CONTACTS
SUBJECTS
Treadmill Heart Stress Test Schedule 200103 0700 Chest Pain Elevated
2403 -
2403 - ..
2404 - Summary/Objective
2405 -
240501 - Follow up ref SDS D7 0000. ref SDS D6 0000.
240502 -
240503 -
240504 -
240505 -
240506 -
240507 -
240508 -
240510 - ..
2406 -
2407 -
2408 - Background
2409 -
240901 - On 191206 1425 letter to VAMCSF Cardiology Doctor Simpson, ref SDS A6
240902 - NE9N, notify possible afib symptoms. ref SDS A6 N874
240904 - ..
240905 - On 191207 0927 Doctor Simpson to order ECG [...electrocariogram...]
240906 - Zio test for AFib, after he returns to work following several weeks
240907 - out of the office. ref SDS A7 NE9N
240909 - ..
240910 - On 191213 0849 call from Tina - scheduled install Zio equipment for
240911 - heart monitoring test; meeting room 2A16 on 191216 1230. ref SDS A8
240912 - NE9N
240914 - ..
240915 - On 191216 1220 Exmeralda in Cardiology at VAMCSF installed Zio XT
240916 - heart monitor on left chest; she added 2 plastic tapes to secure the
240917 - unit against fall off in shower and perspiration during hiking.
240918 - ref SDS B2 AO7H
240920 - ..
240921 - On 191214 1138 letter to Doctor Simpson in Cardiology at VAMCSF,
240922 - ref SDS B0 NE9N, reports 8 weeks ago increased hiking route with steep
240923 - hills from 11 to 15 miles per day. ref SDS B0 MX58 About a week ago
240924 - increased hiking to 20+ miles per day in order to improve weight
240925 - control and to raise lipids toward HDL 80. ref SDS B0 MX61 Weight
240926 - increased after pausing hiking due to orthopedic pain left knee and
240927 - both feet, which was solved after receiving oxycodone and gabapentin,
240928 - and applying elastic bandage to left knee. ref SDS B0 MX64 Today,
240929 - before hiking felt chest swaying indicating afib. ref SDS B0 MY30
240930 - Research indicates walking can aid recovery from afib; during hike
240931 - today, will reduce level of effort back to 15 miles per day, and avoid
240932 - steeper hills. ref SDS B0 368M Ask about medication to treat afib.
240933 - ref SDS B0 MY38 Offer to walk with Doctor Simpson to assist recovery
240934 - from hip surgery. ref SDS B0 MY41
240936 - ..
240937 - On 191214 1138 at 1324 letter from Doctor Simpson in Cardiology at
240938 - VAMCSF says to do hiking that has led to symptoms. ref SDS B1 0K4L
240940 - ..
240941 - On 191228 1416 letter to Doctor Simpson notify Zio log reports chest
240942 - pain hiking with elastic bandage on left knee. ref SDS B4 NE9N 1st
240943 - episode hiking 12 miles through Golden Gate Park on 191220, chest pain
240944 - mild lasted on ly .25 miles. Occurred again next day hiking 20 miles
240945 - up Crystal Ranch Road. ref SDS B4 B652 Occurred next day on 191222, so
240946 - stopped at mile .75 and removed elastic bandage from left leg, pain
240947 - ended for rest of 20 mile hike and on subsequent hikes 20 mile past 6
240948 - days. ref SDS B4 B655 Today on 191228, chest pain occurred hiking up
240949 - mild hills without elastic bandage on left leg, so ended hike at 7
240950 - miles. ref SDS B4 B658 HR 150 - should be 45 - 55. ref SDS B4 B662
240951 - Seems like bypass saphenous graft failed under elevated load wearing
240952 - elastic bandage on left knee. ref SDS B4 B665 Pause hiking until hear
240953 - from the doctor. ref SDS B4 B668
240955 - ..
240956 - On 191228 1416 at 1534 letter from Doctor Simpson notifies he will
240957 - order treadmill stress test. ref SDS B4 RK6L
240959 - ..
240960 - On 191228 1416 at 1537 letter to Doctor Simpson notifies will submit
240961 - Zio XT device with afib data on Monday, 191230. ref SDS B4 WO6F
240963 - ..
240964 - On 191229 1243 received letter from Doctor Simpson notifies need to
240965 - get ECG test at VAMCSF before they can schedule treadmill stress test.
