CONTACTS
0201 - Kaiser Permanente
020101 - Dr. Vincent E. Yamamoto, M.D.; Orthopedic Surgon
020102 - Orthopedic Department
SUBJECTS
Knee Examination re MRI Right Knee
Multiple Medical Charts for Each Facility
Patient Communication Omitted from Medical Chart
Medical Chart Missing Information
1406 -
1406 - ..
1407 - Summary/Objective
1408 -
140801 - Follow up ref SDS 72 0000, ref SDS 71 0000.
140802 -
140803 - Vincent confirmed Craig's recommentation that an MRI is not useful for
140804 - the right knee. ref SDS 0 2860 He identified possible causes of pain
140805 - in the right knee due to degenerative arthritis. ref SDS 0 2860 The
140806 - right knee can become painful from compensating for loss of capability
140807 - in the damaged left knee. The doctor indicated knee replacement
140808 - surgery will likely be needed within 5 years. ref SDS 0 HU5O He
140809 - suggested shoes and training methods that reduce stress and loss of
140810 - cartilage which cause pain in knee and ankle joints. Vincent is
140811 - taking Glucosamine and Chrodroitin. He reports success for himself
140812 - and patients, but no evidence of restoring lost cartilage. ref SDS 0
140813 - 1680 Vincent will submit recommended specifications for shoes that
140814 - minimize stress during tennis and other high stress activity.
140815 - ref SDS 0 4160
140816 -
140817 - [On 000226 submitted letter to Vincent. ref SDS 74 0001]
140818 -
140820 - ..
1409 -
1410 -
1411 - Discussion
141201 - ..
141202 - Medical Chart Omits Communication from Patient
141203 -
141204 - Met with Doctor Vincent Yamamoto in Kaiser Orthopedic Department.
141205 -
141206 - We reviewed the medical chart, as called out in Kaiser's Healthwise
141207 - Handbook, reported on 990625. ref SDS 13 0794
141209 - ..
141210 - Jeanne's letter on 000120, ref DRP 8 0001, and received on 000121,
141211 - ref SDS 72 0863, was in the medical chart record, and Vincent had
141212 - reviewed her letter.
141214 - ..
141215 - There were no communications in the record from the patient on the
141216 - purpose of the meeting, as listed in the record on 000121. ref SDS 72
141217 - 0863 This appears to conflict with Jeannie's report that the medical
141218 - chart is automatically provided to the attending physician, and so
141219 - would be in this case. ref SDS 72 0001
141220 -
141221 - [below, this may indicate multiple medical charts are being used.
141222 - ref SDS 0 2065]
141224 - ..
141225 - Vincint advised that communication from patients is not included in
141226 - Kaiser's medical chart record that is reviewed by the doctor. He
141227 - explained that some patients have threatened doctors, and as a result
141228 - Kaiser has a policy of not communicating with patients in the medical
141229 - record with the result that doctors cannot be prepared to conduct
141230 - productive meetings with patients.
141231 -
141232 - [...today an article reports treatment is witheld for reasons of
141233 - adverse personality. ref SDS 73 0001]
141235 - ..
141236 - [On 050311 doctors have difficulty with communication and
141237 - collaboration among themselves preparing timely reports,
141238 - distribution, review, and feedback. ref SDS 78 PB8N
141240 - ..
141241 - This aligns with the record on 990816 that revealed a lot of missing
141242 - information in the Medical Chart. ref SDS 21 2601
141244 - ..
141245 - The policy of shielding doctors from communication with the patient
141246 - conflicts with Kaiser's Healthwise Handbook that calls for patients to
141247 - submit medical history, including symptoms, to doctors, reported on
141248 - 990625. ref SDS 13 5740
141249 -
141250 - 1. What happens to this history if it is not reviewed by the
141251 - doctor and incorporated into the record?
141253 - ..
141254 - 2. Why submit information, if it is not reviewed by the doctor?
141256 - ..
141257 - 3. Who reviews the record, and how is critical information passed
141258 - forward to the doctor?
