CONTACTS
SUBJECTS
Treadmill Heart Stress Test Schedule 200103 0700 Chest Pain Elevated
3503 -
3503 - ..
3504 - Summary/Objective
3505 -
350501 - Follow up ref SDS G9 0000. ref SDS G7 0000.
350502 -
350503 -
350504 -
350505 -
350507 - ..
3506 -
3507 -
3508 - Background
3509 -
350901 - On 191206 1425 letter to VAMCSF Cardiology Doctor Simpson, ref SDS B4
350902 - NE9N, notify possible afib symptoms. ref SDS B4 N874
350904 - ..
350905 - On 191207 0927 Doctor Simpson to order ECG [...electrocariogram...]
350906 - Zio test for AFib, after he returns to work following several weeks
350907 - out of the office. ref SDS B5 NE9N
350909 - ..
350910 - On 191213 0849 call from Tina - scheduled install Zio equipment for
350911 - heart monitoring test; meeting room 2A16 on 191216 1230. ref SDS B6
350912 - NE9N
350914 - ..
350915 - On 191216 1220 Exmeralda in Cardiology at VAMCSF installed Zio XT
350916 - heart monitor on left chest; she added 2 plastic tapes to secure the
350917 - unit against fall off in shower and perspiration during hiking.
350918 - ref SDS C0 AO7H
350920 - ..
350921 - On 191214 1138 letter to Doctor Simpson in Cardiology at VAMCSF,
350922 - ref SDS B8 NE9N, reports 8 weeks ago increased hiking route with steep
350923 - hills from 11 to 15 miles per day. ref SDS B8 MX58 About a week ago
350924 - increased hiking to 20+ miles per day in order to improve weight
350925 - control and to raise lipids toward HDL 80. ref SDS B8 MX61 Weight
350926 - increased after pausing hiking due to orthopedic pain left knee and
350927 - both feet, which was solved after receiving oxycodone and gabapentin,
350928 - and applying elastic bandage to left knee. ref SDS B8 MX64 Today,
350929 - before hiking felt chest swaying indicating afib. ref SDS B8 MY30
350930 - Research indicates walking can aid recovery from afib; during hike
350931 - today, will reduce level of effort back to 15 miles per day, and avoid
350932 - steeper hills. ref SDS B8 368M Ask about medication to treat afib.
350933 - ref SDS B8 MY38 Offer to walk with Doctor Simpson to assist recovery
350934 - from hip surgery. ref SDS B8 MY41
350936 - ..
350937 - On 191214 1138 at 1324 letter from Doctor Simpson in Cardiology at
350938 - VAMCSF says to do hiking that has led to symptoms. ref SDS B9 0K4L
350940 - ..
350941 - On 191228 1416 letter to Doctor Simpson notify Zio log reports chest
350942 - pain hiking with elastic bandage on left knee. ref SDS C2 NE9N 1st
350943 - episode hiking 12 miles through Golden Gate Park on 191220, chest pain
350944 - mild lasted on ly .25 miles. Occurred again next day hiking 20 miles
350945 - up Crystal Ranch Road. ref SDS C2 B652 Occurred next day on 191222, so
350946 - stopped at mile .75 and removed elastic bandage from left leg, pain
350947 - ended for rest of 20 mile hike and on subsequent hikes 20 mile past 6
350948 - days. ref SDS C2 B655 Today on 191228, chest pain occurred hiking up
350949 - mild hills without elastic bandage on left leg, so ended hike at 7
350950 - miles. ref SDS C2 B658 HR 150 - should be 45 - 55. ref SDS C2 B662
350951 - Seems like bypass saphenous graft failed under elevated load wearing
350952 - elastic bandage on left knee. ref SDS C2 B665 Pause hiking until hear
350953 - from the doctor. ref SDS C2 B668
350955 - ..
350956 - On 191228 1416 at 1534 letter from Doctor Simpson notifies he will
350957 - order treadmill stress test. ref SDS C2 RK6L
350959 - ..
350960 - On 191228 1416 at 1537 letter to Doctor Simpson notifies will submit
350961 - Zio XT device with afib data on Monday, 191230. ref SDS C2 WO6F
350963 - ..
