CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 7 0000, ref SDS 5 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - Meeting Radiology for ultrasound scheduled on 180919 1305. ref SDS 7
040902 - RG6H
040904 - ..
040905 - This was ordered by Doctor Wen (Doctor Monto, Attending) on 180802
040906 - 1300. ref SDS 5 XH5U
040908 - ..
040909 - We are evaluating liver function after 10 years of elevated bilirubin
040910 - shown in recent lab on 180802 0640. ref SDS 4 015M
040912 - ..
040913 - Elevated bilirubin can indicate disruptive liver function, shown by
040914 - HDL lower than expected.
040916 - ..
040917 - Recently discovered that intoxication caused by acetaminophen
040918 - (Tylonal) also lowers HDL 30%, reported in the record with Lauren on
040919 - 180724 1645. ref SDS 3 EN4L
040920 -
040921 -
040922 -
040924 - ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Tech came to the waiting area and called for me.
041302 -
041303 - He introduced himself as Patrick.
041305 - ..
041306 - Went into Radiology area, and into a room.
041308 - ..
041309 - Laid on a gurney. Lifted shirt for access to skin on stomach and
041310 - sides.
041312 - ..
041313 - Patrick applied a water-based gel on the skin. He then applied the
041314 - transducer to all areas of the stomach and sides.
041316 - ..
041317 - Initially, laid on back. After about 5 minutes turned onto left side.
041318 - Since I had eaten scrambled eggs, sausage, and hashbrowns for
041319 - breakfast, expected this would cause reflux, which usually occurs
041320 - attempting to lay on left side even hours after a meal. Fortunately,
041321 - this did not occur today, despite being on left side for about 15
041322 - minutes or more. This favorable result may reflect Doctor Lee
041323 - dilating LESV 20 mm for the first time on 180904, in combination with
041324 - focus during breakfast this morning on washing down each bite with
041325 - carbonated softdrink.
041327 - ..
041328 - Eventually, turned to the back again, and later laid on right side.
041330 - ..
041331 - Ultrasound examination of abdomen today, evaluates internal organs...
041332 -
041333 - liver
041334 - gallbladder
041335 - intestines
041336 - kidneys
041337 - spleen
041338 - pancreas
041340 - ..
041341 - Patrick noted all blood flows appear patent. Research on 091022,
041342 - found that "patent" blood flows can occur with up to 70% blood vessel
041343 - blockage (stenosis) with plaque. ref SDS 2 RY6H At this time, after
041344 - maintaining HDL > 60 and elevated EPCs, there should be zero blockage
041345 - in all blood vessels.
041347 - ..
041348 - Patrick said the cost for ultrasound training is about $50K at the top
041349 - radiology training centers. Others charge less. Patrick seemed to
041350 - say ultrasound training is offered at some junior colleges.
041352 - ..
041353 - After about 30 minutes, the door opened. A woman's voice introduced
041354 - herself as Caittlyn. At this time I was laying on the left side
041355 - facing away from Patrick. Caitlyn eventually said to turn to my
041356 - back, and then realized she had replaced Patrick, who was sitting on
041357 - an adjacent stool and observing the work.
041359 - ..
041360 - Caitlyn then advised that Patrick is a student. She asked if I
041361 - minded him getting training doing the initial ultrasound imaging.
041363 - ..
041364 - I said this was fine.
041366 - ..
041367 - After Caitlyn took over, she seemed to do the entire examination
041368 - again, i.e., rolled to back, then left side, then back again, and then
041369 - right side. She pressed hard on the ribs, causing slight discomfort.
041370 - Laying on left side, she rolled the trasnducer along the right side,
041371 - and I commented this tickled a little. Caitlyn said most patients
041372 - are sensitive to this area.
041374 - ..
041375 - Asked Caitlyn if ultrasound shows any evidence of vascular blockages?
041376 - Caitlyn said the blood vessels all appear completely open.
041377 -
041378 - [...below on 180927 1000 SONOGRAM ABDOMEN reports blood
041379 - vessels patent. ref SDS 0 PI97
041381 - ..
