CONTACTS
SUBJECTS
VA EGD Procedure Stricture Lower Esophageal Sphincter Valve LESV 10
2503 -
2503 - ..
2504 - Summary/Objective
2505 -
250501 - Follow up ref SDS R7 0000. ref SDS R4 0000.
250502 -
250503 -
250504 -
250505 -
250506 -
250507 -
250509 - ..
2506 -
2507 -
2508 - Background
2509 -
250901 - On 050629 meeting Primary Care swallowing and vomitting problems
250902 - reported. ref SDS 1 K78K
250904 - ..
250905 - On 050714 barrium swallow test, ref SDS 2 2I4S, showed esophagus
250906 - distorted by swallowing problems. ref SDS 2 WE4H
250908 - ..
250909 - On 050816 meeting Primary Care Doctor Sandhu diagnoses achalasia.
250910 - ref SDS 3 DG8G Ultrasound test ordered to verify initial diagnosis of
250911 - swallowing and vomitting problems. ref SDS 3 6E7H Primary Care made
250912 - referral to GI clinic for care to resolve swallowing problems.
250913 - ref SDS 3 0G7M
250915 - ..
250916 - On 050830 ultrasound test evaluate swallowing problems possible
250917 - diagnosis achalasia. ref SDS 4 DG8G
250919 - ..
250920 - On 050830 results received barrium swallow test performed on 050714,
250921 - findings in the lower espohagus and gastroesophageal junction are
250922 - consistent with achalasia - recommend endoscopic examination.
250923 - ref SDS 4 6H9S
250925 - ..
250926 - On 050906 report ultrasound test on 050830, finds no cause for
250927 - swallowing problems and does not diagnose achalasia. ref SDS 5 BM6R
250929 - ..
250930 - On 051202 meeting GI Clinic Doctor Lee diagnoses achalasia.
250931 - ref SDS 6 HP9H Orders endoscopy (EGD) test to verify diagnosis of
250932 - achalasia and assess for cancer. ref SDS 6 NZ5H
250934 - ..
250935 - On 051209 GI Clinic endoscopy examination preliminary findings no
250936 - evidence of cancer, ref SDS 7 0001; biopsy report should be submitted
250937 - in a few weeks to confirm status of cancer, ref SDS 7 PY5J, and if so,
250938 - then a procedure can be schedule for next month to dilate the
250939 - exophageal sphincter valve. ref SDS 7 NZ5H
250941 - ..
250942 - On 051222 biopsy reports no evidence of cancer. ref SDS 8 FT6M
250944 - ..
250945 - On 060111 received letter from Doctor Lee in the Gastrointestinal (GI)
250946 - Clinic reporting that the biopsy was negative for cancer and
250947 - infection; next step is manometry test to verify achalasia, then
250948 - treatment for achalasia. ref SDS 9 4Q3R
250950 - ..
250951 - On 060125 manomety test scheduled for 060209 0800. ref SDS 10 GG9I
250953 - ..
250954 - On 060209 meeting at VA Mather AFB in Sacramento, test was postponed
250955 - until 060223, due to equipment failure. ref SDS 11 OW6M
250957 - ..
250958 - On 060221 Jimmy in GI Department at Sacramento VA Medical Center
250959 - reports manometry equipment still broken; has been sent out for
250960 - repairs and there is no date at this time on when the equipment will
250961 - be available for use at the VA. ref SDS 12 ND7M
250963 - ..
250964 - On 060330 endoscopy follow up examination at GI Department Sacramento
250965 - Medical Center - Doctor Lee finds no evidence cancer performed at VA
250966 - Sacramento condition precedent treatment recover from achalasia.
250967 - ref SDS 13 VX4G
250969 - ..
250970 - On 060330 manometry test performed by Doctor Lee at VA in Sacramento,
250971 - ref SDS 13 MC7P, verifies diagnosis swallowing and vomitting problems
250972 - caused by achalasia, ref SDS 13 MD4N, patient meets criteria for
250973 - treatment with pneumatic dilation. ref SDS 13 MD5G
250975 - ..
250976 - On 060505 Martinez VA GI clinic Doctor Lee reported equipment and
250977 - pneumatic balloon materials on hand to perform dilation for treating
250978 - achalasia; treatment delayed until diagnostic data is received from
250979 - Sacramento VA Medical Center from manometry test performed on 060330;
250980 - doctor following up to obtain data; will submit test data to patient
250981 - during the week of 060508, along with a schedule to treat achalasia.