240966 - ref SDS B6 NE9N Further says to get care in the ER if chest pain
240967 - recurs at rest. ref SDS B6 NH77
240969 - ..
240970 - On 191229 1243 at 1256 letter to Doctor Simpson asks where and when to
240971 - get ECG test. ref SDS B6 YH8N Notifies so far chest pain has not
240972 - occurred at rest; has only occurred when hiking. ref SDS B6 YA48
240973 - Notifies of EGD procedure in GI Clinic at VAMC Sacramento on 200107,
240974 - and getting MRI studies on feet and knees at VAMCSF on 200109.
240975 - ref SDS B6 YA51
240977 - ..
240978 - On 191229 1243 at 1420 received letter from Doctor Simpson advising
240979 - ECG is done on 2nd floor building 203, and to arrive about 1000.
240980 - ref SDS B6 LG4J Recommends notifying GI Clinic to delay EGD until
240981 - after resolution of current Cardiology issue. ref SDS B6 6H6G
240983 - ..
240984 - On 191229 1243 at 1538 received letter from Doctor Simpson advising
240985 - ECG was done in this case at the end of Oct, so do not need a new one;
240986 - next step is for VA to schedule stress test. ref SDS B6 E17N
240988 - ..
240989 - On 191229 1243 at 1619 sent letter to Jessica on notifying Doctor Lee
240990 - to delay next EGD scheduled on 200107 0730 for a month until 200204
240991 - 0730. ref SDS B6 4R7J
240993 - ..
240994 - On 191229 1243 at 1700 letter thanks Doctor Simpson for advising ECG
240995 - not needed. ref SDS B6 M48J
240997 - ..
240998 - On 191229 1243 at 1946 letter notifies Doctor Simpson that feet
240999 - elevated on footrest seem swelled. Cellphone reports HR 38. That is
241000 - low for me. Don't feel dizzy or light headed; seems like afib event,
241001 - with chest swaying back and forth. ref SDS B6 MH6N
241003 - ..
241004 - On 191229 1243 at 1946 letter notifies Doctor Simpson Zio device was
241005 - mailed to company a day early on 191229. ref SDS B6 UA47
241007 - ..
241008 - On 191230 0930 received call from Tina in Cardiology at VAMCSF
241009 - scheduled treadmill stress test on 200103, ref SDS B8 NE9N, report
241010 - first at 0700 to ASU on 3rd floor Building 200 for IV, then go to
241011 - Neuclear Medicine on ground floor building 203. ref SDS B8 GE5K
241013 - ..
241014 - On 191230 0930 at 0938 received letter from Doctor Simpson in
241015 - Cardiology explaining symptoms reported last night are okay, since not
241016 - dizzy, until after stress test. ref SDS B8 GF3G
241018 - ..
241019 - On 191230 0930 at 0949 received letter Tina in Cardiology confirming
241020 - schedule for stress test on 200103 0700, and submitting instructions
241021 - to prepare for the test. ref SDS B8 Q76I
241023 - ..
241024 - On 191230 0930 at 1021 letter to Doctor Simpson in Cardiology at
241025 - VAMCSF reporting stress test has been scheduled on 200301 0700.
241026 - ref SDS B8 9W6F Reported mild chest pain at rest for 10 minutes, but
241027 - it resolved while writing the letter. ref SDS B8 JY39
241029 - ..
241030 - On 191230 0930 at 1114 received letter from Lauren, NP and PCP in this
241031 - case; she concurs patient should go to ER if chest pain persists at
241032 - rest, and should have a driver. ref SDS B8 2S4N
241034 - ..
241035 - On 191230 0930 at 1117 received call from Aladin who is Lauren's
241036 - assistent in Medical Practice; he indicated Lauren asked him to call
241037 - and get background on chest pain issue. ref SDS B8 578G Explained
241038 - background is reported in correspondence with Doctor Simpson in
241039 - Cardiology, and this has been copied to Lauren. ref SDS B8 5W6J
241041 - ..
241042 - On 191230 0930 at 1135 responded to Lauren citing call from her
241043 - assistent, Aladin, and reporting background on current issue is
241044 - reported in correspondence with Doctor Simpson in Cardiology, who is
241045 - directing the work, and that Lauren has been copied on all
241046 - correspondence. ref SDS B8 659K
241048 - ..