141260 - ..
141261 - 4. Who has reviewed the Welch record, and where is the record of
141262 - follow up action?
141264 - ..
141265 - Vincint advised that patient communication is maintained by Kaiser's
141266 - administrative staff. He is not sure where, because it is witheld
141267 - from doctors.
141269 - ..
141270 - He said patients can request inclusion of patient communication in the
141271 - Medical Chart in order to ensure the doctor sees information on
141272 - medical history.
141274 - ..
141275 - Vincint will include an explanation of this policy in his letter on
141276 - our meeting today.
141277 -
141278 -
141280 - ..
141281 - Multiple Medical Charts Confuse Physicians under Team Care
141282 -
141283 - We discussed the meeting with Christy in Physical Therapy on 990816,
141284 - that showed the report on 8 new therapies was included in the Medical
141285 - Chart, along with a number of patient communications, called "SDS
141286 - records." ref SDS 21 2601
141288 - ..
141289 - However, this medical chart was not submitted for the meeting with
141290 - Craig on 990910, and so the objective of meeting to obtain an opinion
141291 - on the 8 new therapies, was not accomplished. ref SDS 23 3038 and
141292 - ref SDS 23 7802
141294 - ..
141295 - Vincint recalled the article on 8 new therapies that came to his
141296 - attention from another patient. He said it was very helpful for due
141297 - diligence that patients and doctors have a comprehensive checklist of
141298 - issues to consider in evaluating treatment choices. This aligns with
141299 - Doctor Sylvia Connolly's recommendation to obtain expert opinion on
141300 - application of these 8 new therapies in the Welch case, during the
141301 - meeting on 990625. ref SDS 13 5400 At that time, review of Kaiser's
141302 - Healthwise Handbook found a comprehensive checklist for communication
141303 - that makes the doctor/patient partnership effective. ref SDS 13 0806
141305 - ..
141306 - The fact that the medical chart at Park Shadelands has a lot of
141307 - information that is not contained in the chart Vincent showed today,
141308 - per above, ref SDS 0 3862, suggests there are multiple medical charts,
141309 - each with a different body of information.
141311 - ..
141312 - Who is responsible for reviewing the record and coordinating to ensure
141313 - that each doctor sees needed information for effective Team Care. Who
141314 - reviews for conflicting information?
141316 - ..
141317 - Jeanne is the Site Coordinator, and so may be involved in this
141318 - process. She reported on 000121 that Kaiser will roll out in late
141319 - 2001 a technology solution. ref SDS 72 7654 She directly coordinated
141320 - the medical chart issue to help Doctor Yamamoto, yet the complexity of
141321 - the process caused another failure. ref SDS 0 3862
141322 -
141323 - [On 000207 submitted letter on this. ref SDS 74 0004]
141324 -
141325 -
141326 -
1414 -
SUBJECTS
Knee Examination re MRI Right Knee
Therapies - 8 New Proceddures
Xrays on Knees, 990910
Shoes Special Soles Relieve Stress on Knee Joints
Strength Relieves Stress on Knee Joints
Right Knee Arthritic
Compensatory Pain Due to Left Knee Injury
2209 -
221001 - ..
221002 - MRI Not Required Absent Specific Acute Injury
221003 - Xray Shows Right Knee Suffers General Arthritis
221004 - Compensatory and Cartilage Wear Causes Pain in Right Knee
221005 -
221006 - Vincint clarified evaluation of xray issues for right knee.
221007 -
221008 - He identified defects in the cartilage of the right knee by measuring
221009 - a 7 millimeter cartilage separation on one side and a 5 millmeter gap
221010 - on the other side of a slight ridge in the lower bone. Vincent noted
221011 - that a 1 millimeter difference in these measurements is normal, but
221012 - the additional millmeter establishes cartilage deterioriation in the
221013 - right knee, i.e., arthritis, which contributes to pain during heavy
221014 - physical activity.
221016 - ..
