OCT 17, 2017
: PSYCHOLOGY Comment
AUTHOR: RODRIGUEZ,STEPHANIE PHD Clinical Psychrist

Identifying information: This is a 69 year old, Partnered, Viet Nam, NSC, transgender woman.The session lasted: 60
Problem: Social isolation, “lack of joy,” “soul sickness”

Discussed with Veteran how she has been the part of supportive networks throughout her life
(Cub Scouts and military) which worked well and efficiently.
She expects the same level ofefficiency (which in itself is not an unreasonable request) with her healthcare,
which appears to have led to frequent and high levels of distress in interacting with her care team.
This works as a barrier to her care interfere
because the high emotion maywith her ability to efficiently communicate, has lasting somatic symptoms,
Patient Comment; by Vet:
Please see below
lasting somatic symptoms and impacts her comfort level with different VA facilities.
She is aware of how in the past efficiency and effectiveness was tied to life or death
situations (e.g., military, health issues). It is possible a pattern is emerging
in which Veteran continuously seeks contact with the VA in hopes for an improved
experience, and disappointments build up on each other, and in turn are response
to with the emotional intensity associated with a life and death situation,
which impacts her effectiveness. Encouraged Veteran to start noticing her wise
mind to move towards a middle path in regards to how to proceed with her health
plan.

MENTAL STATUS EXAM:
APPEARANCE: dressed in milieu appropriate clothing
SPEECH: normal rate/rhythm, talkative
LANGUAGE: intact
ORIENTATION: Alert and Oriented x 4
MOOD/AFFECT: labile
THOUGHT CONTENT: WNL [within normal limits].
THOUGHT PROCESS: normal, coherent, linear, logical, goal-directed
PERCEPTION: No issues observed
MEMORY: Not formally assessed, intact
INSIGHT: awareness of struggles and a desire to make changes
JUDGEMENT: no issues observed in session
SAFETY: Chronic SI.

12/08/2017 Date Inactivated:
(by RODRIGUEZ,STEPHANIE R PHD)
INACTIVATED GOAL: “Find peace, come home.”
Comments:
Inactivated by inactivating problem. “Soul sickness”
lasting somatic symptoms
I have the Agent Orange induced CLL.
Adrenal fatigue for me manifest 1st as a

SPIKING Spleen PAIN
that then takes over my gut
a need to vomit that never comes
Spiking BP
Panic Attacks
Explosive cowpie/like BM, that necessitates
another bathroom cleaning.
5 ER visits from May of 2019 to Jan ’21 at which time i was experiencing
White Blood Count Spikes; the highest yet.
Panic Attacks that i learned to control w Tactical Breathing.

$ $ $ $
Problem: Cough (ICD-9-CM 786.2)
Date/Time Entered: 30 Dec 2009 @ 1200
Location: Portland OR VAMC
Status: ACTIVE
Provider: HARPER,CYNTHIA
Comments: pulm visit Dec-2009
Patient Comment; by Patient Vet:
Hello dear reader, and welcome to our world:
Cold war & Vietnam Vet here = You’re welcome & War Crimes,
just like Putin’s Combatants & predictable resulting Moral Injury/Adrenal Fatigue; Asbestos, COPD, Agent Orange Leukemia, PTSD, MAI Lung Infection; and: Sexually Assaulted by opportunistic Urology Providers, to be covered-up by Advocates, Mental Health Therapist, Veteran Experience Officer…

2005 This Vet started being unable to ignore the Lung Vomit.
2009 Dec,VA Pulmology said it was Asthma, maybe GERD. Drs wanted to install a “Flutter Valve”. “…Googeled Home Remedies for persistent productive cough…”
2011 regularly coughing myself down into an exhausted heap.
2016 Occupy Street Medical Diagnosed the COPD & referred me to White Bird Clinic; who Diagnosed the Leukemia as well.
2016 VA FINALLY!; Confirmed the Asbestos and MAI Lung Infection.
2016 July; Coughing out Ribs; VA “has no treatment for this” said PCP.
2016 White Bird Clinic Nurse text, “GET TO URGENT CARE NOW”
2016 To the UC Provider i said, “i left you a lung vomit sample in your
garbage can”.
He looked. He gasped! “Never seen anything like that” he said.
“Heavy Hammer for you”.
After 11 years of deliberate VA dereliction… 3 pills into the 7 pill series that Lung Vomit was gone. GONE!;
Gone was the debilitating cough and the Lung Vomit which has never!!!!; re-occured; except in the clinically useless VA fantastica Medical Record
= stress & time-consuming while re-provoking persistent Adrenal Fatigue, urge to vomit that never comes, Spleen Pain, Blood Pressure & White Blood Count Spikes [as discovered by nonVA ER.]
Attorney said,
18 months after presenting w Asbestos Post-Latency complex, my SS Demographic is 82% dead. For this vet that was Oct 2009.
Oregon Senior Services sez, often, families become destitute & the Caretaker Spouse succumbs to the stress before the Vet.

Herein is the backstory of the Veteran’s vital health care front line;
the as yet unrecognized, un-suppoted and vigorously ignored Demographic,
❤ The Caretaker Spouse <
Please consider;
would you rather Suffer all the above
[Death by asbestos for my Demographic is a slooooo suffocation
as the fibers migrate from the lungs to form a concrete-like shell.
The pain is said to be 2nd only to Bone Cancer]
Would you rather go thru this yourself; or witness
and support a loved one succumb ever so slowly??.