250982 - ref SDS 14 FT6M
250984 - ..
250985 - On 060614 Martinez VA GI clinic reports increased work load treating
250986 - soldiers returning from war in Iraq requires prioritizing; patient
250987 - advocate, Rubin Soto, will coordinate with the GI Clinic notifying the
250988 - customer of the schedule based on current priorities. ref SDS 15 J86N
250990 - ..
250991 - On 070220 letter to VA asks about progress getting test results from
250992 - VA in Sacramento, and scheduling surgery for achalasia, ref SDS 16
250993 - 5R5R
250995 - ..
250996 - On 090812 1030 continued vomitting achalasia causes weight loss 30
250997 - pounds in a few months, Primary Care physician notified GI clinic to
250998 - review schedule for dilation to relieve achalasia. ref SDS 17 7L5O
251000 - ..
251001 - On 090908 meeting GI Clinic in Martinez reports treatment for
251002 - achalasia still waiting to receive results for manometry test on
251003 - 060330, at Sacramento VA Medical Center. ref SDS 18 HX46 Prepared new
251004 - work plan to treat achalasia without manometry test results, because
251005 - the doctor performed the test 3 years ago, and is so knows results
251006 - consistent with achalasia, shown on 060330 0712, ref SDS 13 MD4N;
251007 - schedules treatment for achalasia after treadmill stress test,
251008 - ref SDS 18 BU6W, to evaluate new chest pains hiking hills at Lafayette
251009 - Reservoir which have not occurred doing extended exercise hiking 3 -
251010 - 14 miles a day over the past 5 years. ref SDS 18 MY4N
251012 - ..
251013 - On 091021 report history achalasia issue during meeting with
251014 - cardiothoracic surgery team to prepare for heart bypass surgery the
251015 - next day. ref SDS 20 NX6M Surgery team will coordinate with
251016 - anesthesia team to provide swallowing relief during heart surgery to
251017 - prevent choking. ref SDS 20 R78O
251019 - ..
251020 - On 091022 0700 meeting anesthesia team - Doctor Brezinski not familiar
251021 - with achalasia - asked if achalasia has been reported to the VA?
251022 - ref SDS 21 JF9K While being prepared with IVs for surgery, patient
251023 - assists anesthesia find VA records on achalasia, ref SDS 21 2W4K;
251024 - Doctor Brezenski makes plans for patient care and safety so that
251025 - achalasia does not risk death during heart surgery. ref SDS 21 GX4J
251027 - ..
251028 - On 091022 cabg x4 cardiothoracic surgery San Francisco Medical Center.
251029 - ref SDS 21 PQWU
251031 - ..
251032 - On 091030 0800 at 1406 meeting with Doctor Stewart at San Francisco
251033 - Medical Center during recovery from heart surgery, proposes Heller
251034 - Myotomy surgery rather than pneumatic (balloon) dilation as more
251035 - effective and longer lasting solution to recover from swallowing and
251036 - vomitting problems caused by achalasia. ref SDS 24 KE3B
251038 - ..
251039 - On 091030 0800 at 1430 received documentation from GI Department at
251040 - San Francisco Medical Center - review shows 3 different treatments for
251041 - achalasia - pills, pneumatic dilation, Heller Myotomy surgery.
251042 - ref SDS 24 495I
251044 - ..
251045 - On 091030 0800 at 1440 meeting cardiothoracic surgery team; Doctor
251046 - Ratcliff concerned about how to maintain nutrition for the patient to
251047 - recover from heart surgery while digestion remains problematic due to
251048 - achalasia; proposes feeding tube for several months until Heller
251049 - Myotomy surgery. ref SDS 24 03GF
251051 - ..
251052 - On 091216 Heller Myotomy surgery at San Francisco VA Medical Center to
251053 - recover from achalasia. 091216 0600, ref SDS 36 KE9U
251055 - ..
251056 - On 100202 meeting with Doctor Lee - report swallowing and vomitting
251057 - problems 3 months after Heller Myotomy surgery. Doctor explains
251058 - achalasia disease breaks nerve connections from the brain that
251059 - contract the esophagus to force food and liquid from the mouth through
251060 - the esophagus; as well broken nerve connections prevent the lower
251061 - esophageal sphincter valve (LESV) to relax so that content can pass
251062 - into the stomach. Without esophageal contractions, food and liquid
251063 - can only reach the stomach with gravity, but since the LESV won't
251064 - relax the patient continues to have swallowing and vomitting problems,
251065 - despite Heller Myotomy surgery on 091216, intended to maintain
251066 - adequate opening into the stomach. ref SDS 47 485W
251068 - ..