241049 - On 200108 1130 Doctor Simspon ordered cardiac catheterization
241050 - (Angiogram) to evaluate for failed saphenous bypass graph. ref SDS C5
241051 - UV3M He also cordered Echocardiogram (ECHO) to evaluate cardiac
241052 - remodeling that may be causing atrial fibrillation. ref SDS C5 GG4F
241054 - ..
241055 - On 200113 0841 call from Gina in Cardiology scheduled echocardiogram
241056 - on 200214 1300 to evaluate for cardiac remodeling causing AF due to
241057 - high-intensity hiking. ref SDS C8 NE9N
241059 - ..
241060 - On 200115 0933 called VA Cardiology, ref SDS D0 Q18G; and talked to
241061 - Sue, who has taken the position of Karen for scheduling and
241062 - coordinatoing patient procedures. ref SDS D0 NB9G Sue scheduled
241063 - cardiac catheritization (angiography) on 200128 0730; and, pause
241064 - Apixaban blood thinner 2 days before the procedure. ref SDS D0 4L5N
241066 - ..
241067 - On 200115 0933 at 1747 submitted letter confirming work plan for
241068 - cardiac catheritization on 200128. ref SDS D0 5J7M
241070 - ..
241071 - On 200115 0933 at 1936 submitted another letter correcting date error
241072 - in the letter at 1747. ref SDS D0 4K5G
241074 - ..
241075 - On 200116 0948 received letter from Sue in Cardiology at VAMCSF
241076 - instructions for cardiac catheritization scheduled 200118, ref SDS D1
241077 - G367, pause Apixaban 2 days before 200118, ref SDS D1 G45M; NPO after
241078 - midnight, and until after Cath, ref SDS D1 6S30; bring list of
241079 - medications, ref SDS D1 6S76; bring charger for cellphone, ref SDS D1
241080 - 4B9H; do not drive for 24 hours after cardiac catheritization.
241081 - ref SDS D1 6S98
241082 -
241083 -
241085 - ..
2411 -
2412 -
2413 - Progress
2414 -
241401 - Lauren and Long woke me up for blood draw in Med-Surg 2B room 45-2.
241402 - Lauren asked how I was sleeping, since they applied oxygen last night,
241403 - reported in another record on 200122 0028. ref SDS D8 RR7H
241405 - ..
241406 - Explained slept very well. Oxygen seems to be a complete solution.
241408 - ..
241409 - Asked why are we doing blood draw so early, since normaly the lab
241410 - nurse does daily blood draws starting at 0600, reported yesterday on
241411 - 200121 0552 at 0610. ref SDS D7 9J4M
241413 - ..
241414 - Lauren explained they will try this morning getting blood draw using
241415 - IV set in the ER by JR on 200120 2017. ref SDS D6 233K If this works,
241416 - they will avoid a needle stick.
241418 - ..
241419 - Long flushed the IV with saline. He then did the blood draw.
241420 - Eventually, blood flow stopped. Lauren thought they had enough for
241421 - the lab to make all the tests ordered for this morning.
241423 - ..
241424 - They left and took the blood vials to the lab.
241425 -
241427 - ..
2415 -
2416 -
2417 - 0706
2418 -
241801 - Woke and asked Lauren about taking a shower?
241802 -
241803 - Lauren got some soap and towels. Then we realized the wireless heart
241804 - monitoring equipment needs to be removed to prevent getting weat in
241805 - the shower.
241807 - ..
241808 - She suggested asking the medical team during the meeting this morning.
241809 -
241810 -
241811 -
241813 - ..
2419 -
2420 -
2421 - 0757
2422 -
242201 - Khristine and Patricia reported they are nurses taking over from
242202 - Lauren and Long, and replacing Sherri from yesterday on day
242203 - shift.
242205 - ..
242206 - They will be back later to deliver medicines and do vitals.
242207 - ref SDS 0 UF9K
242208 -
242209 -
242211 - ..
2423 -
2424 -
2425 - 0804
2426 -
242601 - Breakfast delivered, an error because NPO for cath lab later
242602 -
242603 -
242605 - ..
2427 -
2428 -
2429 - 0809
2430 -
243001 - Erron arrived with Medicine Group.