221017 - Vincent advised that an MRI would disclose spot loss of material in
221018 - the center of the cartilage mass, that is not evident to normal xray,
221019 - and which can be repaired in some cases by injection treatments,
221020 - and/or replacement therapies, cited in the record on 990625, leading
221021 - to the examination on 990910. ref SDS 23 7802
221023 - ..
221024 - Vincent explained the right knee assumes a greater load than the left
221025 - knee in order to compensate for injury to the left knee. He had me
221026 - walk down the hall, and reported observing a distinct favoring of the
221027 - right knee, even though there is no mental awarensss of compensation.
221029 - ..
221030 - In strenuous activity for example running, tennis, etc., this
221031 - compensation burden on the right knee causes pain, in combination with
221032 - the evident cartilage loss reported today.
221034 - ..
221035 - Under these conditions, Vincent feels an MRI is not needed, confirming
221036 - Craig's report on 991028. ref SDS 34 5820
221038 - ..
221039 - Explained urgency for MIR has subsided. Since meeting with Doctor
221040 - Boulris on 000910, have stopped playing tennis. Working with
221041 - mainstream organizations, e.g., see Medical Chart at Kaiser above,
221042 - ref SDS 0 XF8H, efforts increased developing SDS, POIMS, and
221043 - Communications Metrics...
221044 -
221045 - http://www.welchco.com/03/00050/01/09/01/02/00030.HTM#SY3K
221047 - ..
221048 - This work requires 24/7 using a computer at a desk, which precludes
221049 - athletic activity. As a result, pain has stopped in both left and
221050 - right knees just doing normal walking around.
221051 -
221052 -
221054 - ..
221055 - Left Knee Prognosis Replacement Surgery in 5 Years
221056 -
221057 - Asked about left knee.
221058 -
221059 - Doctor Yamamoto said that after 2 surgeries (1974, 1988), daily life,
221060 - including tennis and running, the left knee has moderate
221061 - osteoarthritis that cannot be improved, and will worsen without
221062 - treatment and/or change in lifestyle. Doctor Yamamoto further said
221063 - that this significant degenerative arthritis in left knee actually
221064 - will continue to worsen, evident from continuing pain. He diagnosed
221065 - knee replacement surgery will likely be needed in 5 years. Vincint
221066 - feels this might be stretched out to 10 years by avoiding high stress
221067 - athletics like running, tennis, basketball, football, etc. He also
221068 - recommended Glucosamine Chondroitin explained below. ref SDS 0 1680
221070 - ..
221071 - This aligns with prognosis Doctor Boulris offered during the meeting
221072 - on 090910; he recommended Glucosamine Chondroitin and advised left
221073 - knee replacement might be needed in 10 years by ending high stress
221074 - activity. ref SDS 23 9733 A few weeks later on 990925, received
221075 - Craig's letter confirming prognosis that knee replacement might be
221076 - needed in 10 years. ref SDS 26 2951
221077 -
221078 -
221079 -
221081 - ..
221082 - Cross Training Shoes, Biking, Circular Exercise for Knees, Strength
221083 -
221084 - Vincint says he wears cross-training shoes for tennis because they
221085 - have greater cushioning in the sole than regular tennis shoes. He
221086 - advised that increased cushioning in shoes for tennis reduces strain
221087 - on knees and so helps slow down the natural wear and loss of
221088 - cartilage.
221090 - ..
221091 - Vincint will submit suggestions on athletic shoes to minmize stress,
221092 - in his report and indicate the style or vendor that might be
221093 - considered.
221095 - ..
221096 - He recommends against a vertical stair master type exercise, because
221097 - it places a lot of stress on the knee joint.
221099 - ..
221100 - Biking, stationary bikes, or other circular motion exercise, is
221101 - recommended to build strength and maintain motion in the knee joint.
221103 - ..
221104 - Vincint confirmed Christy's suggestion on 990816 to build strength in
221105 - the leg muscles to further reduce stress on the knee joint.
