4 UD6L...], it appears
040934 - getting 8 mL in 3 months, may have tipped the patient into a
040935 - neurological deficit, where 1.5 mL is a common adult dose.
040936 - This fits the model posed by Doctor Vora at Stanford
040937 - Neuroscience noting on 160802, that something happened to the
040938 - patient on 160617, that accumulated from prior procedures.
040939 - Fortunately, this is an easy fix, reducing exposure to
040940 - Triamcinolone down to a dose that has historically been well
040941 - tolerated.
040943 - ..
040944 - 6. I expect that was done on 160816, i.e., administering no
040945 - Triamcinolone; and, that none will be administered for the
040946 - procedure this Friday on 160909, since 5 mL given on 160617,
040947 - should be effective for several more months. We will see how
040948 - this goes.
040950 - ..
040951 - 7. Good news - recall Doctor Lee reported that LESV was so
040952 - severely ulcerated on 160816, that he was unable to perform any
040953 - dilation (see the letter below). Nominally, this would mean
040954 - that severe swallowing problems leading up to the procedure,
040955 - and which caused the procedure to be performed on an exigent
040956 - basis, 3 weeks ahead of schedule, would only get worse. The
040957 - opposite has occurred. Swallowing has been perfect with only a
040958 - single vomiting episode since 160816. Seems like a miracle -
040959 - too good to be true.
040961 - ..
040962 - 8. More good news - on 150916, I fell hiking Half Dome. VA has
040963 - done terrific work patching up injuries, and resolving BPPV
040964 - balance failure, that caused the fall. But of course "the
040965 - proof is in the pudding." Last week on 160825, I did a trial
040966 - hike to see if it might be possible to get back to the top of
040967 - Half Dome, which of course is a metric of health care. Just
040968 - like the 2nd MRI you ordered that found no adverse neurology
040969 - problems on 160805, the test on 160825, was successful.
040970 - Actually, traversed well beyond where the fall occurred, and
040971 - was fine, though at various locations there was concern about
040972 - falling again, as the terrain presents a neurological
040973 - kaleidoscope of stepping choices. ref SDS 39 6Q97
040975 - ..
040976 - 9. Still more good news - on 160805, VA MRI studies on both knees
040977 - reported numerous problems with right knee, ref SDS 23 DQ5J,
040978 - and even more on the left knee. ref SDS 23 PSWR Then there is
040979 - the metatarsalgia problem with both feet. Orthopedics said I
040980 - would need a wheel chair, walker, crutches, knee replacement -
040981 - something. Hiking has been reduced 50% this year; yet, somehow
040982 - the knees have come back doing 15 mile training splits the past
040983 - few weeks. This morning knees and feet were pain level 0
040984 - entire route. Another miracle.
040986 - ..
040987 - 10. Next week will do Half Dome again. We'll see what happens.
040989 - ..
040990 - 11. Thanks to you, Doctor Lee and the entire VA team for great
040991 - care, along with the folks at Stanford Neuroscience. Doctor
040992 - Abrams said on 160619, it is critical to discover what caused
040993 - stroke symptoms on 160617, in order to have confidence avoiding
040994 - severe consequences of recurrence. ref SDS 10 SV54 Similarly,
040995 - it was critical to discover what caused falling problems on
040996 - 150916, and this year on 160501, in order to have confidence
040997 - that correction can avoid more severe consequences. While this
040998 - has been difficult and tedious at times, your support has been
040999 - effective and greatly appreciated.
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