243002 -
243003 - He said the team removed NPO, so patient can eat today, because there
243004 - is no chance of doing Cath Lab today. There are a number of new
243005 - emergencies, so procedures scheduled for yesterday, were been pushed
243006 - ahead for today.
243008 - ..
243009 - Erron said they have discussed this case with Doctor Shunk. He
243010 - expects to do this Cath Lab tomorrow for sure. It could still be
243011 - delayed again until Friday, at this time very sure it will be
243012 - tomorrow.
243014 - ..
243015 - Erron was familiar with difficult side effects using Isosorbide
243016 - Mononitrate, reported last night on 200122 0028. ref SDS D8 JW4M and
243017 - prescribed yesterday afternoon on 200121 0552 at 1442. ref SDS D7 T34A
243019 - ..
243020 - At this time Khristine and Patricia had come into the patient room
243021 - with their mobile workstation. They were standing by waiting for
243022 - Erron to complete his patient consult.
243024 - ..
243025 - Erron advised Khristine that the Medicine Group approves ending
243026 - Isosorbide Mononitrate medication.
243028 - ..
243029 - He also told Khristine okay to disconnect the heart monitoring
243030 - equipment for a few minutes, while the patient showers.
243032 - ..
243033 - Explained elevated HR and EKG episode last night that prevented
243034 - sleeping, reported in the record on 200122 0028 at 0041. ref SDS D8
243035 - O55L
243037 - ..
243038 - Asked about getting a stronger sleeping medication for tonight?
243040 - ..
243041 - Erron will investigate.
243042 -
243043 - [...below on 200122 0423 at 2108 Lauren provided melatonin
243044 - which is a new sleeping medication. ref SDS 0 084K
243046 - ..
243047 - He was aware of elevated HR and EKG correlating with AF last night,
243048 - reported on 200121 0552. ref SDS D7 UC9N
243050 - ..
243051 - Explained was able to sleep after Lauren and Long applied oxygen, also
243052 - reported on 200122 0028, ref SDS D8 RR7H
243054 - ..
243055 - Erron explained notebook computer can be connected to cellphone as
243056 - hot spot Internet access.
243058 - ..
243059 - This needs a network security password.
243061 - ..
243062 - On c23 settngs, Network & Internet, Mobile Hotspot shows Network
243063 - Password.
243064 -
243066 - ..
243067 - Get password from cellphone...
243068 -
243069 - Settings, Connections, Mobile Hotspot & Tethering, Mobile Hotspot
243070 - on
243072 - ..
243073 - Press hard on "Mobile Hotspot"
243075 - ..
243076 - This opens a screen that shows password.
243078 - ..
243079 - Enter password in notebook box for password.
243081 - ..
243082 - Connect cellphone to charger to maintain battery.
243083 -
243084 -
243085 -
243087 - ..
2431 -
2432 -
2433 - 0826
2434 -
243401 - Ate few bites of breakfast after NPO status lifted by Erron, per
243402 - above. ref SDS 0 M55O
243403 -
243404 -
243406 - ..
2435 -
2436 -
2437 - 0852
2438 -
243801 - Khristine and Patricia came back.
243802 -
243803 - The pocket that holds the wireless heart monitor tore through, so the
243804 - device was falling out.
243806 - ..
243807 - Khristine brought a new hospital gown. Changed into that.
243809 - ..
243810 - Vitals....
243811 -
243812 - Blood pressure......... 115 73
243813 - Heat rate.............. 59
243814 - Temperature............ 97.4
243815 -
243816 -
243817 -
243819 - ..
2439 -
2440 -
2441 - 1039
2442 -
244201 - Kevin visited from Cardiology Department, following up meeting
244202 - yesterday on 200121 0552. ref SDS D7 E57K
244204 - ..
244205 - He explained there are groups of teams considering treatment options.
244207 - ..
244208 - The Cardiology Electrophysiologists are evaluating ablation.
244210 - ..
244211 - This was discussed with Doctor Simpson citing research indicating
244212 - paroxysmal atrial fibrillation (PAF) occurs in patients who have had
244213 - heart surgery and with prolonged exercise, reported on 200108 1130.
244214 - ref SDS C5 Q34K
244215 -
244216 - [...below on 200122 0423 at 1344 Doctor Cara Pelligrinni
244217 - visited to discuss ablation; will consider further after
244218 - Cath. ref SDS 0 MN4O
244220 - ..
