CONTACTS
SUBJECTS
Treadmill Heart Stress Test Schedule 200103 0700 Chest Pain Elevated
3503 -
3503 - ..
3504 - Summary/Objective
3505 -
350501 - Follow up ref SDS I7 0000. ref SDS H9 0000.
350502 -
350503 -
350504 -
350505 -
350506 -
350508 - ..
3506 -
3507 -
3508 - Background
3509 -
350901 - On 191206 1425 letter to VAMCSF Cardiology Doctor Simpson, ref SDS B5
350902 - NE9N, notify possible afib symptoms. ref SDS B5 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 B6 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 B7
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 C1 AO7H
350920 - ..
350921 - On 191214 1138 letter to Doctor Simpson in Cardiology at VAMCSF,
350922 - ref SDS B9 NE9N, reports 8 weeks ago increased hiking route with steep
350923 - hills from 11 to 15 miles per day. ref SDS B9 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 B9 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 B9 MX64 Today,
350929 - before hiking felt chest swaying indicating afib. ref SDS B9 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 B9 368M Ask about medication to treat afib.
350933 - ref SDS B9 MY38 Offer to walk with Doctor Simpson to assist recovery
350934 - from hip surgery. ref SDS B9 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 C0 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 C3 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 C3 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 C3 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 C3 B658 HR 150 - should be 45 - 55. ref SDS C3 B662
350951 - Seems like bypass saphenous graft failed under elevated load wearing
350952 - elastic bandage on left knee. ref SDS C3 B665 Pause hiking until hear
350953 - from the doctor. ref SDS C3 B668
350955 - ..
350956 - On 191228 1416 at 1534 letter from Doctor Simpson notifies he will
350957 - order treadmill stress test. ref SDS C3 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 C3 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 C5 NE9N Further says to get care in the ER if chest pain
350967 - recurs at rest. ref SDS C5 NH77
350969 - ..
350970 - On 191229 1243 at 1256 letter to Doctor Simpson asks where and when to
350971 - get ECG test. ref SDS C5 YH8N Notifies so far chest pain has not
350972 - occurred at rest; has only occurred when hiking. ref SDS C5 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 C5 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 C5 LG4J Recommends notifying GI Clinic to delay EGD until
350981 - after resolution of current Cardiology issue. ref SDS C5 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 C5 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 C5 4R7J
350993 - ..
350994 - On 191229 1243 at 1700 letter thanks Doctor Simpson for advising ECG
350995 - not needed. ref SDS C5 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 C5 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 C5 UA47
351007 - ..
351008 - On 191230 0930 received call from Tina in Cardiology at VAMCSF
351009 - scheduled treadmill stress test on 200103, ref SDS C7 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 C7 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 C7 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 C7 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 C7 9W6F Reported mild chest pain at rest for 10 minutes, but
351027 - it resolved while writing the letter. ref SDS C7 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 C7 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 C7 578G Explained
351038 - background is reported in correspondence with Doctor Simpson in
351039 - Cardiology, and this has been copied to Lauren. ref SDS C7 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 C7 659K
351048 - ..
351049 - On 200108 1130 Doctor Simspon ordered cardiac catheterization
351050 - (Angiogram) to evaluate for failed saphenous bypass graph. ref SDS D4
351051 - UV3M He also cordered Echocardiogram (ECHO) to evaluate cardiac
351052 - remodeling that may be causing atrial fibrillation. ref SDS D4 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 D8 NE9N
351059 - ..
351060 - On 200115 0933 called VA Cardiology, ref SDS E0 Q18G; and talked to
351061 - Sue, who has taken the position of Karen for scheduling and
351062 - coordinatoing patient procedures. ref SDS E0 NB9G Sue scheduled
351063 - cardiac catheterization (angiography) on 200128 0730; and, pause
351064 - Apixaban blood thinner 2 days before the procedure. ref SDS E0 4L5N
351066 - ..
351067 - On 200115 0933 at 1747 submitted letter confirming work plan for
351068 - cardiac catheterization on 200128. ref SDS E0 5J7M
351070 - ..