251069 - On 100305 meeting at GI Clinic in Martinez, EGD procedure dilated LESV
251070 - from 11 to 15 mm. ref SDS 48 WR6L
251072 - ..
251073 - On 100827 meeting at GI Clinic in Martinez, EGD procedure dilated LESV
251074 - from 11 to 15 mm. ref SDS 55 JE6X
251076 - ..
251077 - On 101210 EGD procedure dilated esophageal sphincter valve (LESV)
251078 - without sedation, ref SDS 67 BE7K - dilated LESV again from 11 to 14
251079 - mm. ref SDS 67 BF6L
251081 - ..
251082 - On 101216 1021 letter commends medical team for excellent work, and
251083 - confirms schedule next EGD on 110218 0730. ref SDS 69 K35G
251085 - ..
251086 - On 110218 0730 4th EGD procedure at VA in Martinez, and using
251087 - anesthesia with Fentanyl. ref SDS 72 PQWY LESV dilated 11 - 14 mm,
251088 - and added triamcinolone steriod injections to resist contraction of
251089 - LESV so that swallowing is maintained over the next 3 month cycle.
251090 - ref SDS 72 SR4G
251092 - ..
251093 - On 110429 0830 5th EGD dilation at VA in Martinez - triamcinolone
251094 - steriod injections worked well to resist contraction of LESV so that
251095 - swallowing was maintained over the prior 3 month cycle, ref SDS 76
251096 - FE3F, so LESV dilated from 13 - 16.5 mm, ref SDS 76 U23I, and
251097 - triamcinolone injections were continued. ref SDS 76 SS5N
251099 - ..
251100 - On 110607 1414 visited GI Department, ref SDS 78 HC5H, and Charlene
251101 - reported a computer mistakes requires scheduling next EGD dilation on
251102 - 110819 0830. ref SDS 78 N642 Requested meeting with Doctor Lee to
251103 - review pending action items. ref SDS 78 4P6J,
251105 - ..
251106 - On 110819 0830 EGD and Dilation of stricture at lower esphageal sphincter
251107 - valve. Triamcinolone steriod injections worked well to resist
251108 - contraction of LESV so that swallowing is maintained over the prior 3
251109 - month cycle, so LESV dilated from 15 - 16.5 mm, ref SDS 81 J978, and
251110 - triamcinolone injections were continued. ref SDS 81 J985
251112 - ..
251113 - On 111115 1300 EGD dilation procedure - triamcinolone steriod injections
251114 - worked well over the prior 3 month cycle, so LESV dilated from 16.5 -
251115 - 18 mm, ref SDS 82 IR57; for some reason triamcinolone injections to
251116 - resist contraction of LESV was not performed. ref SDS 82 IS6L
251118 - ..
251119 - On 111201 0928 seems to be 10% increase in blood pressure the past
251120 - month, ref SDS 83 ZM5H, beginning on 111030, shown by case study on
251121 - 101010 0744. ref SDS 57 UT6K Case study reports Omeprazole paused on
251122 - 111201. ref SDS 57 734L
251124 - ..
251125 - On 120322 1030 notified Doctor Lee during meeting at VA changed dose
251126 - for Omeprazole to reduce sudden increase from low to high blood
251127 - pressure. ref SDS 85 UH5F
251129 - ..
251130 - On 120322 1030 EGD dilation procedure - swallowing and vomitting problems
251131 - increased without triamcinolone steriod injections on prior 3 month
251132 - cycle. ref SDS 85 UI9H LESV dilated from 16.5 - 18 mm. ref SDS 85
251133 - 516N Triamcinolone injections to resist contraction of LESV was not
251134 - performed. ref SDS 85 5179
251136 - ..
251137 - On 120925 0900 meeting Doctor Lee reported schedule mistake using new VA
251138 - business unit; reported patient history. ref SDS 88 RG9K Scheduled
251139 - EGD and dilation procedure for 1300; returned and performed procedure,
251140 - ref SDS 88 TB4J; dilated from 15 mm to 18 mm. ref SDS 88 XB51
251141 - Swallowing and vomitting problems increased after omitting
251142 - triamcinolone steriod injections to resist contraction of LESV after
251143 - dilation, ref SDS 88 TZ4M; therefore, injections were resumed to
251144 - complement dilation to enable and maintain effective swallowing.
251145 - ref SDS 88 R87N
251147 - ..