041382 - Asked if Caitlyn knew Irene, explaining that she did initial
041383 - ultrasound test to verify carotid arteries were clear enough for CABG
041384 - surgery, reported on 091021 0716. ref SDS 1 04CH
041386 - ..
041387 - Caitlyn said Irene taught her ultrasound skills, and she is currently
041388 - Patrick's teacher.
041390 - ..
041391 - Irene can be reached at...
041392 -
041393 - ileech@gurnick.edu
041395 - ..
041396 - She said to tell Irene that Caitlyn says hello (with a heart).
041398 - ..
041399 - After the ultrasound, showed Caitlyn and Patrick pictures from recent
041400 - hike to top of Half Dome in Yosemite on 180912 0545. ref SDS 6 0001
041402 - ..
041403 - Caitlyn likes hiking. She showed her computer splashscreen there in
041404 - the examination room, which is a picture of her on top of Mount
041405 - Tamalpais, with the Bay Area displayed in the background.
041407 - ..
041408 - She was concerned about not having enough arm strength for ascending
041409 - the cables to reach the top of Half Dome.
041411 - ..
041412 - Explained that nearly half the people who get to the top of Half Dome
041413 - are women. My guide, Lindsey, is about like Caitlyn, and she has
041414 - beaten me to the top twice.
041415 -
041416 -
041417 -
041419 - ..
0415 -
0416 -
0417 - 1537
0418 -
041801 - Sent letter to Irene saying...
041802 -
041803 - 1. Subject: You Have So Many Fans!!
041804 - Date: 2018-09-27 16:13
041811 - ..
041812 - 2. Had an ultrasound on my stomach today at VAMCSF. Patrick
041813 - started, and then Caitlyn finished up. Nothing wrong with
041814 - stomach, just ordered because the VA has radiology studies on
041815 - everything but the stomach, so not to worry.
041817 - ..
041818 - 3. Asked Patrick if he knew "Irene, who used to work here?" He
041819 - said yes. Later a woman came into the room and took over. She
041820 - explained that Patrick is a student, and asked if I minded him
041821 - working on me? I said, no of course not. Asked if she also
041822 - knew you. Caitlyn explained you were her ultrasound teacher,
041823 - and are currently teaching Patrick.
041825 - ..
041826 - 4. Caitlyn was kind enough to provide your work contact address,
041827 - so I could write and say how terrific you were as part of the
041828 - prep for my heart surgery now 9 years ago on 091021 (see line
041829 - 400502. ref SDS 1 04CH
041831 - ..
041832 - 5. She said to say "Hello" and with a heart!!!
041834 - ..
041835 - 6. Have been fortunate to have many terrific care givers at the VA
041836 - (e.g., Karen in Cardiology, Arora, Lana, Bella, Caroline, Pat,
041837 - Bennie, Joe, Danis, Gracie, on and on and on..). Now Karen has
041838 - retired, and you moved on. Just glad this chance came to thank
041839 - you, as I have others.
041841 - ..
041842 - 7. Letting you know your former heart patient has been lucky post
041843 - surgery. Thanks to the VA team I am hiking 11 - 15 miles per
041844 - day. Over the past 5 years have hiked 16K miles. In 2013, 4
041845 - years after CABG in 2009, hiked to top of Half Dome in
041846 - Yosemite. Did it again in 2016. Two weeks ago made it to the
041847 - top again on Sep 12 (see pictures). Half Dome in September has
041848 - become an annual medical metric to test functionality. So far,
041849 - so good. We'll see how next year goes.
041851 - ..
041852 - 8. Hired a guide, Lindsey, for assurance in 2016, and again this
041853 - year. Lindsey is 26, and thinking about becoming a teacher
041854 - like her older sister. She has a degree in Environmental
041855 - Studies from UC Santa Cruz. Seems very dedicated. While on
041856 - top of Half Dome 2 weeks ago, I dropped a plastic bag. It was
041857 - very windy, so the bag blew away before I (at age 73) could
041858 - grab it. Lindsey chased and grabbed it just before either it
041859 - or both of them went over the edge. It is a 1 mile drop to the
041860 - valley floor.