221106 - ref SDS 21 5612
221107 -
221108 -
221109 -
221110 -
2212 -
SUBJECTS
Glucosamine Chondroitin
Rosacia, 940624
2404 -
240501 - ..
240502 - Glucosamine, Chrondroitin Treatment Follow Vendors Instructions
240503 -
240504 - Follow up ref SDS 72 1680, ref SDS 29 3040.
240505 -
240506 - Vincent advised that he has been taking Glucosamine and Chondroitin
240507 - for about 2 years and reports it has helped him alot. He, also, has
240508 - patients who take this treatment. Vincent recommends treatment
240509 - according to the vendors recommendations, as set out in Jeanne's
240510 - letter on 000121. ref SDS 72 1680
240512 - ..
240513 - We reviewed reports in the Medical Letter submitted to Craig that,
240514 - seem to relate cartilage growth. ref SDS 34 2596
240516 - ..
240517 - Vincent advised that he has not seen any evidence of cartilage
240518 - restoration. He is not familiar with the Medical Letter.
240520 - ..
240521 - We did not review today the duration for taking 3 pills a day spread
240522 - out at approximate each meal time. The record so far suggests this
240523 - is a continuous regimine, that lasts for life, rather than a process
240524 - that completes a particular mission.
240526 - ..
240527 - Need opinion on problems taking Glucosamine and Chrondroitin in
240528 - combination with Tetracycline medication for rosacea, prescribed by
240529 - Doctor Kory Zipperstein on 940624, ref SDS 5 0001, and received in the
240530 - record on 940628. ref SDS 6 0877
240532 - ..
240533 - What experience does Kaiser have on this issue?
240535 - ..
240536 - We did not have time to review this issue today. It probably needs
240537 - consideration to avoid adverse impacts.
240539 - ..
240540 - Glucosamine and Chrondroitin are taken 3 times a day during meals, as
240541 - reported on 991011, ref SDS 30 9702, while rosacea treatment is taken
240542 - 2 - 4 times a day on an empty stomache, as shown on 940628.
240543 - ref SDS 6 6016 Does this relieve or compound any conflict, if a
240544 - conflict exists?
240545 -
240546 - [On 000206 submitted letter asking about this issue. ref SDS 74
240547 - 0001]
240549 - ..
240550 - [On 000216 received letter from Kory indicating there is no
240551 - evident conflict. ref SDS 75 8944]
240553 - ..
240554 - Over next few months tried Glucosamine Chondroitin but could not
240555 - swallow pills, so ended efforts to try this treatment.
240557 - ..
240558 - [On 030807 case study shows personal history using liquid
240559 - Glucosamine Chondroiten and clincial research. ref SDS 76
240560 - FN9N
240562 - ..
240563 - [On 040529 0248 report that Glucosamine Chondroitin in liquid
240564 - form relieved knee pain from hiking 3 - 10 miles per day.
240565 - ref SDS 77 MN9P
240566 -
240567 -
240568 -
2406 -
SUBJECTS
Default Null Subject Account for Blank Record
2503 -
250401 - ..
250402 - Medical Chart Doctor Yamamoto 2nd Opinion Left Knee Examination
250403 -
250404 -
250405 - Later received Doctor Yamamoto's Opinion Consultation memo saying...
250406 -
250407 - 1. KAISER PERMANENTE, WALNUT CREEK
250409 - ..
250410 - 2. THIS REPORT HAS BEEN TRANSCRIBED
250411 - BUT NOT REVIEWED BY DICTATING PHYSICIAN
250412 -
250413 - 3. 2ND OPINION CONSULTATION - ORTHOPEDICS
250415 - ..
250416 - 4. DATE.......................... 01/24/2000
250418 - ..
250419 - PATIENT
250423 - ..
250424 - 5. PHYSICIAN REFERRING PHYSICIAN
250425 - V. Yamamoto, M.D.
250427 - ..
250428 - 6. HISTORY: This patient is a 54-year-old Caucasian male who has
250429 - complaints of post activity pain involving both of his knees,
250430 - left equally with the right. His left knee, he however has a
250431 - more chronic history of having previous problems and surgery. He
250432 - had a previous open meniscectomy on his left knee in the 1970's.
