CONTACTS 

SUBJECTS
Stroke Symptoms After EGD Dilation  Pocedure VAMC Sacramento Left Si                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
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0404 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040501 - Follow up ref SDS 47 0000. ref SDS 45 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
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040505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040506 -            [On 160922 2010 letter from Robin commenting favorably on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040507 -            pictures. ref SDS 49 PI9F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
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0408 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040901 - Sent letter to medical team saying...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040902 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040903 -    1.  Subject:  Half Dome Functional Medical Metric                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040904 -        Date:  2016-09-19 03:51                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040910 -         ..
040911 -    2.  Dear Doctor Massa,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040913 -         ..
040914 -    3.  This past Wednesday, hiked to the top of Half Dome in Yosemite,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040915 -        shown by attached pictures [...reported on 160914 0530,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040916 -        ref SDS 48 0001...].  This was a good effort, having failed the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040917 -        past 2 years due to medical maladies, now resolved by good                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040918 -        care.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040919 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040920 -            [On 161019 0618 sent copy of this letter to Pat Lincoln,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040921 -            Directory Computer Lab at SRI. ref SDS 50 6Z7M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040923 -         ..
040924 -    4.  Since June, I have had about 10 neurology tests [...listed in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040925 -        the record on 160620 0707. ref SDS 13 1I4H...], following                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040926 -        diagnosis of stroke on 160618. ref SDS 9 MX8L  This diagnosis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040927 -        was clarified by Stanford Neuroscience [...on 160802,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040928 -        ref SDS 24 SU3H, confirmed in SN letter received on 160820                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040929 -        0940. ref SDS 40 OE7M...], and later in your call on 160802.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040930 -        ref SDS 25 WF5I...]  The cause of stroke symptoms on 160617,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040931 -        following EGD procedure, and MRI findings the next day on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040932 -        160618, remain to be determined.  As shown in the letter on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040933 -        160912 (see below), Doctor Lee indicated stroke symptoms were                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040934 -        related to conscious sedation. ref SDS 47 RT36  He reduced the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040935 -        dose by 50% for the procedure on 160909.  Resulting confidence                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040936 -        that the cause of stroke symptoms could be "fixed" gave                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040937 -        confidence that Half Dome could be attempted without recurrence                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040938 -        of symptoms.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040940 -         ..
040941 -    5.  The ultimate metric of health care is functionality.  Can you                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040942 -        breath, eat, walk.... climb half Dome and get back alive?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040943 -        Unless you have done it, is difficult to appreciate the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040944 -        significant physical and neurological challenges presented by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040945 -        Half Dome, listed as 1 of the 10 most difficult hikes in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040946 -        world.  Having fallen twice this past year, disclosed a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040947 -        neurological deficit initially diagnosed by Doctor Simpson as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040948 -        BPPV [...reported on 160504 1000. ref SDS 4 MO74...].  Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040949 -        Yoo made timely referral to Physical Therapy and to Audiology                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040950 -        and Balance [...reported on 160603 1430. ref SDS 5 PT9F...].                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040951 -        Ultimately, Bethany performed procedures on 160707, which                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040952 -        seemed to eliminate dizziness and balance symptoms [...reported                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040953 -        in the record on 160707 0900. ref SDS 15 6E7J...].  Testing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040954 -        requires going back and doing what caused prior falls.  That                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040955 -        testing was successful on September 14, 2016.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040957 -         ..
040958 -    6.  Accordingly, it is a privilege and honor to again commend VA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040959 -        health care for outstanding work providing excellent medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040960 -        services in this case since 2005.  On 091022, Doctor Tseng,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040961 -        Doctor Ratcliffe, and the entire CT surgery team (Neal, KC,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040962 -        Paula, Joe) restored the patient to better than full                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040963 -        functionality, now at age 70+.  Of course full credit goes to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040964 -        VA team care, specifically Doctor Stewart in General Surgery,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040965 -        Doctor Alba in Endocrinology, Lana in Wound Care, Doctor Tang                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040966 -        in Podiatry, and Doctor Hewitson in Biomechanics.  Doctor Dang                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040967 -        and Betty in Orthopedics have been extremely helpful, as have                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040968 -        Doctor Jha and Doctor Elicker, Bella, Youseff, and Irene in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040969 -        Radiology.  As well Doctor Egan in Cardiology and Doctor Sandhu                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040970 -        in Primary Care at the Martinez Clinic have provided excellent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040971 -        care.  Doctor Lee in GI at VAMC Sacramento has worked                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040972 -        tirelessly to restore near normal digestion essential for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040973 -        hiking Half Dome.  Everyone working together through doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040974 -        patient partnership got me to the top of Half Dome.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040976 -         ..
040977 -    7.  You all deserve a Congressional Award.  Not for treating me,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040978 -        but for treating thousands of veterans who daily get the best                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040979 -        care in the world.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040981 -         ..
040982 -    8.  All I can say is thank your for being there.  What a great                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040983 -        country.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040985 -         ..
040986 -    9.  Very best regards,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040987 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
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040996 -   11.  Attachments:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
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041004 -            [On 160922 2010 letter from Robin commenting favorably on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041005 -            pictures. ref SDS 49 PI9F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
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