351071 - On 200115 0933 at 1936 submitted another letter correcting date error
351072 - in the letter at 1747. ref SDS E0 4K5G
351074 - ..
351075 - On 200116 0948 received letter from Sue in Cardiology at VAMCSF
351076 - instructions for cardiac catheterization scheduled 200118, ref SDS E1
351077 - G367, pause Apixaban 2 days before 200118, ref SDS E1 G45M; NPO after
351078 - midnight, and until after Cath, ref SDS E1 6S30; bring list of
351079 - medications, ref SDS E1 6S76; bring charger for cellphone, ref SDS E1
351080 - 4B9H; do not drive for 24 hours after cardiac catheterization.
351081 - ref SDS E1 6S98
351083 - ..
351084 - On 200124 0705 cardiac catheterization angiogram performed by Doctor
351085 - Tietjens, ref SDS F2 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 F2 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 F2 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 F4 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 G3 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 G3 YV4L
351109 - ..
351110 - On 200424 1640 Laurie called, Doctor Pellegrini's assistant; scheduled
351111 - ablation procedure on 200430; check in day before on 200429 for prep
351112 - and be admitted to hospital. ref SDS G5 9C9M
351114 - ..
351115 - On 200430 0700 in hospital at VAMCSF for left atrial pulmonary vein
351116 - isolation ablation procedure. ref SDS G7 9C9M
351118 - ..
351119 - On 200501 022805 in hospital VAMCSF recover from left atrial pulmonary
351120 - vein isolation ablation procedure, did not sleep well; at 0230 needed
351121 - assistance in the night getting up. ref SDS G8 9C9M Left knee hurting
351122 - - given oxycodone; ref SDS G8 F28L At 0800 entire body hurting,
351123 - especially the chest; given another oxycodone. Could not eat
351124 - breakfast, so drank carton of ensure. ref SDS G8 PT9T Walked laps
351125 - around the ward to condition body for driving home. ref SDS G8 LF5H At
351126 - 1000 asked to see Doctor Pellegrini to ask about readiness for driving
351127 - home; she was busy with other patients. ref SDS G8 IP7I Driving home
351128 - was disoriented, seemed very precarious, but made it. ref SDS G8 AV4G
351130 - ..
351131 - On 200503 1014 letter notifies medical team great job performing
351132 - pulmonary vein isolation ablation on 200430; thank Doctor Pellegrini
351133 - for getting early approval to perform the procedure. ref SDS G9 9C9M
351134 - Initial indications show successful procedure. ref SDS G9 EV53
351136 - ..
351137 - On 200503 1014 at 1102 letter notifies Doctor Pellegrini of severe
351138 - bruising at insertion points for ablation. ref SDS G9 TU5O
351140 - ..
351141 - On 200503 1014 at 2343 letter from Doctor Pellegrini advises bruising
351142 - expected; asks about swelling, pain and bleeding. ref SDS G9 U55G
351144 - ..
351145 - On 200504 0818 letter to Doctor Pellegrini reports no pain nor
351146 - bleeding at penetration sites for pulmonary vein isolation ablation
351147 - procedure on 200430. ref SDS H0 9C9M Explain how to access Polar HR
351148 - reports. ref SDS H0 L267 Report continuing dizziness, disorientation,
351149 - weakness following ablation on 200430. Ask if there was blood loss
351150 - during the procedure. ref SDS H0 L343
351152 - ..
351153 - On 200504 0818 at 2306 letter from Doctor Pellegrini says there is
351154 - minor blood loss during cardiac ablation procedures, and that it is an
351155 - ordeal; people usually feel back to normal in 1-2 weeks. ref SDS H0
351156 - YA6V
351158 - ..
351159 - On 200505 2152 letter thanks Doctor Pellegrini for
351160 - reporting cardiac ablation causes loss of blood and it is
351161 - an ordeal, Explain plans for hiking which should increase
351162 - production of new blood to replace blood lost during
351163 - ablation procedure. ref SDS H1 9C9M
351165 - ..