251148 - On 130110 0900 meeting Doctor Lee EGD dilation procedure found
251149 - improvement recovering from acalasia, LESV contracted only slightly
251150 - from 18 mm down to 15 mm. ref SDS 96 Q333
251152 - ..
251153 - On 130416 1100 meeting Doctor Lee EGD procedure no dilation required LESV
251154 - remained at 18 MM, ref SDS A2 CO5N, same as dialated 4 months earlier
251155 - on 130110 0900. ref SDS 96 Q333 Report CT test on 130117, shows
251156 - esophagus fully recovered from severe distortions caused by achalasia
251157 - 8 years earlier. ref SDS A2 MT6F Doctor Lee injected steriod again to
251158 - maintain swallowing. ref SDS A2 F38G Prescribed reducing Omeprazole
251159 - to 1 pill per day. ref SDS A2 R74M Scheduled next EDG dilation in 6
251160 - months, instead of 3. ref SDS A2 6P6G
251162 - ..
251163 - On 131115 0700 meeting Doctor Lee EGD prodecure dialation LESV from 16.5
251164 - to 18 mm. ref SDS A8 CO5N Triamcinolone steriod injected again to
251165 - maintain improved swallowing. ref SDS A8 I167 Omeprazole medication
251166 - maintained 20 mg taken morning and evening for 1 month, then reduce to
251167 - 20 mg once per day. ref SDS A8 R74M Biopsies taken. ref SDS A8 3N8L
251169 - ..
251170 - On 131121 1604 ordered refill of Omeprazole to aid digestion. There
251171 - is 1 refill remaining. ref SDS A9 YS4O
251173 - ..
251174 - On 131205 1443 received order for Omeprazole prescription placed on
251175 - 131121. ref SDS B0 5N3O
251177 - ..
251178 - On 140318 1043 received letter cancelling meeting scheduled for
251179 - EGD/Dilation procedure on 140425 1000, ref SDS B3 935L; a second
251180 - letter scheduled prodedure on 140509 0900. ref SDS B3 5D7H
251182 - ..
251183 - On 140401 1659 ordered refill Omeprazole; none are remaining; need
251184 - Doctor Lee to order new prescription to increase refills. ref SDS B4
251185 - 4P5M
251187 - ..
251188 - On 140509 0900 meeting Doctor Lee for EGD Dilation at VA medical
251189 - center in Sacramento, Mather. ref SDS B6 K37G Pre-op preperation went
251190 - well - IV setup on first stick. ref SDS B6 EP75 Doctor ordered refills
251191 - for Omeprazole. ref SDS B6 AW5O Doctor patient partnership continues
251192 - to progress with doctor reading up on patient history to be prepared
251193 - for effective meeting. ref SDS B6 ZZ6J Doctor Lee recalled today
251194 - having made timely referral for having heart surgery, enabling patient
251195 - to recover and Half Dome 4 years later. ref SDS B6 0N6I Reported
251196 - swallowing and vomitting problems reduced past 6 months with
251197 - triamcinolone steriod injections to resist contraction of LESV.
251198 - ref SDS B6 VV6N Doctor Lee dilated LESV contracted to only 16.5 MM
251199 - over past 6 months with triamcinolone steriod injections to resist
251200 - contraction; he dilated LESV back to 18 MMy, ref SDS B6 5H5J, scheduled
251201 - next EGD dilation in 6 months since this worked well the past 6 months
251202 - with triamcinolone steriod injections. ref SDS B6 549I The doctor
251203 - explained that since there was no tearing of LESV during procedure
251204 - today, triamcinolone steriod was not injected into LESV to resist
251205 - contraction. ref SDS B6 I167 Progress notes report small tearing of
251206 - LESV during dilation procedure. ref SDS B6 P680
251208 - ..
251209 - On 140718 1017 planning for notifying VA to update current fill date
251210 - for Omeprazole. ref SDS C0 U88L Kathy visited VA in Sacramento, and
251211 - requested changing refill date for Omeprazole to 140718. ref SDS C0
251212 - OL5K VA representative called customer, and said Doctor Lee would
251213 - call back later that day to consider action on updating scheduled
251214 - refill date of Omeprazole to 140718. ref SDS C0 U76M
251216 - ..
251217 - On 140810 1839 letter to Doctor Lee requesting EGD dilation with
251218 - triamcinolone injection soonest, if cancellation occurs; but, not an
251219 - emergency, ref SDS C2 W83K, based on history rising vomitting
251220 - swallowing problems, shown in patient history case study on 120101,
251221 - beginning 140712. ref SDS 84 4E4M
251223 - ..