244221 - Kevin said another option being discussed is a pacemaker.
244223 - ..
244224 - Kevin seemed to say that treatment with a pacemaker would not limit
244225 - physical activity, with respect to hiking at current level of effort,
244226 - i.e., 11 - 20+ miles per day, 250 - 400 miles per month, 3,000 miles
244227 - per year, including Half Dome.
244228 -
244229 -
244231 - ..
2443 -
2444 -
2445 - 1042
2446 -
244601 - Found Khristine in the nurses station.
244602 -
244603 - She removed the heart monitor and all leads pasted to the chest, arms
244604 - and legs, approved by Errron, earlier this morning, per above.
244605 - ref SDS 0 2X4N
244607 - ..
244608 - Took shower.
244610 - ..
244611 - Shower head is broke. Reported to nursing station.
244612 -
244614 - ..
2447 -
2448 -
2449 - 1109
2450 -
245001 - Doctor R Bamvi Fohtung, Clinical Fellow Cardiology visited.
245002 -
245003 - Doctor Fohtung remembered meeting when he took over from Doctor
245004 - Anderson to complete the treadmill stress test on 200103 0700.
245005 - ref SDS C1 Q54O
245007 - ..
245008 - He will come back around lunchtime.
245009 -
245010 -
245012 - ..
2451 -
2452 -
2453 - 1202
2454 -
245401 - Doctor Ben Kelemen with Cardiology visits.
245402 -
245403 - He is a resident with Cardiac Catheritization team.
245405 - ..
245406 - Ben said they will try to do the procedure later today; said not to
245407 - eat anything more.
245409 - ..
245410 - The procedure might be done by Doctor Shunk, Doctor Zimmet or another
245411 - doctor.
245412 -
245413 -
245415 - ..
2455 -
2456 -
2457 - 1535
2458 -
245801 - Eller and Kevin visited. We met in the hallway. They related
245802 - possibility of doing cardiac catheritization today. They asked about
245803 - lunch?
245805 - ..
245806 - Explained just met with Doctor Keleman, who advised the Cath Lab will
245807 - try to do the procedure today, per above. ref SDS 0 OT7V
245808 -
245809 -
245811 - ..
2459 -
2460 -
2461 - 1344
2462 -
246201 - Doctor Cara Pellegrinni visited, with Cardio Electrophysiology. The
246202 - meeting was planned in a meeting with Kevin earlier this morning at
246203 - 1039, per above. ref SDS 0 OT5M
246205 - ..
246206 - The doctor explained the medical team is considering treating
246207 - paroxysmal atrial fibrillation (PAF) with an ablation medical
246208 - procedure.
246209 -
246210 - [On 200123 2038 letter to Doctor Simpson notifies of
246211 - meeting with Doctor Pellegrini. ref SDS E1 P135
246213 - ..
246214 - On 191206 1425 research found "Pulmonary vein isolation" ablation
246215 - should be considered for first-line therapy in endurance athletes with
246216 - atrial fibrillation for arrhythmia-free survival, improvement in
246217 - exercise capacity so that one can resume endurance sports practices.
246218 - A redo-ablation procedure may be considered with recurrence," reported
246219 - ref SDS A6 1143
246221 - ..
246222 - Ablation was reviewed following treadmill stress test that diagnosed
246223 - PAF on 200103 0700. ref SDS C1 Q57G
246224 -
246225 - "Our threshold for AF ablation in these people [...senior
246226 - athletes doing high-intensity extended endurance running and
246227 - hiking...] is quite low because the response rate is high in
246228 - paroxysmal AF in the absence of underlying structural heart
246229 - disease,"
246231 - ..
246232 - Ablation was researched again following meeting with Doctor Simpson on
246233 - 200108 1130. ref SDS C5 6Y4N More recently, a letter to Doctor
246234 - Simpson cited ablation as possible remedy to onset of AF, reported on
246235 - 200119 0851. ref SDS D2 QC66
246237 - ..
246238 - After results of cardiac catheterization are reviewed, the doctor will
246239 - schedule a meeting to consider catheter ablation.
246241 - ..
246242 - Cara seemed to confirm understandings that pulmonary vein isolation
246243 - catheter ablation procedures are 75% - 85% successful treating
246244 - paroxysmal atrial fibrillation (PAF), and repeat ablation procedures
246245 - are 80% - 90% successful, reported in research on...