351166 - On 200506 1008 letter to Doctor Simpson on prognosis for good recovery
351167 - from cardiac ablation, and ask how his recovery is going from hip
351168 - surgery last year. Doctor Simpson's prescription for gabapentin has
351169 - worked well. ref SDS H2 9C9M PRP has worked well, when Doctor Tucker
351170 - increased concentation 300%. Need another PRP for left knee in August
351171 - before Half Dome in September. ref SDS H2 0K62 Have appreciated
351172 - working with Doctor Simpson; expect to see him at end of October.
351173 - ref SDS H2 0K65
351175 - ..
351176 - On 200507 0956 letter to Doctor Simpson asks about article on exercise
351177 - reversing aging effect on stem cells. ref SDS H3 9C9M Asks if this is
351178 - studied in Cardiology Research Department at VAMCSF. ref SDS H3 8W78
351180 - ..
351181 - On 200507 0956 at 1158 letter from Doctor Simpson says of course
351182 - exercise effect on reversing aging is being studied in the Cardiology
351183 - Research Department he runs at VAMCSF. ref SDS H3 L34J
351185 - ..
351186 - On 200508 0916 letter notifies Doctor Pellegrini HR spiked above 140,
351187 - and stayed there overnight. ref SDS H4 9C9M Reviewed 10 issues that
351188 - occur with cardiac ablation, e.g., resting HR rises 10, but usually
351189 - resolves. ref SDS H4 PC85 In morning, HR dropped back to 50,
351190 - ref SDS H4 PC9J, so plan to go hiking, which maintains steady HR and
351191 - has dropped weight from 190 to 179. ref SDS H4 PC42 AF ablation is a
351192 - big procedure requiring 50 - 75 burns to atrial chamber of the heart.
351193 - Ask how many burns were used in this ablation on 200430? ref SDS H4
351194 - PC50 Many patients remain on AF drugs (e.g., metoprolol) for 1 - 2
351195 - months after ablation. ref SDS H4 N48L
351197 - ..
351198 - On 200508 0916 at 1713 sent letter to Doctor Pellegrini saying HR
351199 - spiked to 160 after hiking for less than 1 mile. Didn't feel well -
351200 - weak, disoriented with temperature above 90 degrees. Device would not
351201 - record BP, so layed down for 60 minutes; then got BP 96 65.
351202 - ref SDS H4 A44H
351204 - ..
351205 - On 200508 2318 received letter from Doctor Pellegrini advises HR
351206 - continually elevated above 140 all night may indicate atrial flutter,
351207 - another form of arrhythmia related to atrial fibrillation; and, it is
351208 - curable. ref SDS H5 9C9M The doctor wants ECG during periods of atrial
351209 - flutter. She mentions Kardiamobile ECG cellphone system. ref SDS H5
351210 - DT90
351212 - ..
351213 - On 200508 2312 letter notifies Doctor Pellegrini HR elevated 160
351214 - again, and with low BP. ref SDS H6 9C9M
351216 - ..
351217 - On 200508 2312 at 2331 letter notifies Doctor Pellegrini HR elevated
351218 - 160 after taking metoprolol, ref SDS H6 WW5X; considers being admitted
351219 - to hospital for performing ECG test during period of atrial flutter,
351220 - similar to when ECG tests were performed in hospital during periods of
351221 - atrial fibrillation. ref SDS H6 WW61
351223 - ..
351224 - On 200508 2352 purchased Kardiamobile ECG system $128, to get timely
351225 - heart data when HR elevates. ref SDS H7 F95I
351227 - ..
351228 - On 200509 0937 letter from Doctor Pellegrini advises coming to
351229 - hospital good idea because HR elevated 160s and BP is low. ref SDS H8
351230 - 9C9M
351232 - ..
351233 - On 200509 0953 letter notifies Doctor Pellegrini of elevated HR and
351234 - low BP, submit Polar HR report overnight. ref SDS H9 9C9M
351236 - ..