251224 - On 140819 0800 during meeting at VA Primary Care Clinic in Martinez,
251225 - Doctor Sandhu indicated Doctor Lee at VA Medical Center in Sacramento
251226 - will be notified about rising achalasia symptoms for consideration to
251227 - advance EGD dilation procedure. ref SDS C3 EX78
251229 - ..
251230 - On 141014 0943 Kathy visited VA Medical Center in Sacramento and met
251231 - with Lapria again, who advised that the VA responded in a letter on
251232 - 141001, to the letter on 140810, and further scheduled a meeting with
251233 - Doctor Lee on 141121 1530. ref SDS C4 QJ5N
251235 - ..
251236 - On 141103 2152 submitted agenda for meeting with Doctor Lee at VA
251237 - Sacramento Medical Center on 141107 0800, for next EGD dilation.
251238 - ref SDS C5 K37G Submit record showing normal swallowing occurs longer
251239 - with triamcinolone steriod injection to resist contraction of LESV.
251240 - ref SDS C5 3U97 Request schedule next EGD dilation in 4 months, and
251241 - if LESV does not contract, then schedule following EGD dilation in 6
251242 - months. ref SDS C5 3U66 Notified results of Half Dome hike.
251243 - ref SDS C5 3U6Y
251245 - ..
251246 - On 141107 0800 EGD dilation procedure - setting IV for conscious
251247 - sedation required 3 sticks. ref SDS C6 5W5I Meeting Doctor Lee guided
251248 - by agenda facilitated collaboration through doctor patient
251249 - partnership. ref SDS C6 VV6N Doctor explained increased difficulty
251250 - swallowing due to experiment omitting triamcinalone steriod injection
251251 - on prior procedure, ref SDS C6 4U8I, shown by LESV contracting back to
251252 - from 15 mm. ref SDS C6 T55I Progress Notes report finding ulceration
251253 - and hiatal hernia. ref SDS C6 MG6N Photographs seem to show
251254 - significantly different condition of fundoplication from a year
251255 - earlier. ref SDS C6 I74I
251257 - ..
251258 - On 150319 0800 meeting Doctor Lee in GI Clinic VA Medical Center
251259 - Sacramento report swallowing improved with triamcinalone steriod
251260 - injections on 141107 EGD dilation procedure. ref SDS D2 0M6I Doctor
251261 - Lee advised that increased orange juice consumption aids digestion,
251262 - and presents no health risks. ref SDS D2 YF5M Scheduled next EGD
251263 - dilation procedure on 150421 1300. ref SDS D2 PS4O Fundoplication
251264 - failure increases acid burn that caused ulceration with hiatal hernia
251265 - with increased recurrance achalasia. ref SDS D2 O56O Doctor Lee will
251266 - make referral to Doctor Stewart at General Surgery VA Medical Center
251267 - in San Francisco for consideration of "redo" fundaplicaiton.
251268 - ref SDS D2 JQ5J Doctor Lee completed Progress Notes for EGD dilation
251269 - on 141107. ref SDS D2 PS53 Doctor Lee will recommend Doctor Stewart
251270 - order CT test to evaluate recurrance achalasia due to failure
251271 - fundoplication. ref SDS D2 TH5M This test can include coronary CTA to
251272 - evaluate regression atherosclerosis. ref SDS D2 GB56
251274 - ..
251275 - On 150420 1752 submitted letter to Doctor Lee with agenda for meeting
251276 - the next day on 150421 1300 for EGD dilation. ref SDS D4 0M6I
251278 - ..
251279 - On 150421 Met with Doctor Lee at VA Medical Center in Sacramento
251280 - (Mather). ref SDS D5 K37G No difficulties setting IV for conscious
251281 - sedation. ref SDS D5 5W5I Reported pain level 2 right knee MCL.
251282 - ref SDS D5 LO9K Doctor Lee advised referral to San Francisco will be
251283 - filed after EDG dilation procedure (this day) to evaluate loosening
251284 - fundoplication. ref SDS D5 DZ4I Patient reported difficulty
251285 - swallowing this cycle did not occur until 4 weeks or so, because
251286 - triamcinalone steriod was injected during prior procedure on 141107,
251287 - ref SDS D5 P55L, and shown by EGD dilation LESV from 16.5 mm back to
251288 - 18 mm. ref SDS D5 HU42 Progress Notes report findings of hiatal
251289 - hernia. ref SDS D5 QD6O Impression today that ulceration has subsided
251290 - to mere errosions seems promising. ref SDS D5 PXXY
251292 - ..