350964 - On 191229 1243 received letter from Doctor Simpson notifies need to
350965 - get ECG test at VAMCSF before they can schedule treadmill stress test.
350966 - ref SDS C4 NE9N Further says to get care in the ER if chest pain
350967 - recurs at rest. ref SDS C4 NH77
350969 - ..
350970 - On 191229 1243 at 1256 letter to Doctor Simpson asks where and when to
350971 - get ECG test. ref SDS C4 YH8N Notifies so far chest pain has not
350972 - occurred at rest; has only occurred when hiking. ref SDS C4 YA48
350973 - Notifies of EGD procedure in GI Clinic at VAMC Sacramento on 200107,
350974 - and getting MRI studies on feet and knees at VAMCSF on 200109.
350975 - ref SDS C4 YA51
350977 - ..
350978 - On 191229 1243 at 1420 received letter from Doctor Simpson advising
350979 - ECG is done on 2nd floor building 203, and to arrive about 1000.
350980 - ref SDS C4 LG4J Recommends notifying GI Clinic to delay EGD until
350981 - after resolution of current Cardiology issue. ref SDS C4 6H6G
350983 - ..
350984 - On 191229 1243 at 1538 received letter from Doctor Simpson advising
350985 - ECG was done in this case at the end of Oct, so do not need a new one;
350986 - next step is for VA to schedule stress test. ref SDS C4 E17N
350988 - ..
350989 - On 191229 1243 at 1619 sent letter to Jessica on notifying Doctor Lee
350990 - to delay next EGD scheduled on 200107 0730 for a month until 200204
350991 - 0730. ref SDS C4 4R7J
350993 - ..
350994 - On 191229 1243 at 1700 letter thanks Doctor Simpson for advising ECG
350995 - not needed. ref SDS C4 M48J
350997 - ..
350998 - On 191229 1243 at 1946 letter notifies Doctor Simpson that feet
350999 - elevated on footrest seem swelled. Cellphone reports HR 38. That is
351000 - low for me. Don't feel dizzy or light headed; seems like afib event,
351001 - with chest swaying back and forth. ref SDS C4 MH6N
351003 - ..
351004 - On 191229 1243 at 1946 letter notifies Doctor Simpson Zio device was
351005 - mailed to company a day early on 191229. ref SDS C4 UA47
351007 - ..
351008 - On 191230 0930 received call from Tina in Cardiology at VAMCSF
351009 - scheduled treadmill stress test on 200103, ref SDS C6 NE9N, report
351010 - first at 0700 to ASU on 3rd floor Building 200 for IV, then go to
351011 - Neuclear Medicine on ground floor building 203. ref SDS C6 GE5K
351013 - ..
351014 - On 191230 0930 at 0938 received letter from Doctor Simpson in
351015 - Cardiology explaining symptoms reported last night are okay, since not
351016 - dizzy, until after stress test. ref SDS C6 GF3G
351018 - ..
351019 - On 191230 0930 at 0949 received letter Tina in Cardiology confirming
351020 - schedule for stress test on 200103 0700, and submitting instructions
351021 - to prepare for the test. ref SDS C6 Q76I
351023 - ..
351024 - On 191230 0930 at 1021 letter to Doctor Simpson in Cardiology at
351025 - VAMCSF reporting stress test has been scheduled on 200301 0700.
351026 - ref SDS C6 9W6F Reported mild chest pain at rest for 10 minutes, but
351027 - it resolved while writing the letter. ref SDS C6 JY39
351029 - ..
351030 - On 191230 0930 at 1114 received letter from Lauren, NP and PCP in this
351031 - case; she concurs patient should go to ER if chest pain persists at
351032 - rest, and should have a driver. ref SDS C6 2S4N
351034 - ..
351035 - On 191230 0930 at 1117 received call from Aladin who is Lauren's
351036 - assistent in Medical Practice; he indicated Lauren asked him to call
351037 - and get background on chest pain issue. ref SDS C6 578G Explained
351038 - background is reported in correspondence with Doctor Simpson in
351039 - Cardiology, and this has been copied to Lauren. ref SDS C6 5W6J
351041 - ..