041862 - ..
041863 - 9. This winter after hiking gigs end, Lindsey plans to waitress at
041864 - the Ahwahnee Hotel, teach skiing, and being part of a singing
041865 - group until hiking season opens next year. Would be nice if
041866 - she could consider a career move into healthcare. Radiology,
041867 - sonography, et al, seems like a good entry. What is the cost
041868 - and level of effort required to become credentialed, working as
041869 - a student, like Patrick at VAMCSF today? Any thoughts are
041870 - greatly appreciated. Haven't talked to Lindsey about this.
041871 - Last we spoke was after the 14 hour hike on Sep 12th at 8pm,
041872 - when we met up with her boyfriend for pizza. After the
041873 - ultrasound today, Caitlyn showed pictures of her hiking Mount
041874 - Tamalpais. It occurred becoming a radiology tech might be a
041875 - direction for Lindsey to consider.
041877 - ..
041878 - 10. Anyway, hope you like the pictures. I look a little different
041879 - from when you saw me on the gurney.
041880 -
041887 - ..
041888 - 13. Attachments:
041889 - 20180912_070758.jpg 3.1 MB
041890 - 20180912_102657.jpg 4.5 MB
041891 - 20180912_122859.jpg 4.7 MB
041892 - 20180912_140008.jpg 7.9 MB
041893 -
041894 -
041895 -
041896 -
0419 -
SUBJECTS
Ultrasound Stomach Sonogram Abdomen Liver Spleen Gallbladder Spleen
0903 -
090401 - ..
090402 - Medical Chart Progress Notes for Ultrasound Test 180927
090403 - Progress Notes for Ultrasound Test 180927 Stomach Organs Arteries
090404 -
090405 -
090423 - ..
090424 - 1. Procedure/Test Name: SONOGRAM ABDOMEN COMPLETE [DESCENDANT]
090425 - Date/Time Exam Performed: 27 Sep 2018 @ 0952
090426 - Ordering Location: San Francisco CA VAMC
090427 - Requesting Provider: MONTO,ALEXANDER
090428 - Reasons for Study: 73y.o. M, elevated LFT's
090430 - ..
090431 - 2. Clinical History:
090432 - 73y.o. M, no known chronic liver disease, r/o cirrhotic liver,
090433 - r/o liver masses, r/o portal HTN
090434 -
090436 - ..
090437 - 3. Performing Location: San Francisco CA VAMC 4150 CLEMENT STREET, SAN FRANCISCO 94121
090439 - ..
090440 - 4. Radiologist: SUN,DEREK C
090441 -
090442 - --------------------------------------------------------------------------
090444 - ..
090445 - 5. RADIOLOGY REPORT
090446 -
090447 - Report:
090448 - Exam: Limited Abdominal Ultrasound
090450 - ..
090451 - 6. History: 73-year-old with elevated LFTs
090453 - ..
090454 - 7. Technique: Grayscale and Doppler ultrasound images with spectral
090455 - analysis were obtained of the abdomen.
090457 - ..
090458 - 8. Comparison Studies: CT abdomen/pelvis 11/2/2009
090460 - ..
090461 - 9. Findings:
090463 - ..
090464 - Pancreas: The visualized portion of the pancreas is unremarkable.
090465 - The pancreatic head and tail is obscured by overlying bowel gas.
090467 - ..
090468 - 10. Liver:
090470 - ..
090471 - Length: 12.1 cm.
090473 - ..
090474 - Liver parenchyma: Normal in echogenicity without focal masses.
090475 - Liver contour is smooth.
090477 - ..
090478 - 11. Ducts:
090480 - ..
090481 - Common hepatic duct: 0.3 cm
090483 - ..
090484 - CBD: 0 point. cm.
090486 - ..
090487 - Portal vein: Patent, antegrade and normal in size.
090489 - ..
090490 - 12. Hepatic veins: Patent, antegrade
090492 - ..