04/01/2010
BART C MOULTON
PULMONARY & CCM FELLOW
She is very fixated on previous exposure to asbestos >SNIP<
– Cont to recommend albuterol however understand that
pt does not want to take this
– consider flutter valve in the future
This patient was discussed with Dr. Chesnutt who agrees with the plan as outlined above.
$ $ $ $ $ $ $ $ $ $
07 Feb 2013
PC – RESULTS LETTER Portland OR VAMC
Comments:
your labs show psa, prostate test, no change from prior year (it had been
above normal in past but is within normal range and same as before now)
$ $ $ $
13 May 2013 Portland OR VAMC
Medical Record Comment

SNIP< HPI: 64 patient (biologically male but identifies as female) >SNIP<
“No issues with incontinence”.
No GI problems.
$ $ $ $

21 May 2015 @ 0536
Comment Title: NURSE – TELEHEALTH AFTER HOURS
Location: Portland OR VAMCRESULTS
System Concern: Excessive or Persistent Depression

SNIP<
NURSE COMMENTS
SNIP<
“Veteran wanted to debate
about not being treated for his not sleeping at night
which he states has been going on for four years.
He does not wish to address his urinary frequency.
Veteran was made aware he needs to decide what he wants to do able his care.
The conversation was ended.”

10/23/2015
RN BSN Length: 7 minutes.
Chief Complaint: Not applicable to call.
Comments:
Veteran requesting pcp please contact mental health to discuss care a
coordination continuity of care.
Veteran feels care is fragmented.
Veteran canceled upcoming pcp appt. for 10/29/15 d/t wanting to
see mental health prior to pcp appt.
(requesting appt. with Mental Health).

Veteran wanting clinic to know frequent urination is getting under control
with the herbal medication.

* Veteran requesting clinic Nurse to please call.
Identified problem: COUNSELING, UNSPECIFIED.
$ $ $ $

12 Nov 2015 Portland OR VAMC
       UROLOGY - CONSULT REQUESTED             

By: SAITZ,THEODORE ROBERT MD Urology Resident OHSU Urology

The attending of record for this patient care encounter is Dr Skeeters
HPI:
“67 yo non-op male to female TG refered for LUTS, primarily nocturia. >SNIP<
No UUI. No dysuria/ gross hematuria. good stream. no UTI, AUR, bladder stone. …
Assessment/Recommendations:
67 yo preop TG male to female with mixed LUTS. Emptying well. Discussed behavioral modifications, medications. discussed possible micro hematuria and eval with cysto.

• Will try alfuzosin and then if no imptovement will add oxybutynin
• UA/micro/cx, will need cysto if micro hematuria
• RTC 3 mos with PVR
• DRE and PSA with PCP

$ $ $ $
NOV 13, 2015
PHARMACY OUTPATIENT COUNSELING Comment
Per PSU representative:
Place RX on
OXYBUTYNIN CHLORIDE TAB 5MG
ALFUZOSIN TAB,SA 10MG

Vet is requesting that they above medication be placed on hold till he
requests otherwise.
Pharmacist action: Placed on hold

$ $ $ $
11/13/2015
TELEPHONE ENCOUNTER Comment
Chief Complaint: Not applicable to call
AUTHOR: STAC Comments:
Vet is requesting a call back from NCM. Vet states
“I was prescribed two new medications and I am very worried about them so I don’t want to take them”
Comment; by Patient Vet
AUTHOR: STAC Comments: need correcting.
“I was prescribed two new medications>SNIP< is true.
I was prescribed 2 more as well.
All of them prescribed for Urology Problems that
i do not and never have endured.
=i do not need the drugs and will not take them.
What i need is less VA Induced
Stress,ANXIETY, Depression, Delay, Denial, Disgust, Death
Chief Complaint: “Not applicable to call”
= Catch 22 Derelict VA Deferral to ❤ Caretaker Spouse <3”
because VA vigorously ignores any problem
that involves ANY VA error or culpability;
such as,
this Patient Vet’s Chief Complaint: is
“about not being treated
for his not sleeping at night;
which he states has been going on for four years”,

demonstrating in this Caretaker Spouse and
Patient Vet’s belief, exactly why
the attorney said>>>18 months after presenting w >>>> Asbestos Post-Latency complex, my SS480 Demographic is 82% dead.
By 2005 i was beginning to notice
i was regularly coughing up wads
of “Like glue” said the Salem Urgent
Care Provider; finally, in July of 2016;
when i was coughing out ribs.
MEANWHILE; back at VA Urology @ PDX:

NOV 19, 2015
TELEPHONE ENCOUNTER Comment
Comments:
The veteran’s first words: “Super-stressed.”
He is feeling stressed and requesting a call back to discuss further coordination of care.

11/24/2015 ADDENDUM
THEODORE ROBERT SAITZ MD UROLOGY RESIDENT
Will plan complete CTU and cystoscopy to complete hematuria workup
infromed pt, orders placed
$ $ $ $ $
NOV 25, 2015@15:41
MHD – INDIVIDUAL Comment
MENTAL HEALTH OUTPATIENT Comment
AUTHOR: PRINE,JANYCE ANNE

*** MHD – INDIVIDUAL Comment Has ADDENDA ***

Primary Diagnosis for this visit
Unspecified Problem Related to Medical Facilities and other Health Care
Procedure performed: Psychotherapy Only
Length of time with patient during this visit in minutes: 60

SNIP<
Ms. continues to process pain from the care she has received at the VA.
This is caused increased emotional and financial distress.
She acknowledges some comfort as she participates in alternative care she is able to
receive through referrals from friends and community providers.