250433 - He subsequently had an arthroscopy of the left knee in 1988 on
250434 - his left knee. He pretty much says that he is not fully
250435 - recovered from his left knee arthroscopy in 1988 and still had
250436 - some chronic symptomatology involving his left knee.
250438 - ..
250439 - 7. He, however, had noticed over the last two years pain in both
250440 - of his knees after he would play tennis. He said that he would
250441 - initially play tennis, he would have some soreness but would
250442 - actually feel better as he played and then about 2 hours
250443 - afterwards, he would have excruciating pain involving both of
250444 - his knees.
250446 - ..
250447 - 8. He has not played tennis since October 1999 and has devoted
250448 - himself to his professional work. He said since not playing
250449 - tennis and since pretty much doing sedentary activities,
250450 - working mainly at his computer 24 hours a day', he has not had
250451 - any knee pain since October.
250453 - ..
250454 - 9. He said that the pain in his knee is not well localized. It is
250455 - more or less diffuse and he cannot say where specifically his
250456 - knees hurt when they do hurt. He has recently started
250457 - glucosamine and chondroitin in combination. He does not do any
250458 - exercise or any physical activity currently.
250460 - ..
250461 - 10. PHYSICAL EXAMINATION: The patrient appears to be a little bit
250462 - overweight. He ambulates with a slight limp that favors his
250463 - left lower extremity with a shortened stance of phase on the
250464 - left compared with the right during ambulation. He has a mild
250465 - deqree of soft tissue swelling diffusely in the left knee when
250466 - compared with the right. The right has absolutely no swelling
250467 - or effusion. He has absolutely no tenderness. throughout his
250468 - right knee. He has no detectable ligamentous laxity to his
250469 - right knee with no varus or valgus laxity and negative
250470 - Lachman's. Negative anterior and posterior drawer.
250472 - ..
250473 - 11. His left knee currently is non-tender to examination. He has no
250474 - varus or valgus laxity to his left knee and negative 'Lachman's to
250475 - his left knee. His ROM is slightly restricted on the left when
250476 - compared with the right. Extension appears full in both knees
250477 - but flexion, he lacks approximately 10 to 15 degrees on the left
250478 - compared to the right.
250480 - ..
250481 - 12. X-rays reveal a moderately advanced arthritis involving his left
250482 - knee. He has mild degenerative changes noted in his right knee
250483 - on the medial side with some joint space narrowing and some
250484 - irregularity of the medial femoral condyle.
250486 - ..
250487 - 13. IMPRESSION/PLAN: This patient has moderately advanced arthritis
250488 - involving the left knee. Has mild arthritis in the right knee.
250489 - Also appears to have some compensatory pain involving the right
250490 - knee when he does higher level activities because he favors his
250491 - left lower extremity during these high impact activities.
250493 - ..
250494 - 14. I agree completely with Dr Boulris that the patient is best
250495 - advised to avoid the hard court tennis surfaces and softer
250496 - surfaces would be much more important and that doubles tennis
250497 - would be much more advisable thafr singles tennis. I did,
250498 - however, also emphasize the importance of cross training
250499 - modalities involving low impact activities, especially
250500 - stationary bike, some activities such as lightweight weight
250501 - trained to strengthen the lower extremities. Also elliptical
250502 - machine in the patient's health club to keep the knees
250503 - conditioned and the muscles around the knees well conditioned.
250505 - ..
250506 - 15. Also strongly encouraged proper shoe wear with maximal cushion
250507 - and built in arch supports to provide the cushion on his
250508 - joints. Also reconunended trying glucosamine 500mg 3 times
250509 - a day with chondroitin 400mg 3 times a day,
250511 - ..