090493 - Visualized Inferior Vena Cava: Patent, antegrade
090495 - ..
090496 - Gallbladder: Contracted due to nonfasting state without
090497 - gallstones, pericholecystic fluid, or sonographic Murphy's sign.
090499 - ..
090500 - Ascites: None
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090503 - 13. Spleen: 9 cm in greatest craniocaudad dimension without focal
090504 - lesions.
090506 - ..
090507 - No right or left hydronephrosis. 2 parenchymal calcifications in
090508 - the left kidney measuring up to 0.6 cm. Bilateral renal cysts
090509 - measuring up to 1.1 cm on the left.
090511 - ..
090512 - Significance calcifications in left kidney, and cysts on left??
090513 -
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090516 - 14. Impression:
090517 -
090518 - 1. No acute findings. Unremarkable abdominal ultrasound.
090519 -
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090522 - Primary Diagnostic Code:
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090525 -
090526 - =========================================================================
090527 - 15. Procedure/Test Name: SONOGRAM ARTERIAL/VENOUS FLOW
090528 - Date/Time Exam Performed: 27 Sep 2018 @ 0952
090529 - Ordering Location: San Francisco CA VAMC
090530 - Requesting Provider: MONTO,ALEXANDER
090531 - Reasons for Study: 73y.o. M, elevated LFT's
090532 - Clinical History:
090533 - 73y.o. M, no known chronic liver disease, r/o cirrhotic liver,
090534 - r/o liver masses, r/o portal HTN
090535 -
090537 - ..
090538 - Performing Location: San Francisco CA VAMC 4150 CLEMENT STREET, SAN FRANCISCO 94121
090539 - Radiologist: SUN,DEREK C
090540 - --------------------------------------------------------------------------
090541 - RADIOLOGY REPORT
090543 - ..
090544 - How does this report differ from report above? ref SDS 0 5N3J
090546 - ..
090547 - This says "arterial/venous flow", but there is no evident discussion
090548 - of "flow."
090550 - ..
090551 - 2nd Ultrasound report continues...
090552 -
090553 - Report:
090554 - Exam: Limited Abdominal Ultrasound
090556 - ..
090557 - History: 73-year-old with elevated LFTs
090559 - ..
090560 - Technique: Grayscale and Doppler ultrasound images with spectral
090561 - analysis were obtained of the abdomen.
090563 - ..
090564 - Comparison Studies: CT abdomen/pelvis 11/2/2009
090566 - ..
090567 - Findings:
090569 - ..
090570 - Pancreas: The visualized portion of the pancreas is unremarkable.
090571 - The pancreatic head and tail is obscured by overlying bowel gas.
090573 - ..
090574 - Liver:
090576 - ..
090577 - Length: 12.1 cm.
090579 - ..
090580 - Liver parenchyma: Normal in echogenicity without focal masses.
090581 - Liver contour is smooth.
090583 - ..
090584 - Ducts:
090586 - ..
090587 - Common hepatic duct: 0.3 cm
090589 - ..
090590 - CBD: 0 point. cm.
090592 - ..
090593 - Portal vein: Patent, antegrade and normal in size.
090595 - ..
090596 - Hepatic veins: Patent, antegrade
090598 - ..
090599 - Visualized Inferior Vena Cava: Patent, antegrade
090601 - ..
090602 - Gallbladder: Contracted due to nonfasting state without
090603 - gallstones, pericholecystic fluid, or sonographic Murphy's sign.
090605 - ..
090606 - Ascites: None
090608 - ..
090609 - Spleen: 9 cm in greatest craniocaudad dimension without focal
090610 - lesions.
090612 - ..
090613 - No right or left hydronephrosis. 2 parenchymal calcifications in
090614 - the left kidney measuring up to 0.6 cm. Bilateral renal cysts
090615 - measuring up to 1.1 cm on the left.
090616 -
090618 - ..
090619 - Impression:
090620 -
090621 - 1. No acute findings. Unremarkable abdominal ultrasound.
090622 -
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090626 - Primary Diagnostic Code:
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