$ $ $ $ $

11/25/2015 09:19 NIKKI A BREITBARTH
Urology Nurse – Operative Care
ADDENDUM
Called and spoke to patient. Explained microhematuria work up.
Patient will stop by radiology today to schedule CTU while here for another appt.
Will schedule cystoscopy once date of CTU is known.

: 11/25/2015 13:00
THEODORE ROBERT SAITZ MD UROLOGY RESIDENT

11/27/2015 ADDENDUM

11/27/2015 07:2
THEODORE ROBERT SAITZ MD
UROLOGY RESIDENT
CTU:

1. Prostatomegaly and chronic bladder outflow dysfunction.
   No direct evidence of urothelial malignancy, although the distal ureters are not well visualized.
   Cystoscopy and retrograde ureteroscopy may be helpful.

Will plan for cystoscopy for completion of workup

12/01/2015
NIKKI A BREITBARTH Urology Nurse – Operative Care
Called and spoke to patient.
Patient does not wish to schedule at this time.
Has asked to be called after the first of the year and will reconsider.
Will cancel cysto order and flag to call in January.

Receipt Acknowledged By:
12/01/2015 15:08 THEODORE ROBERT SAITZ MD
UROLOGY RESIDENT

12/21/2015 ADDENDUM
Veteran called in and scheduled 12/23/2015 07:30 CYSTOSCOPY-AREA E appt.
He states that Nurse Breitbarth had contacted him about this procedure and he
requests to let her know that he did decide to go ahead with it.
$ $ $ $ $ $

23 Dec 2015 @ 0754AM

Comment Title: INFORMED CONSENT
Location: Portland OR VAMC

By: AHMADI,HAMED
Signature Informed Consent for
BLADDER – CYSTOSCOPY DIAGNOSTIC
(POSSIBLE INTERVENTIONS)

1. Anatomical Location: lbadder and urethra
2. Informed consent was obtained
   Patient Comment; by Patient Vet:
   As per this Vet’s memory;
   i had been naked lying alone, in a too cold room .
   A female Provider entered in a wholl lotta hurry.
   A www search of AHMADI,HAMED,
   indicates this is a man;
   and not who, that very afternoon when i REPORTED
   this incident to MSW Captain Janyce Pryne; i identified as,
   ‘the Smelly Crotch Provider, wearing Excessive make-up;
   and under her white Provider smock, the sexy bright red garment”.
   Captain Prone lied when she identified thiat single Provider as,
   “the nurses who were attending the procedure”.

{please see below23 Dec 2015 @ 1725}
{please also see below at the end of this
so-called INfORMED CONSENT

4. The patient HAS decision-making capacity.
   ?????REALLY ????
5. Surrogate (if applicable):
6. Reason for the treatment (diagnosis, condition, or indication): To
   examine the urethra and bladder for disease or abnormality.
   Treatment(s) may be performed depending on findings.
7. Treatment/procedure: Your doctor will look at your bladder and
   urethra with a scope. A scope is a thin, lighted tube. It is used
   to see inside the urethra and bladder. The scope is passed through
   the urethra into the bladder. In males, it passes through the
   prostate. Your doctor may also do other procedures, including:
   Bladder biopsy: a small amount of tissue is taken for examination.
   Cytology: the bladder is flushed with a salt-water solution. The
   fluid is collected and examined.
   Dilation: narrow parts of your urethra may be stretched.
8. Neither anesthesia nor moderate sedation will be used.
9. Consent to Blood Products (if applicable):
   It is not expected that blood products will be used in this
   treatment/procedure.
10. Practitioner obtaining consent: Ahmadi,Hamed (RESIDENT)
11. Supervising practitioner: Tessier,Christopher D (PHYSICIAN)
12. Practitioner(s) performing or supervising treatment/procedure (if
    not listed above):
13. Witness Name(s):
14. Supervising practitioner:
    Tessier,Christopher D (PHYSICIAN)
15. Practitioner(s) performing or supervising
    treatment/procedure (if not listed above):
16. Witness Name(s):
    please Comment; there are none listed in #s
17. Practitioner &
18. Witness

Somewhat stunned was i.
She handed me the Consent Demand.
I believed it to be as i had been told & retold the Procedure would be; and
as this following UROLOGY PROCEDURE Comment reported to be
4 minutes later falsely describes:

DEC 23, 2015@07:58
UROLOGY – DIAGNOSTIC FLEX CYSTO
UROLOGY PROCEDURE Comment
Procedure:
After obtaining informed consent,
Patient Comment;.byVet:
4 minutes ago as per these Records
“the patient was taken to the procedure room,
placed in the supine position,
then prepped and draped in the usual sterile fashion.
Local anesthesia consisting of 10cc of 2%
lidocaine jelly was instilled
into the urethra and allowed to remain
for several minutes before the procedure.”
End Patient Comment; by Patient Vet: and
back to the Record of the “Informed Consent”.
at 7:55 AM on December 23, 2015.