351237 - On 200509 0953 at 1447 letter notifies Doctor Pellegrini HR and BP at
351238 - criteria that require care in ER. ref SDS H9 YV8F At 1515 leaving for
351239 - hospital; objectives raise BP and lower ER, and perform ECG test, when
351240 - patient in atrial flutter to confirm diagnosis. ref SDS H9 6W46
351242 - ..
351243 - On 200509 1517 drove to VA Medical Center in San Francisco, admitted
351244 - to ER. ECG did not show AF, but HR elevated. ref SDS H0 9C9M However,
351245 - EKG heart monitor shows atrial flutter. ref SDS H0 VC4O Given
351246 - Adenosine for treatment of SVT - supraventricular tachycardia, where
351247 - HR elevated and BP low. This was momentarily difficult to tolerate.
351248 - ref SDS H0 T440 Doctor Pellegrini notified ER to admit patient for
351249 - another ablation on Monday, 200511, to treat atrial flutter.
351250 - ref SDS H0 NE3H Had another coronavirus (COVID-19) nasal test; very
351251 - difficult to tolerate. ref SDS H0 UL3L Transferred to Med-Surg
351252 - Telemetry. ref SDS H0 PG5M
351254 - ..
351255 - On 200510 0613 Woke in VA hospital Med surg, vitals okay, went for
351256 - walk. ref SDS I1 9C9M Adenosine was not given in ER for therapy, but
351257 - for diagnostics to aid Doctor Pellegrini decide on performing cardiac
351258 - ablation on 200510. ref SDS I1 OV3F Researched swab test for
351259 - coronavirus. ref SDS I1 FQ30 Prescription for metoprolol changed to
351260 - every 8 hours. ref SDS I1 06H4 Doctor Durstenfeld advised scheduled
351261 - for ablation tomorrow. ref SDS I1 7O6G ARDS (shortness of breath)
351262 - occurred bending down to tie shoes. ref SDS I1 P45E
351264 - ..
351265 - On 200510 2012 letter to Doctor Pellegrini saying thanks for
351266 - coordinating with ER on admission for atrial flutter, and getting
351267 - ablation on 200511, to resolve ahrythmia. ref SDS I2 6F5W
351269 - ..
351270 - On 200510 2012 letter to Doctor Pellegrini confirming planning to
351271 - perform cardiac ablation next day on 200511. HR profile seems little
351272 - shakier in evening that earlier in the day, while taking metoprolol.
351273 - ref SDS I2 9C9M Thank Doctor Pellegrini for coordinating work in ER;
351274 - face still feels fuzzy, so glad proceeding with ablation. ref SDS I2
351275 - 6F5W
351277 - ..
351278 - On 200511 0546 prepare for ablation right atrial to recover atrial
351279 - flutter, vitals good, took metorpolol, but no more meds until after
351280 - procedure. ref SDS I3 9C9M Blood draw includes lipids for HDL, then
351281 - went for walk around the ward, 5 laps. ref SDS I3 DN9H
351283 - ..
351284 - On 200511 0546 at 0844 Doctor Pellegrini visits - patient out of
351285 - atrial flutter, not sure ablation in right atrial today, will
351286 - completely resolve all AF issues. ref SDS I3 RY5F Another catheter
351287 - ablation may be needed in left atrial in about 2 months. Procedure
351288 - today in right atrial will be less significant (fewer burns) than the
351289 - left atrial 10 days ago, so patient will have less post-procedure
351290 - discomfort. Doctor Pellegrini pre-approved fentyl for pain relief
351291 - after the procedure, and patient can stay in hospital an extra day to
351292 - avoid difficulties driving home after the procedure. ref SDS I3 H36F
351293 - Signed consent for catheter ablation in right atrial today.
351294 - ref SDS I3 P98I
351296 - ..
351297 - On 200511 0546 at 1342 pushed from Med-Surg Telemetry to ASU on gurney
351298 - for cardiac catheter ablation right atrial. ref SDS I3 244I An "atrial
351299 - line" was set on left wrist, after debate about whether this step was
351300 - needed. ref SDS I3 9689 Discussion on choice for anesthesia drug,
351301 - given short duration of procedure (less than 4 hours); there was
351302 - awareness to avoid versed > 5 mg. ref SDS I3 HS6H
351304 - ..
