The recommendation letter from OHSU for MALS surgery with Dr. Hsu: (Scanned copy included)
I am writing on the behalf of my patient, Mr. Donovan, whom I have been following at the Oregon Health and Science University division of Gastroenterology.
Mr. Donovan presented to our clinic earlier this year suffering from chronic disabling abdominal pain and unintentional weight loss that had been present since 2009. Prior to our initial encounter he had underwent an extensive evaluation into the cause for this pain that included tests such as endoscopies, blood work, computed tomography scans, and a gastric emptying study without a clear explanation for his symptoms.
Mr. Donovan independently submitted the results of his computed tomography scan to Dr. Richard Hsu of Southern Connecticut Vascular Center who, after review suspected that his symptoms were due to Median Arcuate Ligament Syndrome (MALS), a disorder characterized by compression of the celiac artery that is believed to cause postprandial abdominal pain and weight loss, consistent with Mr. Donovan’s symptoms.
At the suggestion of Dr. Hsu, our facility was able to perform an endoscopic celiac plexus nerve block which served as a diagnostic tool to confirm MALS. Following the procedure Mr. Donovan reported to me that he had complete (albeit short term) resolution of his symptoms and was able to eat, exercise and complete his activities of daily life without intolerable pain.
In my professional opinion, it is medically necessary that Mr. Donovan be able to work with Dr. Hsu in pursuit of a surgical treatment for MALS. Please afford him the ability to see this vascular specialist and obtain definitive treatment for this disabling condition.
“Signed Laura Kading” MHS, PA-C, Instructor.
Reply from the VA:
DNY-Community Care care request disapproved:
DIS-Reason Service available at the VA.
Alerting PACT, this consult will be cancelled per COS guidance as services available within VA. COS recommends IFC consult to PVAMC.