Patient Comment; by Vet:
NIKKI A BREITBARTH
Urology Nurse – Operative Care
is not identified as being present.
2 men are identified.
As i Reported to Captain PryneThere was the
1 smelly crotch provider .
Captain Pryne identified her as ,
““the nurses who were attending the procedure””
and back to the Record

23 Dec 2015 @ 0828
Date/Time: 23 Dec 2015 @ 0758
Comment Title: UROLOGY – DIAGNOSTIC FLEX CYSTO
Location: Portland OR VAMC
Signed By: AHMADI,HAMED
UROLOGY PROCEDURE Comment
FLEXIBLE CYSTOURETHROSCOPY
The attending of record for this patient care encounter is Dr. Tessier .
PROCEDURE Comment
Identification:
67 years old male (gender indetity disorder) goes by “Sarah”) with
longstanding history of LUTS specially nocturia
Comment; by Patient Vet
67 years old [now 75] Transgender MTF with
longstanding history of VA induced
Stress, ANXIETY, Depression, dereliction
Delay, Denial, Despair &
Psycho~Spiritual Death

who has been taking herbal medications for his problem

10/23/2015
Length: 7 minutes.
Chief Complaint: Not applicable to call.
Veteran wanting clinic to know
frequent urination is getting under control
with the herbal medication.

(he reports that he cannot take any of his prescribed medications>SNIP<
Comment; by Patient Vet
Please see above:
13 May 2013
12/01/2015
NOV 19, 2015
11/13/2015
11/13/2015
NOV 13, 2015
10/23/2015

21 May 2015 @ 0536
NURSE – TELEHEALTH AFTER HOURS
Portland OR VAMCRESULTS
System Concern: Excessive or Persistent Depression

SNIP<
NURSE COMMENTS
SNIP<
“Veteran wanted to debate about not being treated
for his not sleeping at night
which he states has been going on for four years.
He does not wish to address his urinary frequency.
Veteran was made aware he needs to decide what he wants to do able his care.
The conversation was ended.”
Oh how i wish i had

End Patient Comment; by Vet: and
back to 0754AM & the Record of thethe so-called

Anterior urethra: normal, no strictures

SNIP< The instrument was then removed from the bladder under vision; the patient was permitted to void; and he was discharged home in satisfactory condition.
Impression:
67 years old transgender with LUTS due to BPH as evident by cystoscopy.
Plan:
Continue alpha blocker and Oxybutynin
She will follow up with 2 months in clinic for evaluation
SNIP<
The Attending for this patient care encounter is Dr. Tessier
by HAMED AHMADI MD
Resident Physician
: 12/23/2015 08:28
Patient Comment; byVet:
Please see below; 9 hours later@ 1725
V $ V $ V $ V
23 Dec 2015 @ 1725
Comment Title: MHD – INDIVIDUAL Comment
Location: Portland OR VAMC
By: PRINE,JANYCE ANNE
Primary Diagnosis for this visit
Medical Care complications
A: 66 yo, transgender male to female, white, Navy; NSC; Vietnam Era, clean,
appropriately dressed, and groomed. Speech clear, articulate and coherent,
mood: distressed affect full range, TP&C normal, focused; Denies SI/HI;
appears oriented x5; concentration: WNL; Memory good; Fund of Knowledge:
average; Intelligence average based on vocabulary and fund of knowledge;
Judgment and Insight: fair
Procedure performed: Psychotherapy Only

Length of time with patient during this visit in minutes: 60

<SNIP by Veteran
she went what appeared to be in a euthymic mood to a bitter/distressed mood.
When asked what happened she reported “I realized they lied to me”.
As she elaborated on this statement she reflected on the comments from
the nurses who were attending the procedure,

the terminology they used to comfort her,
and in doing so they lied about it not hurting etc.
Ms. Veteran Patient then related to other times she has been lied to at the hospital as well and shared how wrong that is.

<SNIP by Veteran

Receipt Acknowledged By:
12/30/2015 14:55 NIKKI A BREITBARTH
Urology Nurse – Operative Care
$ $ $ $
——Original Message————————
Sent: 02/29/2016 10:04 AM
From: PHARIS, CARLA LPN
To: Veteran
Subject: ????????????? (AECB)<<<<<<<<

Hi Sarah,
Thanks for your email.

1. I’m so glad your sleep is improved, that is great, i will hold off on the
   sleep referral but please let me know anytime you want to or need to proceed.
   (please don’t worry about tax$, the benefit of the sleep clinic and good treatment is cost saving in the long run and you are worth it, deserve it, and
   earned it)
2. Regarding the decrease in night time urination,
   I’m not sure the reason for the improvement,
   it may be the herbs ofcourse but I’m sure you are right that stress/improvement in stress can play a role.
3. Regarding the cough, the question to suppress is a good one, suppressing
   controlling the cough to the extent that it can improve your quality of life
   should be balanced with the need to get moisture out of the lungs, so
   continue what you are doing in that regard.

$ $ $ $

: 03/06/2016 19:05

$ $
MAY 26, 2016
PRIMARY CARE OUTPATIENT Comment
REASON FOR VISIT/CHIEF COMPLAINT:
f/u breathing
INTERVAL HISTORY:
Patient Comment; by Vet:

3. asthma, suspected copd,
   however per pulm in the past she has asthma, we
   discussed ct scan findings and there appears to be asthma with overlying
   infectious process causing cough with sputum which is blurring the diagnosis

SNIP<
ROS: per HPI
no fever, fatigue, myalgia, skin rash, headache, pharyngitis, cervical
adenopathy, arthralgia, night sweats, or diarrhea.
Weight: 141 lb [64.1 kg] (05/26/2016 13:38)
CONSTITUTIONAL: well groomed, NAD, looks stated age, slim, wearing hair in
ponytails and feminine clothing
RESPIRATORY: scattered rhonchi throughout improved from last exam, no w/r/r
Psych: alert and oriented x 3,mood improved from last visit, more calm, pleasant
and cooperative, good interactions with her wife and myself. Recent and remote
memory appears intact.
ASSESSMENT & PLAN:

1. cough-astham and infectious process on CT scan, needs pulm f/u, will work
   with MH on preparing for the visit, discussed need to be concise and have
   realistic expectations about outcome of visit. check sputum sample.