351042 - On 191230 0930 at 1135 responded to Lauren citing call from her
351043 - assistent, Aladin, and reporting background on current issue is
351044 - reported in correspondence with Doctor Simpson in Cardiology, who is
351045 - directing the work, and that Lauren has been copied on all
351046 - correspondence. ref SDS C6 659K
351048 - ..
351049 - On 200108 1130 Doctor Simspon ordered cardiac catheterization
351050 - (Angiogram) to evaluate for failed saphenous bypass graph. ref SDS D3
351051 - UV3M He also cordered Echocardiogram (ECHO) to evaluate cardiac
351052 - remodeling that may be causing atrial fibrillation. ref SDS D3 GG4F
351054 - ..
351055 - On 200113 0841 call from Gina in Cardiology scheduled echocardiogram
351056 - on 200214 1300 to evaluate for cardiac remodeling causing AF due to
351057 - high-intensity hiking. ref SDS D7 NE9N
351059 - ..
351060 - On 200115 0933 called VA Cardiology, ref SDS D9 Q18G; and talked to
351061 - Sue, who has taken the position of Karen for scheduling and
351062 - coordinatoing patient procedures. ref SDS D9 NB9G Sue scheduled
351063 - cardiac catheterization (angiography) on 200128 0730; and, pause
351064 - Apixaban blood thinner 2 days before the procedure. ref SDS D9 4L5N
351066 - ..
351067 - On 200115 0933 at 1747 submitted letter confirming work plan for
351068 - cardiac catheterization on 200128. ref SDS D9 5J7M
351070 - ..
351071 - On 200115 0933 at 1936 submitted another letter correcting date error
351072 - in the letter at 1747. ref SDS D9 4K5G
351074 - ..
351075 - On 200116 0948 received letter from Sue in Cardiology at VAMCSF
351076 - instructions for cardiac catheterization scheduled 200118, ref SDS E0
351077 - G367, pause Apixaban 2 days before 200118, ref SDS E0 G45M; NPO after
351078 - midnight, and until after Cath, ref SDS E0 6S30; bring list of
351079 - medications, ref SDS E0 6S76; bring charger for cellphone, ref SDS E0
351080 - 4B9H; do not drive for 24 hours after cardiac catheterization.
351081 - ref SDS E0 6S98
351083 - ..
351084 - On 200124 0705 cardiac catheterization angiogram performed by Doctor
351085 - Tietjens, ref SDS F1 V544; found all 4 bypass grafts completely clear -
351086 - no plaque buildup of any amount. Saphenous vein grafts in very good
351087 - condition 10 years after CABG x4; best result he has ever seen. He
351088 - said to continue doing whatever you are doing to achieve this
351089 - exceptional result. ref SDS F1 ME8G Doctor asked about hiking and HDL?
351090 - Hiking 3 - 8 miles per day 4 - 6 times a week yielded HDL 30 at time
351091 - of CABG x4 on 091022. About 4 years after surger, increased hiking to
351092 - 11 - 20 miles per day up to 7 days a week, this raised cholesterol to
351093 - HDL 83, that regressed plaque in blood vessels. ref SDS F1 CN7I
351095 - ..
351096 - On 200127 090153 Caroline called scheduled meeting with Doctor
351097 - Pelligrini in Cardiology Arrhythmia Clinic to schedule procedure
351098 - pulmonary vein isolation ablation resolve chest pain peroxysmal atrial
351099 - fibrillation (PAF). ref SDS F3 9C9M
351101 - ..
351102 - On 200320 1741 call from Doctor Pelligrini reporting 2nd Zio heart
351103 - monitor test found PAF episodes increased from 15% found in the 1st
351104 - Zio test last December to 23%. ref SDS G2 9C9M Progression of disease
351105 - requires ablation medical procedure to restore regular sinus heart
351106 - beat, which must be deferred 3 - 4 weeks during current coronavirus
351107 - pandemic. ref SDS G2 YV4L
351109 - ..
