CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 20 0000. ref SDS 18 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - On 171201 1300 visited Audiology and Balance for treatment scheduled
040902 - with Doctor Wiseman at the end of the meeting last week on 171121
040903 - 0800. ref SDS 17 9X3J Met with Bethany Wiseman, MD...
040905 - ..
040906 - On 171207 1833 sent letter to Bethany reporting BPPV dizziness
040907 - symptoms were resolved. ref SDS 19 GG5I
040909 - ..
040910 - On 180514 0829 letter requests VA Audiology and Balance Department
040911 - examination and treatment for initial symptoms of dizziness
040912 - recurrance. ref SDS 20 038J Bethany responded saying the VA can
040913 - provide treatment anyday this week. ref SDS 20 X65O Notified would
040914 - appear for treatment this morning at 0830. ref SDS 20 4F5F
040916 - ..
040917 - Today, meeting with Bethany to perform Dix Hallpike maneuver testing
040918 - for BPPV.
040920 - ..
040921 - On arriving at the counter for Audiology and Balance, there were three
040922 - attendants. They said Doctor Wiseman was in a meeting until 1030.
040923 - Explained the doctor's letter on Monday, saying to visit the office
040924 - anytime this week, and she would be available, reported on 180514
040925 - 0829. ref SDS 20 GE39 The response was I would come in today at 0830,
040926 - unless she proposed another date and time. ref SDS 20 4F5F
040928 - ..
040929 - One of the clerk's said there was a misunderstanding, because Doctor
040930 - Wiseman is in a staff meeting until 1030.
040932 - ..
040933 - Asked them to try giving the doctor a note saying I am here.
040935 - ..
040936 - This was done. The clerk returned and said the doctor will meet with
040937 - the patient.
040939 - ..
040940 - Doctor Wiseman came into the patient waiting area. She smiled and
040941 - apologized for the delay. She explained the staff is getting
040942 - training today on a new system of some kind. She has already had the
040943 - training, and so was just sitting in the meeting along with everyone
040944 - else until I arrived.
040946 - ..
040947 - We walked back through the hallway to the examination and treatment
040948 - room. Passed through everyone listening to the presenter. Several of
040949 - the staff smiled and said hello, remembering prior treatment sessions,
040950 - when they assisted Bethany in my care.
040952 - ..
040953 - In the examination room, the doctor initially did Dix Hallpike, and
040954 - noticed slight flickering of eyes, indicating mild BPPV.
040956 - ..
040957 - We reviewed the record that symptoms do not include common spinning
040958 - sensation. There is a "floating" and "disorientation" feeling that
040959 - precedes the "spinning room" sensation. The concern is that left
040960 - untreated, this could escalate to full blown dizziness, and become
040961 - dangerous, especially when driving, as occurred with a neighbor,
040962 - reported on 170828 1019. ref SDS 4 GG5I There is also concern about
040963 - falling again when doing Half Dome scheduled in 4 months on 180912.
040965 - ..
040966 - Bethany explained recurrence of mild BPPV symptoms is common because,
040967 - after a patient suffers BPPV, then relapse occurs more easily.
040969 - ..
040970 - Advised have not suffered any evident jolts to the head, which caused
040971 - prior BPPV episodes. Falling incorrectly on the trampoline caused the
040972 - first problem, reported during treatment on 160707 0900. ref SDS 3
040973 - TL58 Being flipped over twice with head striking the roof of the car
040974 - during the collision on 170905 2230, ref SDS 6 0001, caused recurrence
040975 - of BPPV, treated again by Bethany on 170921 0800. ref SDS 11 FT6O
040977 - ..
040978 - Possible cause for recurrence of BPPV this time is using the
040979 - trampoline again at the Gandy's home a few months ago. Was
040980 - disappointed with bouncing erratically, and so did not attempt any
040981 - maneuvers. Possibly, mere bouncing up and down could have caused
040982 - recurrence of mild BPPV.
040984 - ..
040985 - Bethany added that even hard sneezing can cause BPPV recurrence.
040987 - ..
040988 - She asked about alergies?
040990 - ..
040991 - Explained having no evident alergies; however, sneezing is common
040992 - occurrance with sudden chill from temperature change.
040994 - ..
040995 - The doctor advised that "mild" symptoms indicate only a few calcified
040996 - crystals fell from the vestibular chamber into one of the three
040997 - semicircle balance rings behind the left ear.
040999 - ..
041000 - As done previously, the doctor performed Epley (see explanation
041001 - reported on 160513 1100, ref SDS 2 M15O) several times, concentrating
041002 - on the left side. After 4 - 6 Epley maneuvers, she continued to
041003 - detect horzontal eye movement, and the patient reported continuing
041004 - dizziness symptoms, though less severe.
041006 - ..
041007 - The doctor indicated that improvement shows some of the calcified
041008 - crystals have moved back into the vestibular chamber of the left ear.
041010 - ..
041011 - She proposed changing the maneuver. Instead of Epley, the patient
041012 - rolls onto the stomach with both arms bent under the chest to support
041013 - the upper body. In this position with the head extended over the end
041014 - of the examination table, Bethany shook the head up and down several
041015 - times very quickly. This line of care was effective during treatment
041016 - on 160707 0900. ref SDS 3 414G
041018 - ..
041019 - After this alternative treatment, i.e., shaking the head up and down,
041020 - there seemed to be further improvement in reducing BPPV symptoms. We
041021 - decided to end treatment and evaluate over the next few days. Since
041022 - the treatment itself induces symptoms cannot fully evaluate results
041023 - immediately afterwards.
041025 - ..
041026 - Thanked the doctor for timely care today, and evident progress. The
041027 - concern is that even mild BPPV symptoms left unresolved could cause
041028 - loss of balance and falling again hiking Half Dome in September.
041030 - ..
041031 - During treatment today, Bethany advised of getting her undergraduate
041032 - degree from Penn State in Penselvania. Must have been 10 years ago or
041033 - more - she didn't say. But, discussion turned to the Penn State v USC
041034 - Rose Bowl 2 years ago. Bethany said she was in the stands for that
041035 - momentous game.
041037 - ..
041038 - Bethany said to let her know if symptoms return.
041039 -
041040 -
041041 -
041042 -
041043 -
041044 -
041045 -
041046 -
041047 -
041048 -
041049 -
041050 -
041051 -
041052 -
041053 -
0411 -