4. transgender-elevated T, defer estrogen treatment at this time, she does not
   have any problems with current secondary gender characteristcs or need to change

them at this time

: 06/08/2016 15:14
CARLA M PHARIS LPN
My weight continues it’s downward trend to now 1 1/2 pound from my all time low
when i was suffering the most in 2011.
Conversely,
Right now there is way more good days than not so good days, , ,and there have
been no really bad days
I’ll be in this afternoon for a weight check if i could please.?
Thank you Ladies
Sarah c:
Veteran walked in for weight check. Weight 143 today

$ $ $ $
08 Jun 2016 @ 1137
SOCIAL WORK SECURE MESSAGING
AUTHOR: PRINE,JANYCE ANNE
——Original Message————————
Sent: 06/07/2016 05:03 PM
From: Patient Veteran
To: Prine J_Social Work_Portland_
Hi Janyce,
Correction,
I continue to struggle with the >>>>Stress<<<<< generated by what appears to me
to be mortally sloppy doctoring in Pulmonology, impeding
truly effective Doctoring by the rest of my care team.

As i trust Pulmonology to continue in their current paradighm [validated yet again yesterday]
I trust the shut down response, that drops me into daytime deep sleep, matched
with the return of Urology problems; and obtw, insomnia is back.
$ $ $ $

Location: Portland OR VAMC
/es/ Leslie E. STRICKLAND MD
WOMEN’S HEALTH PHYSICIAN
Comments:
Your labs show elevation of inflammatory markers crp and esr,
this could be due to lung infection.
You have slight anemia.
Your liver function and electrolytes are normal.
Your urine shows no infection .

SNIP<

JUN 13, 2016@06:25:13
NURSE – TELEHEALTH AFTER HOURS
AUTHOR: SHERYL CURTIS RN/BSN

Facility Appointed PCP: STRICKLAND,LESLIE E
Caller Response: *OTHER

Comments:
Client called this morning stating he placed a letter in the mail on Thursday
06/09/16 and the VA should be receiving the letter today. He is placing the
call as he stated he would like to continue the conversation through My
HEALTHVET. THE STRESS that the VA PULMONOLOGIST appointments has cause him to usually sleep one day before and two day after just to be able to deal with the
appointment.

Receipt Acknowledged By:
06/20/2016 10:08 /es/ MATTHEW CHAMPION
Pulmonary & Critical Care Fellow

JUL 02, 2016@05:25:03
NURSE – TELEHEALTH AFTER HOURS
Caller Response: *OTHER
Chief Complaint: Not applicable to call = Catch 22 Derilect VA Deferal to ❤ Caretaker Spouse <3.
Comments:
Client called and stated he has a new diagnosis of COPD. He was coughing while
on the phone. He is requesting that his PCP order surgical masks for him. He
states that he is having difficulty breathing dust and other particles in the
air this summer. Thank you
Patient Comment; byVet:

13 Jul 2016 @ 0541
Comment Title:POSITIVE RESPONSES

• HPI: chest pain, crushing quality
• HPI: chest pain, duration longer than 10 minutes
• HPI: discomfort, neck or jaw or shoulder or arm

NEGATIVE RESPONSES

• HPI: chest pain, severe
• HPI: syncope
• PMH: angina
• PMH: heart attack

ADDITIONAL INFORMATION
Type of call: Symptom information
Pain level: 10
Veteran Verbalizes Understanding
disagrees with plan: Veteran declined
NURSE – TELEHEALTH AFTER HOURS
Location: Portland OR VAMC
By: JONES,RACHEL R

13 Jul 2016 @ 0615

JUL 13, 2016@05:41:53
NURSE – TELEHEALTH AFTER HOURS
NURSING TELEHEALTH Comment
AUTHOR: JONES,RACHEL R

Facility Appointed PCP: STRICKLAND,LESLIE E
Veteran wanting PCP made aware he has made attempts to contact Mathew Champion
(pulmonary )but has not received a response. Veteran is upset that pulmonary
indicated his cough was recent when it actually started in 1969.
Problem: Cough (ICD-9-CM 786.2)
Date/Time Entered: 30 Dec 2009 @ 1200
Location: Portland OR VAMC
Status: ACTIVE
Provider: HARPER,CYNTHIA
Comments: pulm visit Dec-2009
JUL 21, 2016@06:28:41
NURSE – TELEHEALTH AFTER HOURS
AUTHOR: HOWELL,MONICA L
URGENCY:

Chief Complaint: Chest Pain
RESULTS
System Concern: Heart Attack; Pulmonary Embolism
System Recommendation: Emergency
Nurse Recommendation: Emergency
Recommended Follow-up location: Emergency room, VA
Patient agreement: No

NURSE COMMENTS
Veteran calling stating that he is having cough, back/chest pain and coughing
up “glue like sputum” He states he was at outside UC yesterday July 20’16 where he was
given antibiotics for symptoms.
He states this morning he woke “in cold sweat and temp was 98.7 and 99.1”

Veteran is all over the place when speaking and states “I have a birkenstock
straped to my back to help me breath” He also is stating that he was dx with “2
dislocated ribs” but he states a chest x-ray was never done.
Patient Comment; by Patient Vet:

RN advised Veteran to go to VA ER and he states “I will never set foot in that place again” RN advised Veteran that I will ask the clinic to call for follow
up, he stated thank you and proceeded to end phone call.