251293 - On 150514 0130 letter to Doctor Lee requests file Progress Notes for
251294 - EGD Dilation today, and make referral to Doctor Stewart, to prepare
251295 - for meeting with Doctor Lee scheduled on 150521. ref SDS D7 K37G
251297 - ..
251298 - On 150521 0800 meeting with Doctor Lee at VAMC in Sacramento -
251299 - concensus uncharacteristic vomitting after recent EGD dilation
251300 - procedure on 150421, due to patient not eating slowly with small bites
251301 - and drinking liquids frequently, especially when eating meat products
251302 - that have high viscocity with esophageal tissue, and so tends to
251303 - stick, causing vomitting. ref SDS D9 WT9L
251305 - ..
251306 - On 150526 1300 meeting with Doctor Stewart Chief General Surgery VA
251307 - Medical Center San Francisco, review record indicating ulceration LESV
251308 - caused by reflux backwash into esophagus. ref SDS E0 3E4I Doctor
251309 - Stewart explained redo Dor Fundoplication required for "repairing"
251310 - original surgery, presents high risk of collateral damage. ref SDS E0
251311 - GT5G Considered increase dose Omeprazole (PPI) since ad hoc
251312 - experience occasionally taking 3 and sometimes 4 pills instead of only
251313 - 1 pill per day seemed to reduce reflux based on examination showing
251314 - ulceration of LESV declined; this would avoid need to redo Dor
251315 - Fundoplication. ref SDS E0 5Y4I
251317 - ..
251318 - On 150616 1624 received photographs on CD in word.docx file from
251319 - Phillip in ROI Department at VA MC in Sacramento (Mather) showing Dor
251320 - fundoplication in tact on 131115, beginning to unravel on 140507,
251321 - further unraveled on 141107, and unraveled on 150421. ref SDS E3 XW6M
251323 - ..
251324 - On 150623 1300 during follow up meeting, Doctor Stewart discussed
251325 - again increasing Omeprazole PPI to resolve ulceration of LESV rather
251326 - than risk difficult surgery to redo Dor fundoplication, and she
251327 - ordered prescription for H2 blocker to supplement Omeprazole PPI.
251328 - ref SDS E4 WW5K
251330 - ..
251331 - On 150624 0924 letter notified Doctor Lee of work plan to try
251332 - controlling ulceration of LESV by increasing PPI with Omeprazole
251333 - rather than chance performing high risk surgery to repair Dor
251334 - fundoplication, and that Doctor Stewart ordered H2 Blocker for Doctor
251335 - Lee to consider supplementing PPI to control acid reflux. ref SDS E5
251336 - OP91
251338 - ..
251339 - On 150624 0924 at 1344 Doctor Lee called and will order new
251340 - prescription for PPI increasing Omeprazole from 20 mg twice per day to
251341 - 40 mg twice per day. ref SDS E5 L861
251343 - ..
251344 - On 150925 0336 request switch back to Omeprazole 20 mg twice per day
251345 - in order to reduce severe side effects of dehydration from frequent
251346 - urination causing scaling, peeling, bleeding feet; lower dose
251347 - Omeprazole enables hiking to raise HDL required to regress
251348 - atherosclerosis plaques, thereby lowering risks of CVD and CAD.
251349 - ref SDS E7 5G8T As a result, Pharmacy VA Medical Center San Francisco
251350 - entered new prescription for (PPI) Omeprazole 20 mg. ref SDS E7 FK66
251352 - ..
251353 - On 150925 0336 VA scheduled next meeting for EGD dilation on 151204
251354 - 0800. ref SDS E7 SR6L
251356 - ..
251357 - On 151002 1820 Doctor Lee returned call; will order Omeprazole 20 mg
251358 - prescription sufficient until next EGD Dilation procedure on 151204,
251359 - and complimenting prescription entered on 150925 for only 1 month.
251360 - ref SDS E8 NV5I
251362 - ..
251363 - On 151012 1151 VA Internet Pharmacy lists updated Omeprazole 20 mg
251364 - prescription. ref SDS D6 0C5H
251366 - ..
