CONTACTS
SUBJECTS
Mother Stricken Serious Affliction Hospitalized Providence Medical C
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 30 0000. ref SDS 29 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Received letter from Doctor Beth Leone, DO, saying...
040902 -
040903 - 1. Subject: Lillian
040904 - Date: 2017-05-19 20:06
040911 - ..
040912 - 2. This is Beth Leone..I am the physician at rehab facility...
040913 - I have the absolute pleasure of caring for your mom, Lillian.
040936 - ..
040937 - 3. I have, too, been concerned about her complaint of painful
040938 - swallowing. I have entertained the idea of possible yeast
040939 - infection overgrowth in her esophagus given the prolonged
040940 - courses of antibiotic she has endured. That can certainly mimic
040941 - the symptoms of achalasia.
040943 - ..
040944 - Typically, vomiting is major symptom of ahcalasia. There are no
040945 - reports of mom vomiting. On the other hand in her condition of
040946 - advanced age and other serious infirmities, she may simply have
040947 - refused to eat and attempt to swallow, because she feels clogged in
040948 - her esophagus. Thus, lack of vomiting is not dispositive.
040950 - ..
040951 - Letter from Doctor Leone continues...
040952 -
040953 - 4. Sometimes a barium swallow can pick up some of the inflammation
040954 - of candidiasis in the esophagus. I will get her scheduled for
040955 - this testing. Or, perhaps, if her surgeon feels she could
040956 - tolerate, an upper endoscopy.
040958 - ..
040959 - Nominally, barrium swallow is only diagnostic, as a predicate to
040960 - incurring expense of EGD examination by the doctor using gastroscope.
040961 - Mother's difficulty standing due to lack of strength from lack of
040962 - nutrition, might justify skipping barrium swallow, and doing EGD
040963 - examination, as initial step, and with dilation if found necessary.
040965 - ..
040966 - While EGD gastroscope procedure is invasive, per se, it is generally
040967 - benign, with no after effects. There is minimal disruption of
040968 - internal tissue, except for taking biopsies, which seem very useful in
040969 - this case for evaluating stomach afflictions. The IV for conscious
040970 - sedition is the only painful issue for the patient. This could be
040971 - uncomfortable for mom, due to difficulty getting a blood flow because
040972 - of adhesions in her veins from prior sticks.
040974 - ..
040975 - Letter from Doctor Leone continues...
040976 -
040977 - 5. I have elected to initiate an anti yeast medication, Diflucan,
040978 - over weekend to see if helpful. If it is, may be able to avoid
040979 - invasive testing in her fragile state.
040981 - ..
040982 - Diflucan (Fluconazole 200 MB) was used numerous times for Millie
040983 - recovering from IBC, e.g., on 061208 1200. ref SDS 1 KW45 On 061214,
040984 - Mill's INR increased to 6.4, so discovered Diflucan conflicts with
040985 - warfarin. ref SDS 2 HF4O On 061218, the doctor ended Diflucan.
040987 - ..
040988 - This may present an issue in mom's case, i.e., drug conflicts.
040990 - ..
040991 - Fluconazole was prescribed in Welch case on 121001, and without
040992 - explanation. ref SDS 6 EO5H May have related to findings from EGD
040993 - examination of "Probable esophageal candidiasis" shown in Progress
040994 - Notes for EGD dilation a week earlier on 120925 0900, and confirmed
040995 - with biopsy results. ref SDS 5 E63F Doctor Leone cites possible
040996 - candidiasis in her letter today, per above. ref SDS 0 YQ48 In the
040997 - Welch case, Diflucan (Fluconazole) fully resolved candidiasis, which
040998 - was very helpful. Of course this was independent from achalasia,
040999 - which has been treated continously from 2005 to the present.
041001 - ..
041002 - Accordingly, if the medical team feels mom can withstand EGD
041003 - procedure, this may provide immediate relief for swallowing, and
041004 - further identify other issues to develop comprehensive line of care.
041006 - ..
041007 - Letter from Doctor Leone continues...
041008 -
041009 - 6. Your mother is an absolute delight. I wish nothing more than
041010 - to get her able to participate in therapy and eventually get
041011 - back home.
041013 - ..
041014 - Doctor Leone's letter today, shows she is going the extra mile to
041015 - help mom.
041017 - ..
041018 - Letter from Doctor Leone continues...
041019 -
041020 - 7. Your brother and sister are also such pleasures with which to
041021 - work. I consider myself very privileged to take part in her
041022 - care. Please do not hesitate to continue to ask questions and
041023 - feel free to make any suggestions which may facilitate her
041024 - improved health and well being.
041026 - ..
041027 - Beth Leone
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