Risk education provided. If pt delays or does not seek care, they could have
irreversible damage, loss of function, or potential for death.
07/21/2016 08:31
MD
WOMEN’S HEALTH PHYSICIAN
ADDENDUM
called Veteran
“has dislocated ribs from coughing”
-i explained that we do not have good treatment for this
I told Sara that i could not do much over the phone and i did not know what to
do to help her because she has a lung infection/mucous in her lungs as seen on
CT scan and this needs evaluation by a pulmonologist and cannot be treated in UC
with typical abx for typical duration.
i told them i am leaving the VA and i asked if could put in another consult to
pulmonolgoy
Sarah reiterated she will not see VA pulmonology,
Sarah’s partner confirmed this
and they will be taking care of the issue outside the VA,
they will not go to VA ED

Veteran had an appointment with me that was scheduled for this week that was
cancelled a couple of days ago

$ $ $ $

04/06/2016 21:15

SNIP BY Vet<ASSESSMENT & PLAN:

2. LUTS-prostate exam today,
   refer to pelvic floor rehab for bladder training,
   slightly large prostate on exam,
   discuss medications at f/u

SNIP<
ACTIVE

1. Cough – Still feel that this is possibly cough varient asthma
   however pt is very much against taking albuterol.
   Patient Comment; by Patient Vet:

:

12/06/2010 Molly L Osborne, MD PhD
STAFF Physician, 503-423-5961
Q from Dr. Reuler: Will ask Dr. Osborne to comments on issue of ?asbestosis?

<Snip by Sailor
Comment: there is no specific treatment for asbestosis.
‘googled’ asbestos exposure and home remedies
at Sarah’s request.
Discussed home remedies for intermittent productive cough.
$ $ $ $ $ $ $ $ $
Sisters of the Road Cafe Volunteer Naturopath said,
*”Eat every color of the rainBow every day.
Trix and M&Ms don’t count.

• 100x per day, breath deeeep as possible, , , and 100 more even if i can only think them.
• 1997 OHSU study WHY , HOW do Red and Yellow vegetables protect the Lungs fm . . . .Asbestos. . . .

• Up to this Point, besides being an un-safe and un-reliable outlet from which to purchase Emotional and/or
  Medical Care, most by far of the Tax $ are squandered and no care delivered in this Sailor’s Decade of Care denied.
  $ $ $ $ $ $

Moral Injury
The natural response to an unnatural event

08/23/2017

SNIP< simultaneously experiencing “serious stomach pains that radiate from under left rib cage. Then completely overwhelms my gut and disturbs my breathing and evokes a need to vomit that never comes Much more serious than usual. knocked me down for 2 1/2 daze. Patient Wondering if the problem is VA induced STRESS killing me>SNIP<

Comments:
Pt calling with some issues that he believes are “stress induced”. He state he
is having “stomach pains that radiate left rib cage. Then completely
overwhelms my gut and disturbs my breathing”. >SNIP<

 Sailor Comment  

Oh yes i did notice that the writer of this Comment translated “the problem is VA
induced STRESS killing me”
into “some issues”.
$ $ $ $ $

the other nurse and her medical records.
Patient also made reference of being
suicidal but then she changed the subject. Patient then stated I have to hang
up now, and she ended the call.

This Problem goes back to Attack Sub SS480 On Station 1969 in the Tonkin Gulf.
“. .EXTRAORDINARY RELIABILITY REQUIRED.NOTIFY COMMAND IF?”
= extraordinary reliance on
= “. . . coughing up blood . . .”

$ $ $ $

04/25/2018
TSH was 4.8, 0.6 above normal range.
Will increased levothyroxine to 0.033MG daily and recheck levels in 6 weeks.
04/25/2018 ADDENDUM STATUS: COMPLETED
It seems that increasing to 0.33 would be too rapid an increase for this
veteran
who is very sensative to medications. Will increase to 0.025Mg daily with two
tablets Monday Wednesday and Friday and re-check in 6 weeks.
NURSE PRACTITIONER

——Original Message————————
04/27/2018
From: MATTINGLY, TARYN RN Care Manager
To: Veteran Patient,
Subject: General Inquiry

Ms. Veteran Patient,
Good morning. You were correct, your thyroid levels are elevated.
Sailor Comment: Not important that i am correct. You were wrong and you need to
own it
The provider has increased your dose by adding a day that you take the
levothyroxine twice daily.
Sailor Comment: There are no days that i , take the levothyroxine twice daily.