351110 - On 200509 1517 drove to VA Medical Center in San Francisco, admitted
351111 - to ER. ECG did not show AF, but HR elevated. ref SDS G0 9C9M However,
351112 - EKG heart monitor shows atrial flutter. ref SDS G0 VC4O Given
351113 - Adenosine for treatment of SVT - supraventricular tachycardia, where
351114 - HR elevated and BP low. This was momentarily difficult to tolerate.
351115 - ref SDS G0 T440 Doctor Pellegrini notified ER to admit patient for
351116 - another ablation on Monday, 200511, to treat atrial flutter.
351117 - ref SDS G0 NE3H Had another coronavirus (COVID-19) nasal test; very
351118 - difficult to tolerate. ref SDS G0 UL3L Transferred to Med-Surg
351119 - Telemetry. ref SDS G0 PG5M
351121 - ..
351122 - On 200510 0613 Woke in VA hospital Med surg, vitals okay, went for
351123 - walk. ref SDS 0 9C9M Adenosine was not given in ER for therapy, but
351124 - for diagnostics to aid Doctor Pellegrini decide on performing cardiac
351125 - ablation on 200510. ref SDS 0 OV3F Researched swab test for
351126 - coronavirus. ref SDS 0 FQ30 Prescription for metoprolol changed to
351127 - every 8 hours. ref SDS 0 06H4 Doctor Durstenfeld advised scheduled
351128 - for ablation tomorrow. ref SDS 0 7O6G ARDS (shortness of breath)
351129 - occurred bending down to tie shoes. ref SDS 0 P45E
351130 -
351131 -
351132 -
351133 -
351135 - ..
3512 -
3513 -
3514 - Progress
3515 -
351501 - Went for walk through Med-Surg South and North.
351502 -
351503 - Gladys here for vitals...
351504 -
351505 - BP........... 134 82
351506 - HR........... 87
351507 - Weight....... 182
351509 - ..
351510 - She gave metoprolol to take this morning.
351512 - ..
351513 - Other meds will be at 0800.
351514 -
351516 - ..
3516 -
3517 -
3518 - 0718
3519 -
351901 - Doctor Chang visited. He consulted in the ER yesterday.
351902 -
351903 - He will approve showering.
351905 - ..
351906 - Gladys was also present, and said Famotidine and Mylanta are not on
351907 - the hospital drug list.
351909 - ..
351910 - Explained that is because they are prescribed by Doctor Lee at VA
351911 - Medical Center in Sacramento.
351913 - ..
351914 - I was given Famotidine last night in ER, so should be able to get it
351915 - today, reported on
351916 -
351917 -
351919 - ..
3520 -
3521 -
3522 - 0813
3523 -
352301 - Nurse from lab arrived and did blood draw.
352302 -
352303 -
352305 - ..
3524 -
3525 -
3526 - 0938
3527 -
352701 - Doctor Chang visited again with medical team.
352702 -
352703 - He gave name of medicine used in ER: Adenosine
352705 - ..
352706 - The doctor seemed to say that Adenosine was not given for therapy,
352707 - reported yesterday on 200509 1517. ref SDS G9 T458 He advised that
352708 - Adenosine slows the heart to provide diagnostic data that was
352709 - submitted to Doctor Pelligrini, leading to scheduling ablation on
352710 - Monday.
352712 - ..
352713 - Asked Doctor Chang about coronavirus nasal swab in the ER, reported on
352714 - 200509 1517. ref SDS G9 UL3L
352716 - ..
352717 - Doctor Chang said there are multiple nasal pharyngeal swab procedures
352718 - used at the hospital. The procedure used for access to the hospital
352719 - last week that took 2 seconds pushing a swab into the front of one
352720 - nostral with a slight twist, reported on 200429 0700, ref SDS G5 G647,
352721 - is much different from the nasal swab method yesterday in the ER, that
352722 - pushed a swab to the back of the throat, took 8+ seconds in both
352723 - nostrals and was twisted continuously. ref SDS G9 UL3L
352725 - ..
352726 - The doctor advised that the swab procedure used in the ER takes 800%
352727 - longer than the faster method used on 200429. Virtually all patients
352728 - have difficulty tolerating the longer procedure.
352730 - ..