251367 - On 151204 0800 met with Doctor Lee at VA Medical Center in Sacramento
251368 - (Mather); initial administration went well. ref SDS F5 GD4H
251369 - Preparation for the procedure was professional; no difficulties
251370 - setting IV for conscious sedation today. ref SDS F5 544G The doctor
251371 - reported not receiving letter with agenda for the meeting today,
251372 - submitted on 151201. ref SDS F5 VV6N Patient difficulty swallowing
251373 - occurred after 5 months, because triamcinalone steriod injected prior
251374 - procedure on 150421. Swallowing difficulty/vomiting increased over
251375 - the next 3 months indicates dilate LESV 18 mm and doing EGD dilation
251376 - in 6 rather than 8 months. ref SDS F5 P55L Asked about Baking Soda to
251377 - clear throat in order to avoid vomitting, and prevent ulceration LESV
251378 - alternative to Omeprazole in order to avoid side effects causing
251379 - dehydration. ref SDS F5 G53K Performing EGD dilation procedure went
251380 - smoothly, with no difficulties. ref SDS F5 7V6I Post procedure Doctor
251381 - Lee reported LESV contracted to 10 mm, the worst results in patient
251382 - history, indicating 2 month delay performing procedure this cycle was
251383 - harmful. ref SDS F5 5H5J
251385 - ..
251386 - On 151210 meeting Doctor Lee after EGD on 151204, changed prescription
251387 - of Omeprazole (PPI) to 20 mg every other day to eliminate or reduce
251388 - dehydration from frequent urination, and in order for feet to recover
251389 - from peeling, cracking, bleeding so that hiking can be performed at
251390 - level of 300 miles per month required to raise HDL > 60, required to
251391 - regress athersclerosis. ref SDS F8 J56O Doctor prescribed adding
251392 - Famotidine an H2 blocker taken once a day to compliment Omeprazole.
251393 - ref SDS F8 YL3M
251395 - ..
251396 - On 160325 0900 Diffuculty swallowing this cycle began about 1 month
251397 - after prior EGD dilation on 151204. ref SDS G9 P55L Reported using
251398 - baking soda to relieve reflux that prevents ulceration LESV; this
251399 - reduced Omeprazole in order to avoid dehydration. ref SDS G9 Z84H
251400 - Progress Notes report there is no longer any erosive esophagitis and
251401 - there is no evidence of mass effect, which implies better acid
251402 - suppression compared to previous examination December 2015.
251403 - ref SDS G9 PXXY EGD dilation procedure went smoothly, with no reports
251404 - of difficulties. ref SDS G9 7V6I Post procedure Doctor Lee reported
251405 - LESV contracted to 9.5 mm, the smallest in patient history, indicating
251406 - 2 month delay to 8 months performing procedure in December causing
251407 - continual injury. ref SDS G9 5H5J
251409 - ..
251410 - On 161128 1119 called VA GI Clinic in Sacramento; LaPreia said meeting
251411 - Doctor Lee scheduled for 161214, has been changed to the next day on
251412 - 161215 1200. ref SDS K3 OZ9G
251414 - ..
251415 - On 161205 0846 anonomous flowers and chocolates sent wishing GI staff
251416 - Merry Christmas and Happy New Year for doing terrific work.
251417 - ref SDS K6 FS5I
251419 - ..
251420 - On 180924 0900 meeting Doctor Jothi at VA ENT Clinis Martinex to
251421 - evaluate solutions for voice disruption. ref SDS R7 OL5O
251423 - ..
251424 - On 181001 1948 letter to Doctor Jothi confirming understandings from
251425 - meeting on 180924 0900, and review of her Progress Notes. ref SDS 0
251426 - NU8L
251427 -
251428 -
251429 -
251430 -
251431 -
251433 - ..
2515 -
2516 -
2517 - Progress
2518 -
251801 - Letter to Doctor Sumana Jothi at VA ENT Clinic Martinez CA, saying...
251802 -
251803 - 1. Subject: Meeting 180924 Evaluate Occasional Voice Disruption
251804 - Date: 2018-10-01 20:26
251808 - ..
251809 - 2. Dear Doctor Jothi,
251811 - ..
251812 - 3. Reviewed your Progress Notes for subject meeting. Very pleased
251813 - with accuracy and thoroughness [...referencing the record on
251814 - 180924 0900. ref SDS R7 OL5O...].
251816 - ..
251817 - 4. You correctly note that you could not recognize there is a good
251818 - deal of time when there is no voice disruption, since during
251819 - our meeting there was continual disruption (raspiness). Of
251820 - course I deal with this all the time. I start out talking
251821 - perfectly on the telephone. Part way through, I lean back in
251822 - the chair, and the voice goes raspy, or alternatively high
251823 - pitch. If I lean forward again, the voice goes back to normal,
251824 - not always, but often.