Please start taking it twice daily on Monday, Wednesday, and Fridays.
Sailor Comment: NO

$ $ $ $

STACY M KENNEDY
RN, BSN
10/24/2018 06:00
Comments:
Patient called in with complaints of abdominal pain. The patient was very
tearful, and she kept talking about her nurse some and lies in her medical
records. RN was unable to triage the patient because she was hyper focused on
Patient Comment; by Patient Vet:

FEB 28, 2020@19:25:46
AUTHOR: NAUDASCHER,PAIGE A
Receipt Acknowledged By:
03/02/2020 08:00 TODD QUIER
Physician
Comments:
Veteran called concerning severe SOB.
Correction Fri 1136 19June22 by Customer Veteran
Customer called concerning the series of Calipoia PACT induced Panic Attacks
that began with a call from Calapoia PACT Nov 14 2018.
The previous night i had awoken into one.
My throat closes off.
i can’t inhale or swallow.
IT”S FRIGHTENING
They seem to be happening when i’m trying to ignore that i’m wasting my breath
and Squandering Tax$.

There’s more, but i can feel that recalling the incident is spiking BP.
End Customer Correction

Triage recommended 911 VA ER.
Veteran refused to call 911.

Correction Fri 1136 19June21 by Customer
Customer advised for the gazillionth time since 2013,
“No one i know would take me. All would dis-allow it.
Both VA ERs are more than an hour away.
I will work this Panic Attack back out as i’ve done soooo many times.
End Customer Correction

States “all they will do is hit me with albuterol, and that shit makes me crazy.”
“I’ve bee miss diagnosed by so many doctors with asthma, COPD, MIA, and panic
attacks.” Further reports, “what I have is asbestos exposure!” <<<WRONG =
“Difficult Historian” enlarge to see

Veteran is smoking cannabis during the phone and takes
frequent breaks to inhale/hold/exhale.
Suggestion Fri 1136 19June22 by Customer
Purrrhaps this is a good time to listen to that “Recording for Educational
Any of my Counselors or Caretaker might think it sounded a lot like they all
advise some version of; Inhale DEEP, Hold for 7 Second sloooow exhale.
End Customer Suggestion

Reiterated to call 911, Veteran continued to refuse.
States “I just want to make sure this Comment gets put into my chart!”
This RN stated this Comment will be placed in his chart and forwarded
to his PCP to view. Veteran ended the call.

Chief Complaint: Shortness Of Breath (wheezing)
Triage Comment
71 y/o Male
Results
CC: Shortness Of Breath (wheezing)
Nurse Recommendation: Now, 911
TEDP Suggestion: Now, 911
Nurse Recommended Follow-up Location: Emergency department, VA
TEDP Suggested Follow-up Location: Emergency department, VA

Values and Measures
Pain scale: 3
Duration of CC: 1 Days
Patient Comment; by Patient Vet:

Positive Responses
HPI: dyspnea, severe
HPI: dyspnea, struggling to breathe
HPI: wheezing, within past hour
PMH: COPD

Negative Responses
Denies: PMH: asthma
Veteran Verbalizes Understanding

Patient/Caller disagrees with plan: Veteran refused to call 911.
Correction Fri 1136 19June22 by Customer
I would love to hear the Recording of this Call.
What methinks i heard on this end, was, as i have soooo often heard;
Drs Rhuler and Lucas and Strictland and MSWs Captain Pryne and Gill and Monett
looks to me like desperate frustration with confinements imposed by the VA
Paradigm.
As i recall, i continued to control my closing up throat and end this call
without biting off somebody’s head.