352731 - The difficulty here is variance in how far the swab is pushed into the
352732 - nose. Different authorities point out that some practitioners get
352733 - good results pushing 2 or 3 inches for 1 - 2 seconds, while others get
352734 - poor results pushing a swab 6 to 8 inches for 8 - 15 seconds. The
352735 - challenge is to provide testing that people seek out, because it is
352736 - easy and effective, rather than avoid because the test is extremely
352737 - difficult to tolerate, and may or may not be effective.
352739 - ..
352740 - Research finds...
352741 -
352742 - UC Davis Health
352743 -
352744 - Coronavirus
352745 -
352746 - https://health.ucdavis.edu/coronavirus/coronavirus-testing.html
352748 - ..
352749 - How is testing for coronavirus done?
352751 - ..
352752 - Testing for COVID-19 involves inserting a 6-inch long swab
352753 - (like a long Q-tip) into the cavity between the nose and mouth
352754 - (nasopharyngeal swab) for 15 seconds and rotating the swab
352755 - several times. The swabbing is then repeated on the other side
352756 - of the nose to make sure enough material is collected. The
352757 - swab is then inserted into a container and sent to a lab for
352758 - testing.
352760 - ..
352761 - A video at this site describes minimizing discomfort to the
352762 - person being tested. Does not explain how this is
352763 - accomplished, pushing a swab to the back of the throat and
352764 - twisting it for 15 seconds.
352765 -
352767 - ..
352768 - Another source says...
352769 -
352770 - April 13, 2020
352771 -
352772 - Swabs for COVID-19 don't have to go so deep into your nose,
352773 - local clinic says
352775 - ..
352776 - Most people tested for COVID-19 have had to endure an
352777 - extra-long swab inserted into a nostril and snaked through the
352778 - nasal cavity until it touches the back of the throat.
352780 - ..
352781 - The question... to answer: Could a COVID-19 test be simple,
352782 - safe, and painless
352784 - ..
352785 - Researchers designed a new method of testing. ... used
352786 - Q-tip-sized swabs to probe ...noses.
352787 -
352788 - ...swabbed one nostril, then the other, without going nearly as
352789 - deep as the old method required.
352790 -
352791 - "The samples were just as accurate in making the diagnosis of
352792 - COVID as if a nurse or a medical assistant obtained the sample
352793 - using a nasopharyngeal swab,"
352795 - ..
352796 - "This is much more user-friendly,? ... ?It... is much more
352797 - comfortable. And it also is much quicker."
352799 - ..
352800 - The FDA's guidelines say that, while a nasopharyngeal swab is
352801 - "preferred," ...swabbing method in the front of the nose is
352802 - "acceptable."
352803 -
352805 - ..
352806 - Another source says...
352807 -
352808 - Business Insider
352809 -
352810 - A doctor explains why some people faint when they get a
352811 - coronavirus test
352813 - ..
352814 - Apr 30, 2020 07:52 AM
352815 -
352816 - https://www.businessinsider.com/why-the-coronavirus-test-makes-some-people-faint-2020-4
352818 - ..
352819 - Jane Pauw weathered such a severe case of COVID-19 she once had
352820 - to crawl to get herself water. And yet, ... the worst part was
352821 - before all of that, when she got a coronavirus test in early
352822 - March.
352824 - ..
352825 - The test ? technically known as a RT-PCR test... ? involves a
352826 - healthcare provider pushing a thin, plastic nasal swab three to
352827 - four inches along the floor of the nose through the nostril.
352829 - ..
352830 - The goal of the coronavirus test is to extract sputum ? the
352831 - material that gets ejected through coughing, sneezing,
352832 - spitting, and singing ? in order to test it for some of the
352833 - coronavirus's genes,
352834 -
352835 - "It feels like being stabbed, to me, in a really sensitive
352836 - place and then having it be twisted," she said. "And then,
352837 - they had to do it twice."
352839 - ..
352840 - Even when it was over... she and her husband had just gotten on
352841 - the freeway home when Pauw passed out. Fortunately, she wasn't
352842 - driving. "That was a horrible experience," she said. "That was
352843 - the very worst day of it all."
352845 - ..