351305 - On 200511 0546 at 1413 pushed from ASU on 3rd floor to Cath Lab on 2nd
351306 - floor, where procedure is performed. ref SDS I3 0P3N
351308 - ..
351309 - On 200511 0546 at 1857 woke in recovery room, and taken back to
351310 - hospital room in Surg-Med. ref SDS I3 B26O
351312 - ..
351313 - On 200511 2233 letter notifies Doctor Pellegrini that cardiac catheter
351314 - ablation procedure in right atrial today, was much easier to tolerate
351315 - that prior ablation procedure on left atrial on 200430. ref SDS I4
351316 - 9C9M
351318 - ..
351319 - On 200826 0930 meeting Doctor Pellegrini review improvements in
351320 - cardiac function after recent ablations in May, similar to significant
351321 - improvements after CABG x4 in October 2009. ref SDS I5 7S6M Reported
351322 - recent increased hiking after recovering from ablation procedures.
351323 - ref SDS I5 QM3U Doctor ordered another Zio heart rate test for
351324 - paroxysmal atrial fibrillation. ref SDS I5 363K HDL 53 well below
351325 - health target of HDl 60, reported in lab today; the doctor explained
351326 - her patient practice does not focus on HDL; she treats patients to
351327 - achieve LDL results with statin drugs. ref SDS I5 Y145 Propose
351328 - increasing statins, if HDL does not rise above 60 in next 3 months.
351329 - ref SDS I5 8D6O
351331 - ..
351332 - On 201007 2004 letter to Doctor Pellegrini reports atrial flutter HR
351333 - 160 constant from mile 11 to mile 17, and continued after ending hike.
351334 - ref SDS I7 9C9M Submitted Kardia EKGs showing irregular HR for atrial
351335 - flutter. ref SDS I7 FP42 Cited doctor's letter on 200509 to go to
351336 - hospital with low BP and constant elevated HR. ref SDS I7 FP7L Drove
351337 - to VA Medical Center in San Francisco and went to Emergency Room (ER).
351338 - ref SDS I7 FP7Y
351340 - ..
351341 - On 201007 2004 at 2153 received letter from Doctor Pellegrini saying
351342 - she received letter at 2004, and concurs diagnostic data may indicate
351343 - atrial flutter. ref SDS I7 IY5N Says to head on in to ER, and she will
351344 - notify the department with instructions on admitting patient. She
351345 - will meet with patient in morning to discuss schedule for cardiac
351346 - ablation. ref SDS I7 Q137
351348 - ..
351349 - On 201007 2018 drove to VAMCSF, ref SDS 0 9C9M; Ben provided triage
351350 - and found HR above 150. ref SDS 0 9C9M Multiple EKGs were performed
351351 - and showed atrial flutter with HR 150. ref SDS 0 NH6G Doctor Farzan
351352 - called Doctor Pellegrini. Metoprolol was injection through IV to
351353 - lower heart rate to a safe level in the 70s. ref SDS 0 RE55 Doctor
351354 - Farzan related calling Doctor Pellegrini and gathering she wants to
351355 - experiment managing atrial flutter with metoprolol pills, so agreed to
351356 - discharge. ref SDS 0 FP9J
351357 -
351358 -
351360 - ..
3514 -
3515 -
3516 - Progress
3517 -
351701 - Drove to ER at VA Medical Center in San Francisco, recommended by
351702 - Doctor Pellegrini in a letter received on 201007 2004. ref SDS I7 Q137
351703 -
351705 - ..
3518 -
3519 -
3520 - 2301
3521 -
352101 - Asked screening attendants, if Kathy can come into the hospital
352102 - rather than wait in the car, while getting treatment in the ER. They
352103 - agreed.
352105 - ..
3522 -
3523 -
3524 - 2330
3525 -
352501 - Called Kathy to let her know she can come into the hospital.
352503 - ..