End Customer Correction
Author: BSN,RN
02/28/2020 19:25

Receipt Acknowledged By:
03/02/2020 08:00 TODD QUIER
Physician
Patient Comment; by Patient Vet:

~~~~~~~~`
04/25/2018 ADDENDUM
SUSAN S STARKE, NP
NURSE PRACTITIONER
6 weeks pro AFTER White Bird Dr. Wendy March 7
How is it that Chad PC does not know this?
Chad Dr PC is Squandering Tax $$$ and . . . .
STATUS: COMPLETED
TSH was 4.8, 0.6 above normal range. Will increased levothyroxine to 0.033MG
daily and recheck levels in 6 weeks.
04/25/2018 ADDENDUM STATUS: COMPLETED
It seems that increasing to 0.33 would be too rapid an increase for this
veteran

who is very sensative to medications. Will increase to 0.025Mg daily with two
tablets Monday Wednesday and Friday and re-check in 6 weeks.

/es/ SUSAN S STARKE, NP
NURSE PRACTITIONER
Signed: 04/25/2018 09:01

$ $ $ $ $ $ $ $ $ $ $

Sent: 03/05/2018
From: Veteran Patient,
To: **CalapooiaRiver Daud_Primary Care_Eug RVAHCS
Subject: What is the Status of

Hello,
Does it make sense to order these Labs as well?
03/06/2016 /es/ Leslie E. STRICKLAND MD
WOMEN’S HEALTH PHYSICIAN
“Your labs show elevation of inflammatory markers crp and esr, this could be
due to lung infection. . . .

<SNIP by Veteran Patient

Reply by Nurse Tarren
I have requested records from White Bird concerning the lab for MAI markers,
per the Comments of your last visit they did not order any labs. If you could
bring me paperwork that states they wanted you to get that lab done
I will be able to enter it.
Hope this finds you in good health.

$ $ $ $ $ $ $ $ $ $ $
$ $ $

Veteran Patient to Nurse Taren
The Lab Test > > > inflammatory markers crp and esr, for the MAI Infection < < <
was not Ordered BY, but was to be FOR my upcoming and
now past Appointment w Dr. Wendy.
Dr. Wendy at White Bird Clinic does not yet know about
Dr Strictland, -Strickland L_Women’s Health_Portland_WMS –
who Ordered the Lab Test in July of 2016:

inflammatory markers crp and esr, for the MAI Infection < < <
the MAI Infection which was revealed in the CAT Scan where they lost me and the
implement in my arm on the way to ICU
-because ICU was NOT involved-
the MAI Infection to which Pulmonary Fellow Matthew Champion failed to respond;
See below
the MAI Infection causing the coughing with which i Presented in `09 that was
incessantly mis-diagnosed by numerousVA Pulmonologist at $ub$tantial Co$t to
our Government myself and Family.
until July 2016
by Dr. Strictland, confirmed by Dr. Leigh at White Bird Clinic, then the Urgent
Care Doctor after i was blowing out ribs.
“We don’t do ribs”, said TeleNurse
the MAI Infection which caused the odd Lung Vomit, “I’ve never seen anything
like that” said the Urgent
Care Doctor. “Like Glue.”
Well it’s back.
$ $ $ $ $ $ $ $ $
MAY 26, 2016
MD
REASON FOR VISIT/CHIEF COMPLAINT:
f/u breathing

AUG 11, 2017
Author: MSA Length: 6 minutes.
URGENCY: STATUS: COMPLETED

No Team Identified
No Primary Provider Identified
No Associate Provider Identified

Chief Complaint: Not applicable to call = Catch 22 Derilect VA Deferal to ❤ Caretaker Spouse <3.
Comments:
Pt called & heard about the bad air that is around. Pt stated staying inside is
not an option since Pt does not live inside, so interested in getting some nosh breathing masks.

Receipt Acknowledged By:
RN, NCM

08/14/2017 RN
STATUS: COMPLETED
Return call to veteran to inquire about his need for mask due to smoke. Veteran
states his name is Sarah and he would still like to have a mask, but the blue
mask that we have to offer are not “appropriate” for him.

$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

08/23/2017
uthor: HILLARD,SCOTTRINA D
Patient calling ><Snip
simultaneously experiencing
“serious stomach pains that radiate from under feft rib cage.
Then completely overwhelms my gut and disturbs my breathing and evokes a need to vomit that never comes
Much more serious than usual.
knocked me down for 2 1/2 daze.
Patient Wondering if the problem is VA induced STRESS killing me….

Comments:
Pt calling with some issues that he believes are “stress induced”. He state he
is having “stomach pains that radiate left rib cage. Then completely
overwhelms my gut and disturbs my breathing”.

——Original Message————————
Sent: 09/11/2017 06:14 PM
From: FONSECA, CHERIE
To: Veteran Patient,
Subject: General Inquiry

Per provider:

Sarah, this is what the pharmacist states:
From PACT Pharmacist

ASSESSMENT AND PLAN:

HYPOTHYROIDISM
Medication Intervention(s)
Adjust dose or frequency of current medication
Plan: mild hypothyroidism, poor medication adherence. it is possible to that since her TSH is just slightly elevated that low dose levothyroxine may have some side effects. However I would not expect severe pain shooting from stomach up rib cage.
she may either take 1/2 tablet levothyroxine 25mcg OR just stay off and come
back for thyroid panel in 2 months.
Cherie Fonseca, Calapooia pact/ Randy Silverstine M.D
LPN
Christina Heinrich, PharmD, BCPS
Clinical Pharmacy Specialist
Signed: 09/11/2017 13:32

Telehealth
12/14/2021 07:53
Comments:
Veteran starts off by asking is this writer familiar with Adrenal fatigue and
Moral injury?
Triage deferred/ when as if Veteran having worsening s/s, he reports how to you
fuc..ng, have worsening s/s this gave me leukemia etc.

Veteran says I do not want to waste your time if you cannot discuss these two
things. Veteran informed nurses at triage do not diagnose but his s/s can be
assessed.

Advised if worsening or life threatening s/s ER/911 or condition could worsen.

Chief Complaint: Not applicable to call = Catch 22 Derilect VA Deferal to ❤ Caretaker Spouse <3.

Class Code: Other specified counseling.

Length: 11 minutes.

 $     $     $            $$ $$$ $ 

Wellll, 2 Tax$ Squandering years and 2 months later, in about 20 Minutes
2 Students -NUNM in SW PDX
summized that gut ecology was being toxified by the STRESS
Klaire Labs VITAL 10® suggested.
5 Billion CFU Multispecies Probiotic Supplement.
Results show in the toilet the next morn.
A month out, the Injury for me is hard to remember. llollol (
:
Caretaker is quite good at correcting me however.
Sent: 06/19/2020 05:50 PM
From: customer
To: **CalapooiaRiver_FeldhoffPrimCareEug RVAHCS
Subject: frequent breaks to inhale/hold/exhale

06/29/2020
From: Patient
To: **CalapooiaRiver_FeldhoffPrimCareEug RVAHCS
Subject: shared care, w you taking over in Jan, Yes Pl

<Snip by Patient

The ONLY time the Panic Attacks occur is when in me Soul i know i wasn’t heard by one of you on the accordion folded list attached to my VA ID Card, entitled:
“This murder brought to you by these VA Providers”,
or i won’t be heard, or i’m wasting my breath,

10/23/2018 ADDENDUM STATUS: COMPLETED
Spoke with veteran and she is not happy that her CC ophthalmology was put in for Eugene.
Correction 1337 Sun 21jun20 by Customer
BILGE BUNK SEAGUL SHIT AND VULTURE VOMIT
End Customer Correction