352846 - On the other hand, inexperienced clinicians may not insert the
352847 - swab far enough, in which case it may be more comfortable but
352848 - less effective.
352849 -
352850 -
352851 -
352852 -
352854 - ..
3529 -
3530 -
3531 - -0950
3532 -
353201 - Jessica and Lora in the room to have another metoprolol pill.
353202 -
353203 - Explained that Gladys gave metoprolol at 0613 this morning, per above.
353204 - ref SDS 0 9C9M Have been taking it once a day, in order to avoid side
353205 - effects of acute resperatory distress syndrome (ARDS), reported on
353206 - 200330, cited in case study on 200101 0702. ref SDS C8 KB45
353208 - ..
353209 - This was changed to twice a day on 200507. ref SDS C8 QA9L
353211 - ..
353212 - Jessica said the prescription has been changed to every 8 hours.
353214 - ..
353215 - In that case, since Gladys gave metoprolol at 0613 this morning, 8
353216 - hours later would be 1400, when next pill is taken.
353217 -
353219 - ..
353220 - Asked if nurses and doctors get tested for coronavirus?
353222 - ..
353223 - Jessica said employees don't get tested, because this would exhaust
353224 - the supply of coronavirus tests available for patients.
353226 - ..
353227 - Jessica said she has given coronavirus tests to 2 patients. Each time
353228 - was a very emotionlly challenging experience, because patients react
353229 - with extreme emotion to avoid discomfort of the test.
353230 -
353231 -
353232 -
353234 - ..
3533 -
3534 -
3535 - 1007
3536 -
353601 - Nurses Jessica and Lora applied plastic wrap to protect IV in right
353602 - arm from moisture.
353604 - ..
353605 - Took shower.
353606 -
353607 -
353609 - ..
3537 -
3538 -
3539 - 1404
3540 -
354001 - Doctor Durstenfeld visited.
354002 -
354003 - I am second up for Cath Lab tomorrow, so will likely be in the
354004 - afternoon.
354005 -
354006 - [On 200510 2012 letter to Doctor Pellegrini report meeting
354007 - with Doctor Dursgenfeld and staff anesthesiologist planning
354008 - ablation on 200511, 2nd up. ref SDS H0 9C9M
354010 - ..
354011 - NPO after midnight.
354013 - ..
354014 - Take Apixaban tonight, but not tomorrow morning.
354016 - ..
354017 - Take Clopedigrel today and tomorrow.
354018 -
354020 - ..
3541 -
3542 -
3543 - 1430
3544 -
354401 - Visit with staff anesthesiologist - did not get name.
354402 -
354403 - Similar interview to prior pre-procedure screening with Karen for
354404 - readiness to get anesthesia for cardiac ablation on 200429 0700.
354405 - ref SDS G5 U43I
354406 -
354407 -
354409 - ..
3545 -
3546 -
3547 - 1548
3548 -
354801 - Putting on shoes for a walk before dinner, notice ARDS symptoms
354802 - beginning to occur bending down to tie the shoes, as a result of
354803 - increasing Metoprolol today.
354804 -
354805 -
354806 -
354807 -
354809 - ..
3549 -
3550 -
3551 - 1653
3552 -
355201 - Visited with Jessica and Lora in the hall. Jessica will investigate
355202 - to provide Mylanta this evening.
355204 - ..
355205 - She wants to give Apixaban within the hour. This will be the last
355206 - Apixaban treatment until after ablation tomorrow afternoon.
355207 -
355208 -
355210 - ..
3553 -
3554 -
3555 - 1700
3556 -
355601 - Jessica and Lora stop by.
355602 -
355603 - Did vitals - good numbers.
355605 - ..
355606 - Get last Apixaban pill for today, before ablation tomorrow.
355607 -
355609 - ..
3557 -
3558 -
3559 - 1750
3560 -
356001 - Dinner - hamburger, ate a few bites.
356002 -
356003 - Jessica brought a ginger ale to help swallowing. She and Lora have
356004 - been terrific.
356005 -
356006 -
356007 -
356008 -
356009 -
356010 -
356011 -
356012 -
356013 -
356014 -
356015 -
356016 -
3561 -