352504 - Ben provided triage services; he found HR elevated above 150. He was
352505 - aware of letter from Doctor Pellegrini on scope of care required in
352506 - this case to evaluate for atrial flutter, cited in the doctor's letter
352507 - a few hours ago on 201007 2004 at 2153. ref SDS I7 Q137
352509 - ..
352510 - Received care in a cubical with IV in right arm. Multiple EKG sensors
352511 - were positioned around the chest and legs, see picture...
352518 - ..
352519 - David set the IV for blood draw and to inject medicine. Recommended
352520 - trying either of the large veins at inner elbow for IV entry point.
352521 - David tried another location further down about halfway between inner
352522 - elbow and inner wrist. There was difficulty with 1st stick. This
352523 - hurt quite a bit, pain level 9, and had low blood flow. He removed
352524 - the needle, and tried the large vein at right side of inner elbow.
352525 - This didn't hurt and provided good blood flow.
352527 - ..
352528 - Drew blood for lab.
352530 - ..
352531 - Ben ran EKG equipment and reported initial study shows patient in
352532 - atrial flutter with HR above 150.
352534 - ..
352535 - Visited with Doctor Neda Farzan. She was very good to work with. The
352536 - doctor had received instructions from Doctor Pellegrini, saying they
352537 - spoke on the telephone.
352539 - ..
352540 - Doctor Farzan commented the patient appears unusally healthy for age
352541 - 75.
352543 - ..
352544 - Further EKG tests were performed, showing atrial flutter.
352546 - ..
352547 - Doctor Farzan instruced injection of metorpolol to lower HR.
352549 - ..
352550 - Explained metoprolol was paused on 200830, due to adverse side effects
352551 - that reduced sexual function and lowered HDL. On 200903, letter
352552 - notified Doctor Pellegrini that metoprolol was paused, and HDL 53
352553 - increased to HDL 63. ref SDS I6 0S4K
352555 - ..
352556 - Doctor Farzan Farzan explained providing metoprolol in the ER this
352557 - evening is a patient safety measure to prevent continually elevated
352558 - heart rate seen from EKG studies.
352560 - ..
352561 - Ben prepared metoprolol injection syringe. David injected the
352562 - metoprolol.
352564 - ..
352565 - Ben advised this immediately lowered HR from 150+ into 70s.
352567 - ..
352568 - There were multiple calls with Kathy. She was in the ER waiting room.
352569 - David advised the ER does not support visitors in ER due to risk of
352570 - spreading coronavirus.
352571 -
352573 - ..
3526 -
3527 -
3528 - 0041
3529 -
352901 - While talking to Kathy with the cellphone, Doctor Farzan came into the
352902 - cubical and explained having reported results of EKGs, that providing
352903 - metoprolol lowered HR into 70s, and heart returned to regular sinus
352904 - rhythm. Let kathy listen to discussion.
352906 - ..
352907 - Doctor Farzan related having gathered from talking with Doctor
352908 - Pellegrini that she wants the patient discharged to experiment
352909 - resuming metoprolol pills at home that may lower HR into 70s, and
352910 - prevent further episodes of atrial flutter.
352912 - ..
352913 - Not clear why, when episodes of atrial flutter were diagnosed by
352914 - Doctor Pellegrini on 200508, ref SDS H5 9C9M, despite taking
352915 - metoprolol, shown in case study on 200101 0702, ref SDS C9 116N,
352916 - cardiac ablation was planned 2 days later, reported on 200510 2012.
352917 - ref SDS I2 9C9M
352918 -
352919 - [On 201008 1021 letter to Doctor Pellegrini confirms
352920 - understandings getting care for atrial flutter in the ER at
352921 - VAMCSF. ref SDS I8 YM61
352923 - ..
352924 - Doctor Farzan was very helpful, saying she can admit the patient into
352925 - the hospital this evening, so Doctor Pellegrini can discuss the work
352926 - plan with the patient in the morning, as set out in Doctor
352927 - Pellegrini's letter earlier this evening, reported in another record
352928 - on 201007 2004. ref SDS I7 Q137
352930 - ..