246246 -
246247 - [On 200123 2038 letter to Doctor Simpson notifies of
246248 - discussing ablation procedure with Doctor Pellegrini.
246249 - ref SDS E1 P135
246251 - ..
246252 - Did not discuss research showing chronically elevated HDL causes
246253 - paroxysmal atrial fibrillation (PAF), reported on 200103 0700.
246254 - ref SDS C1 N68K This might be a factor in this case. Patient history
246255 - shows HDL > 60 for past 6 years, see labs listed in the record on
246256 - 191228 1508. ref SDS B5 VZ6G
246258 - ..
246259 - Also did not discuss that PAF lowers lipids, including HDL and LDL,
246260 - reported in same article, ref SDS C1 MZ37, which has occurred in this
246261 - case, shown in blood test on 191228 1508. ref SDS B5 5C7M This was
246262 - reported to Doctor Simpson in a letter on 200120 1426. ref SDS D4 OE60
246264 - ..
246265 - Thanked Doctor Pellegrini for timely review of this case.
246266 -
246267 -
246268 -
246270 - ..
2463 -
2464 -
2465 - 1414
2466 -
246601 - Nurse came with a wheelchair and said the Echo ultra sound study,
246602 - ordered by Doctor Simpson on 200108 1130, ref SDS C5 GG4F, can be done
246603 - now in Cardiology. She pushed me to the Echo room in Cardiology down
246604 - the hall from the hospital, reported in another record today on 200122
246605 - 1414. ref SDS D9 NE9N
246607 - ..
246608 - [On 200122 1414 echocardiogram study performed. ref SDS D9
246609 - NE9N
246610 -
246611 -
246613 - ..
2467 -
2468 -
2469 - 1539
2470 -
247001 - Cynthia and Brittina.
247002 -
247003 - Cynthia presented 2 clinical trial opportunities...
247005 - ..
247006 - Signed up for clinical trial on alternate cardiac catheritization
247007 - preparation modalities for applying stents.
247009 - ..
247010 - Title....
247011 -
247012 - Evaluation of Treatment Strategies for Severe CaLclfic
247013 - Coronary Arteries: Orbital ATHERECTOMY V Conventional
247014 - Angioplasty Technique Prior to Implantation of Drug-Eluting
247015 - Stents (ECLIPSE)
247016 -
247017 - [On 200123 1514 received letter from Cynthia transmitting
247018 - explanation of ECLIPSE study, and enrollment documents.
247019 - ref SDS E0 PF5N
247021 - ..
247022 - Principal Investigator........ Kendrick Shunk MD San Francisco
247023 - VAMC University of California, San Francisco San Francisco Veterans
247024 - Affairs Medical Center
247025 -
247026 - Consent to Participate in a Research Study
247028 - ..
247029 - Introduction
247031 - ..
247032 - Doctor Kendrick Shunk and his research team at San Francisco VAMC
247033 - are conducting a clinical research study to find out more about the
247034 - preparation of blood vessels prior to placing a stent for the
247035 - treatment of coronary artery disease (CAD) by using the Diamondback
247036 - 360 Coronary Orbital Atherectomy System (OAS). Before you decide
247037 - to take part, you should know why the research is being done, and
247038 - how it will be performed. There may be potential risks and
247039 - benefits if you decide to participate.
247040 -
247042 - ..
247043 - Cynthia presented a 2nd clinical trial evaluating PCSK9 statin drug.
247044 - It requires pausing lipid labs for 18 months.
247046 - ..
247047 - Explained was referred to VAMCSF for consideration of treatment with
247048 - PCSK9 on 131017 1000. ref SDS 16 8B3M
247050 - ..
247051 - On 131121 0930 discussed with San Francisco VA Medical Center
247052 - participating in clinical trial for PCSK9 as alternative to statin
247053 - drug treatment to manage cholesterol for reducing CVD risk of
247054 - atherosclerosis. ref SDS 18 545O
247056 - ..
247057 - On 131121 0930 VA Progress Notes in medical chart report consideration
247058 - for patient to participate in clinical trial testing PCSK9 drugs to
247059 - manage cholesterol for lowering CVD risk through regression of
247060 - atherosclerosis. ref SDS 18 Q17I
247062 - ..