251826 - ..
251827 - 5. During the meeting last Monday, you did not hear the high pitch
251828 - voice situation, but it occurs nearly as often as raspy voice
251829 - you did hear.
251831 - ..
251832 - 6. My understanding from the meeting is your testing identified a
251833 - "slight" gap in the larynx when closed, and that this is
251834 - nominally not sufficient to cause the level of voice disruption
251835 - that periodically occurs.
251837 - ..
251838 - 7. You correctly point out in your Progress Notes that my sense is
251839 - that often voice disruption is resolved by sitting vertical,
251840 - and drinking carbonated soft drink, e.g., coca cola with lots
251841 - of ice and some lime juice. Carbonated soft drink was
251842 - recommended by Doctor Lee, and it has proven effective.
251844 - ..
251845 - 8. Often the voice is disrupted after daily hiking (11 - 20+
251846 - miles; 3 - 5+ hours), since this produces a lot of saliva in
251847 - the throat. This past cycle there has been less saliva buildup
251848 - after Doctor Lee dilated LESV to 20 mm for first time since
251849 - 2005. Reduced saliva pooling in the throat is evident from
251850 - reduced spitting up "bubbles" during these hikes.
251852 - ..
251853 - 9. You further correctly report findings from EGD procedures that
251854 - Dor fundoplication performed at VAMCSF on 091216, has relaxed,
251855 - beginning OA November 2014. When you brought up the
251856 - fundoplication issue, I tried to ask if you have "redone" Dor
251857 - fundoplication; however the direction of discussion prevented
251858 - considering this. Have discussed it with Doctor Lee, as
251859 - possible long term solution to achalasia. The past year,
251860 - Doctor Lee through experiment has formulated a medication
251861 - protocol that manages reflux better than in prior years.
251862 - Actually, 2018, has been our best year ever. Mylanta tends to
251863 - raise blood pressure. Hiking lowers blood pressure, so these
251864 - opposing therapies balance out BP, i.e., blood pressure is not
251865 - a cardiology issue in the case.
251867 - ..
251868 - 10. On 180627, EGD dilation was performed at VAMCSF, because Doctor
251869 - Lee was out of town at VAMC in Sacramento. The GI team, who
251870 - did EGD at VAMCSF, reported they have referred patients to
251871 - outside providers to perform fundoplication with gastroscope.
251872 - They seemed to indicate that so far they have not made
251873 - referrals to "redo" Dor fundoplication with a gastroscope,
251874 - which is my situation.
251876 - ..
251877 - 11. PRP injection therapy is not mentioned in your Progress Notes.
251878 - As you know, I interrupted you explaining your work applying
251879 - PRP to the esophagus, or so I thought you said. PRP has proven
251880 - effective treating metatarsalgia in both feet, and
251881 - osteoarthritis in both knees, with 5 treatments beginning on
251882 - 170726, and the last on 180824. This restored ability to walk
251883 - extended miles, over 3000 miles this year, and for the first
251884 - time in patient history. PRP eliminated the need for pain
251885 - medication, e.g., hydrocodone, naproxen, acetaminophen, thus
251886 - eliminating as well adverse side effects of pain meds. It
251887 - enabled me to hike Half Dome at age 73, on 180924, and to raise
251888 - HDL 30 at the time of CABG, to HDL 73, thereby resoling prior
251889 - CAD symptoms. PRP has thereon been discussed as a research
251890 - project with Doctor Lee for strengthening my weakened
251891 - esophagus. When you mentioned PRP, I was overwhelmed with
251892 - interest. Have you published any papers on this application?
251894 - ..
251895 - 12. Finally, wanted to say what a pleasure it was to hear your
251896 - analysis, and today read your Progress Notes. Your energy,
251897 - expertise, and love of your work was at the very least
251898 - engaging, certainly helpful to me. Accordingly, it was an
251899 - honor to meet with you.
251901 - ..
251902 - 13. Equally, taking this opportunity to apologize for interrupting
251903 - your comments, which you cited several times. My only excuse
251904 - was that each sentence contained 3 or 4 critical points to my
251905 - care, which have been pending for a long time, and I hastened
251906 - to request clarification before losing the moment. I can only
251907 - beg forgiveness and hope for another chance to meet and hear
251908 - your cogent, compelling ideas.
251910 - ..
251911 - 14. In the meantime, I am meeting Doctor Lee tomorrow morning for
251912 - another EGD. Will certainly thank him for making the referral.
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