352931 - Explained conflict trying metoprolol that causes adverse side effects
352932 - that reduce sexual function and lower HDL. Elevated HDL > 60 in this
352933 - case resolved heart disease, shown by catheter IVUS angiogram,
352934 - performed by Doctor Tietjens, who found blood vessels completely clear
352935 - and stenosis 0%, 11 years after CABG x4, reported on 200124 0705.
352936 - ref SDS F2 ME8G
352938 - ..
352939 - There was consideration to be admitted, so HR can be monitored
352940 - overnight for recurrence of atrial flutter. Since atrial flutter
352941 - occurred during hiking, decided to be discharged, rather than cause
352942 - further expense and disruption of hospital operations that occur with
352943 - admission. Will try metoprolol before hiking in the next few days,
352944 - and report results to Doctor Pellegrini.
352945 -
352946 - [On 201008 1021 letter to Doctor Pellegrini confirms
352947 - understandings getting care for atrial flutter in the ER at
352948 - VAMCSF. ref SDS I8 YM61
352949 -
352950 -
352951 -
352953 - ..
3530 -
3531 -
3532 - 0057
3533 -
353301 - Discharge Instructions progress notes saying...
353302 -
353303 - Medical Record...... Progress Notes
353304 - NOTE DATED:..10/08/2020 00:45
353305 - LOCAL TITLE: EMERGENCY DEPARTMENT DISCHARGE INSTRUCTIONS (MED)
353306 - STANDARD TITLE: EMERGENCY DEPT DISCHARGE NOTE
353307 - VISIT: 10/07/2020 23:24 ER - 24 HOUR
353310 - ..
353311 - Attention: Dr Nada Farzan
353313 - ..
353314 - FINAL DIAGNOSIS: atrial flutter
353316 - ..
353317 - SPECIFIC INSTRUCTIONS: It was a pleasure to meet you! You
353318 - were seen in the ER for atrial flutter. You received one dose
353319 - of IV metoprolol (5mg) and your heart rate is now in the 70s
353320 - and in sinus rhythm.
353322 - ..
353323 - Please follow up with Dr Pellegrini to discuss the plan for
353324 - further management of your atrial flutter.
353326 - ..
353327 - Call your doctor if ther is any worsening in the quality or
353328 - increase in the quality [...likely "quantity"...] of our
353329 - symptoms. If you do not have a doctor, call the *24-hour
353330 - TeleCare Nures Advice Line* at 1-800-733-0502 or call 911.
353331 -
353332 - ******************************
353334 - ..
353335 - Reasons to seek further consultatoni:
353336 - fast heart rate, chest pain, difficulty breathing, passing out
353337 - or other concerns
353339 - ..
353340 - I M P O R T A N T N O T E !!! The treatment you received in
353341 - the Emergency Department is an emergency first-step only! You
353342 - are STRONGLY advised to seek follow-up treatment offered by a
353343 - medical provider (MED, NP). Such care may be important for
353344 - your health safety.
353346 - ..
353347 - To make an appointment, please call your primary care provider,
353348 - Monday through Friday from 8am to 4pm or call the *24-Hour
353349 - TeleCare Nurse Advice Line* at 1-800-733-0502. You are urged
353350 - to follow the instructions given on this Emergency Department
353351 - Discharge Instgructions sheet.
353353 - ..
353354 - FUTER APPOINTMENTS
353355 -
353356 - 10/26/20 0830 EYE-H. TECH (VF) MD
353357 - 10/26/20 0900 EYE-OPTOM (FOLLOW/UP)
353358 -
353359 - ** THIS NOTE CONTINUED ON NEXT PAGE **
353361 - ..
353362 - Did not get next page of ER progress notes
353363 -
353367 -
353368 -
353370 - ..
3534 -
3535 -
3536 - 0109
3537 -
353701 - Left hospital and drove back to Concord.
353702 -
353704 - ..
3538 -
3539 -
3540 - 0215
3541 -
354101 - Arrived home. Polar HR monitor shows heart rate 73.
354102 -
354103 -
354104 -
354105 -
354106 -
354107 -
354108 -
354109 -
354110 -
354111 -
354112 -
354113 -
3542 -