247063 - Pausing blood tests 18 months for HDL would prevent testing response
247064 - to treatment with hiking to raise HDL in order to regress
247065 - atherosclerotic plaque in blood vessels. Even if we stopped testing
247066 - lipids, as the end of 18 months could not distinguish between reduced
247067 - plaque due to PCSK9 and continued hiking at levels that maintain
247068 - elevated HDL.
247070 - ..
247071 - [On 200123 1514 received letter from Cynthia transmitting
247072 - explanation of PCSK9 study, and enrollment documents.
247073 - ref SDS E0 PF5N
247074 -
247075 -
247076 -
247077 -
247078 -
247080 - ..
2471 -
2472 -
2473 - 1552
2474 -
247401 - Doctor Shunk arrived with colleagues...
247402 -
247403 - Doctor Kevin ________
247404 - Doctor R Bamvi Fohtung
247406 - ..
247407 - Cynthia and Brittina stayed for this meeting, and then continued
247408 - discussing clinical trial for cardiac catheterization preparing blood
247409 - vessels for stents, per above. ref SDS 0 07F5
247411 - ..
247412 - Doctor Shunk said this case will be performed in the Cath Lab tomorrow
247413 - OA 1450 He said okay to eat breakfast, but then NPO until after the
247414 - procedure.
247416 - ..
247417 - Doctor Shunk initially noted "irony" of asking patient to join his
247418 - IVUS clincal trial, when 10 years ago, during while meeting in Karen's
247419 - office, he declined, "too risky", supporting a clinical trial using
247420 - cardiac IVUS to test response to treatent with hiking that raises HDL
247421 - cholesterol and EPCs, which together regress LDL atherosclerotic
247422 - plaque in blood vessels, reported on 131121 0930. ref SDS 18 MS7G
247423 -
247425 - ..
247426 - [On 200124 0705 report Doctor Shunk was pleased (smiled)
247427 - learning IVUS Cath Lab procedure found bypass grafts after
247428 - 10 years are completely clear of plaque, i.e., 0 stenosis,
247429 - and doctor told patient to continue doing whatever was
247430 - being done to achieve such remarkable results. ref SDS E2
247431 - T531
247433 - ..
247434 - [On 200128 0730 Doctor Shunk attended 2nd cath lab
247435 - procedure, when Doctor Tietjens placed a stent in a branch
247436 - blood vessel; at the beginning he leaned over and said
247437 - hello, and when Doctor Tietjens introduced him, he said "We
247438 - are old friends." ref SDS E4 Y64K
247440 - ..
247441 - [On 200204 2252 submitted copy of letter, to Doctor
247442 - Simpson, to Cynthia, hoping she will share with Doctor
247443 - Shunk in Cardiology Cath Lab department, to extend
247444 - consideration of IVUS clinical trial evaluating hiking for
247445 - raising HDL that regresses atherosclerotic plaque in blood
247446 - vessels. ref SDS E5 UG74
247448 - ..
247449 - Reviewed prior Cath Lab on 091021 0716. ref SDS 5 7L43
247451 - ..
247452 - Kathy suggested discussing procedures for laying flat on the gurney
247453 - during examination and treatment, that will avoid complications from
247454 - achalasia.
247456 - ..
247457 - Reviewed patient history of reflux due to achalasia. Previously the
247458 - team placed a towel under patient's head for elevation that prevents
247459 - reflux through LESV, also reported on 091021 0716. ref SDS 5 KH6L
247461 - ..
247462 - Doctor Shunk said similar measures will be used for this new procedure
247463 - tomorrow.
247465 - ..
247466 - Doctor Shunk asked about clinical trials?
247468 - ..
247469 - Cynthia reported the patient has consented to join the ECLIPSE stent
247470 - preparation trial, per above. ref SDS 0 07F5
247472 - ..
247473 - She explained patient cannot qualify for PCSK9 study, because it
247474 - requires pausing HDL labs for over a year. Patient needs labs to
247475 - determine response to treatment hiking to maintian HDL at therapeutic
247476 - levels, also reported above. ref SDS 0 A87L
247477 -
247478 - [On 200123 1514 received letter from Cynthia transmitting
247479 - explanation of PCSK9 study, and enrollment documents.
247480 - ref SDS E0 PF5N
247482 - ..
