CONTACTS
SUBJECTS
Treadmill Heart Stress Test Schedule 200103 0700 Chest Pain Elevated
2403 -
2403 - ..
2404 - Summary/Objective
2405 -
240501 - Follow up ref SDS F4 0000. ref SDS F3 0000.
240502 -
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240508 - ********** Content Prior Record Begins Here ***********
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240513 -
240515 - ..
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 B3 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 B3 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 B3 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 B3 B658 HR 150 - should be 45 - 55. ref SDS B3 B662
240951 - Seems like bypass saphenous graft failed under elevated load wearing
240952 - elastic bandage on left knee. ref SDS B3 B665 Pause hiking until hear
240953 - from the doctor. ref SDS B3 B668
240955 - ..
240956 - On 191228 1416 at 1534 letter from Doctor Simpson notifies he will
240957 - order treadmill stress test. ref SDS B3 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 B3 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 B4 NE9N Further says to get care in the ER if chest pain
240967 - recurs at rest. ref SDS B4 NH77
240969 - ..
240970 - On 191229 1243 at 1256 letter to Doctor Simpson asks where and when to
240971 - get ECG test. ref SDS B4 YH8N Notifies so far chest pain has not
240972 - occurred at rest; has only occurred when hiking. ref SDS B4 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 B4 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 B4 LG4J Recommends notifying GI Clinic to delay EGD until
240981 - after resolution of current Cardiology issue. ref SDS B4 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 B4 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 B4 4R7J
240993 - ..
240994 - On 191229 1243 at 1700 letter thanks Doctor Simpson for advising ECG
240995 - not needed. ref SDS B4 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 B4 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 B4 UA47
241007 - ..
241008 - On 191230 0930 received call from Tina in Cardiology at VAMCSF
241009 - scheduled treadmill stress test on 200103, ref SDS B5 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 B5 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 B5 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 B5 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 B5 9W6F Reported mild chest pain at rest for 10 minutes, but
241027 - it resolved while writing the letter. ref SDS B5 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 B5 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 B5 578G Explained
241038 - background is reported in correspondence with Doctor Simpson in
241039 - Cardiology, and this has been copied to Lauren. ref SDS B5 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 B5 659K
241048 - ..
241049 - On 200227 0800 Lauren called. She will order Tramadol. ref SDS C8
241050 - NE9N Lauren will also order diclofenac topical medication to try
241051 - before ordering naproxen. ref SDS C8 016I She will call back in 2
241052 - weeks to evaluate results trying diclofenac. ref SDS C8 626M
241054 - ..
241055 - On 200312 082309 Lauren called. She does not want to take
241056 - responsibility for ordering naproxen, because it impacts apixaban that
241057 - is a blood thinner to prevent strokes that could occur, while in
241058 - atrial fibrillation. ref SDS D5 955O
241060 - ..
241061 - On 200611 0730 Lauren called with VAMCSF Medical Practice following up
241062 - prior patient review on 200312 0823. ref SDS C7 NE9N During call
241063 - today, explained pausing metoprolol, apixaban and clopidogrel due to
241064 - adverse side effects, reported this morning in case study on 200101
241065 - 0702. ref SDS C8 PQRQ Severe stomach pain occurring in the moment.
241066 - Dizziness, wobbly, staggering during hikes, fainting while working.
241067 - ref SDS E0 NE9N Lauren ordered examination in Urgent Care at VAMCSF.
241068 - ref SDS E0 H64G She wants EKG and labs to support the examination.
241069 - This was scheduled for today at 1400. ref SDS E0 H66H
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241076 - ..
2411 -
2412 -
2413 - Progress
2414 -
241401 - Sent letter to Doctor Simpson with copy to Doctor Pellegrini saying...
241402 -
241403 - 1. Subject: [EXTERNAL] SECURE BP Very Low
241404 - Date: 2020-07-23, 18:59
241409 - ..
241410 - 2. Dear Doctor Simpson,
241412 - ..
241413 - 3. Notifying you because Doctor Pellegrini is vacationing, per her
241414 - letter yesterday at 1946. Earlier today, received automatic
241415 - reply from her, shown below, indicating she is out of the loop.
241417 - ..
241418 - References automatic reply from Doctor Pellegrini received on 200723
241419 - 0912. ref SDS F4 JZ8F
241421 - ..
241422 - Letter to Doctor Simpson continues...
241423 -
241424 - 4. The issue at the moment is low BP after a hike this afternoon.
241425 - I get low numbers sometimes after a long hike in high heat,
241426 - e.g. 16+ miles and 90+ temp. Today only did 11 miles with temp
241427 - 84. Getting following BP and HR...
241428 -
241429 - 5. 1730..... completed hike+ BP+ + HR
241430 - 1750................... 68 50 101
241431 - 1733................... 67 48 97
241432 - 1814................... 63 49 90
241433 - 1820................... 71 51 84
241434 - 1822................... 72 50 84
241435 - 1841................... 81 54 85
241436 - 1852................... 79 56 77
241438 - ..
241439 - References vitals recorded after the hike today, and reported in case
241440 - study on 200101 0702. ref SDS B8 4T4I
241442 - ..
241443 - Letter to Doctor Simpson continues...
241444 -
241445 - 6. BP usually rises to normal (100+ 60+) in about 60 minutes as
241446 - vasodilation subsides. Today, things seem a little slower.
241448 - ..
241449 - 7. What BP numbers signal medical assistance is needed?
241450 -
241451 - [On 200724 0948 Doctor Simpson called and noted vitals are
241452 - very low, but there is no number that signals medical
241453 - assistance is needed; he described becoming "light headed"
241454 - and wobbly while walking results from low blood pressure,
241455 - and patient can seek medical assistance. ref SDS F5 NE9N
241457 - ..
241458 - 8. Thank very much for your guidance.
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