247483 - Doctor Shunk explained the PCSK9 trial includes doing another cardiac
247484 - catheritization IVUS study a year or so into the study. The doctor
247485 - smiled explaining to his team the irony of prior refusal to patient's
247486 - clinical trial proposing IVUS catheter procedure testing regression of
247487 - plaque in artery bypass grafts after raising HDL > 60 from hiking,
247488 - requested on 131121 0930, ref SDS 18 MS7G, and today, 7 years later,
247489 - inducing participation in a different study by offering an IVUS
247490 - procedure testing for merely reducing the advance of plaque in bypass
247491 - grafts.
247493 - ..
247494 - Briefly considered that the IVUS procedure tomorrow in the Cath Lab
247495 - will finally provide clinical trial results on benefits of elevating
247496 - HDL and EPCs with hiking.
247498 - ..
247499 - Someone commented that not enough people can hike 10 - 20 miles per
247500 - day that would support a formal clinical trial. Several others
247501 - concurred. Doctor Shunk smiled and noted it might be difficult to get
247502 - enough participants to yield sufficient data for such a study.
247504 - ..
247505 - Discussed genetic variability gives rise to a study to help patients
247506 - who might raise HDL > 60 hiking only 5 miles per day 5 days a week.
247507 - If even 10% of patients do this and benefit, this frees up resources
247508 - to treat other patients with drugs, who may resist helping themselves.
247510 - ..
247511 - Did not discuss research showing chronically elevated HDL causes
247512 - paroxysmal atrial fibrillation (PAF), reported on 200103 0700.
247513 - ref SDS C1 N68K
247515 - ..
247516 - Also did not discuss that PAF lowers lipids, including HDL and LDL,
247517 - reported in same article, ref SDS C1 MZ37, which has occurred in this
247518 - case, shown in blood test on 191228 1508. ref SDS B5 5C7M This was
247519 - reported to Doctor Simpson in a letter on 200120 1426. ref SDS D4 OE60
247520 -
247521 -
247522 -
247523 -
247524 -
247526 - ..
2476 -
2477 -
2478 - 1851
2479 -
247901 - Doctor Erron Titus visited. Discussed meeting earlier today, with
247902 - Doctor Shunk, Keven, and Doctor Fontung, planning Cath Lab procedure
247903 - scheduled for tomorrow, per above. ref SDS 0 6Y5R He said eat
247904 - breakfast, but no lunch before the procedure. Tomorrow the doctor
247905 - will enter an order for breakfast.
247907 - ..
247908 - Considered writing the order this afternoon, so it is in the record
247909 - when the kitchen folks are preparing breakfast early tomorrow morning.
247911 - ..
247912 - Erron asked if anyone from Cardiology Electrophysiology has visited
247913 - to discuss options for treating paroxyxmal atrial fibrillation?
247915 - ..
247916 - Explained meeting with Doctor Cara Pellegrini visited at 1450, per
247917 - above, ref SDS 0 MN4O She is with Cardio Electrophysiology, and
247918 - discussed prospects for treating PAF with "Pulmonary vein isolation"
247919 - ablation procedure discussed in the literature reported on 191206
247920 - 1425. ref SDS A6 1143
247921 -
247922 -
247924 - ..
2480 -
2481 -
2482 - 2108
2483 -
248301 - Lauren and Long visited to provide medications. Lauren said she is
248302 - giving a new sleeping aid tonight...
248303 -
248304 - melatonin
248306 - ..
248307 - Sleeping aid given last night did not work well, reported on 200122
248308 - 0028. ref SDS D8 9C9M The change to melatonin this evening, reflects
248309 - request to Erron this morning for stronger sleeping medication, per
248310 - above. ref SDS 0 5N9L
248312 - ..
248313 - Long administered drugs, reported in the record yesterday on 200121
248314 - 0552. ref SDS D7 YW6I Deferred taking calcium carbonate (Tums) for
248315 - another 30 minutes, as requested to align with practice the past 5
248316 - years.
248318 - ..
248319 - Long changed the dressing for the IV set in the ER, reported on 200120
248320 - 2017. ref SDS D6 233K This was pain level 8 because the strong
248321 - adhesive tape securing the IV in place pull skin all along the
248322 - perimeter of the setting.
248323 -
248324 -
248325 -
248326 -
248327 -
248328 -
248329 -
248330 -
248331 -
248332 -
248333 -
248334 -
2484 -