250512 - This aligns with prognosis Doctor Boulris offered during the meeting
250513 - on 090910; he recommended Glucosamine Chondroitin and advised left
250514 - knee replacement might be needed in 10 years by ending high stress
250515 - activity. ref SDS 23 9733 A few weeks later on 990925, received
250516 - Craig's letter confirming prognosis that knee replacement might be
250517 - needed in 10 years. ref SDS 26 2951
250518 -
250519 - [On 030807 case study shows personal history using liquid
250520 - Glucosamine Chondroiten and clincial research. ref SDS 76
250521 - FN9N
250523 - ..
250524 - [On 040529 0248 report that Glucosamine Chondroitin in
250525 - liquid form relieved knee pain from hiking 3 - 10 miles per
250526 - day. ref SDS 77 MN9P
250528 - ..
250529 - 2nd Opinion Memo Doctor Yamamoto continues...
250530 -
250531 - 16. Should these modalities not work, then I would agree with Dr
250532 - Boulris again with consideration of synvisc injections to his
250533 - left knee. I would not at this point recommend cortisone
250534 - injections to his knee unless he had more of an acute flare-up
250535 - of arthritic symptoms.
250537 - ..
250538 - 17. I also discussed with him the issue of MRI and at this point in
250539 - time, agree with Dr Boulris that I do not feel an MRI is
250540 - currently indicated in his right knee being that he has more
250541 - chronic symptoms and being that he is asymptomatic for the last
250542 - three months since not playinq tennis. If, however, he
250543 - developed more acutely painful symptoms with or without an
250544 - injury and if these symptoms do not resolve, an MRI could be
250545 - considered in the future and the patient was made aware of
250546 - this.
250548 - ..
250549 - 18. A letter has also been dictated to the patient summarizing this
250550 - and should be included in the medical record.
250552 - ..
250553 - The doctor's letter is entered below. ref SDS 0 0H64
250555 - ..
250556 - 19. VINCENT YAMAMOTO, M.D.
250557 - D: 01124/00 T: 01125/00
250558 - VY:amp
250559 -
250560 -
250561 -
250562 -
250563 -
250565 - ..
250566 - Letter 2nd Opinion Doctor Yamamoto Confirming Meeting 000124
250567 -
250568 - About a week after the meeting today received following letter from
250569 - the doctor, saying...
250570 -
250571 - 1. Kaiser Perrnanente Medical Offices
250572 - 1425 S. Main Street
250573 - Walnut Creek, California 94596
250574 - (925) 295-4000
250581 - ..
250582 - 2. January 24, 2000
250583 -
250591 - ..
250592 - 3. This correspondence is sent to you regarding our office visit
250593 - today. In review, I want to mention the things that we
250594 - discussed today regarding treatment of your knee problems in
250595 - both knees. It appears that you have a moderately advanced
250596 - arthritis involving your left knee which has had two prior
250597 - operations including the previous open meniscus surgery and the
250598 - subsequent arthroscopy. Your x-rays do show significant
250599 - degenerative arthritic change involving the left knee. Your
250600 - right knee also has equal symptoms when you play tennis by your
250601 - report and I do note on x-ray that you do have a mild degree of
250602 - degenerative change on the inner part of the right knee.
250604 - ..
250605 - Diagnosing "moderately advanced" and "significant degenerative
250606 - arthritic change in the left knee, aligns with the doctor's
250607 - examination memo, per above, ref SDS 0 6S4K, and further with
250608 - discussion during the meeting at Kaiser Orthopedics Department, also
250609 - above. ref SDS 0 HU5O
250611 - ..
250612 - Doctor Yamamoto's letter continues...
250613 -
250614 - 4. In addition, as I explained to you that because of your more
250615 - significant arthritis on your left knee and the previous
250616 - injuries to your left knee, you are compensating for the
250617 - injured left knee and putting more demand on your right knee
250618 - when you play higher level of sports. This I refer to you as a
250619 - "compensatory pain". Subsequently, this would explain some of
250620 - the symptoms in your right knee with activity.
250622 - ..
250623 - 5. My recommendations at this point in time would be to start
250624 - taking Glucosamine and Chondroitin with a dose of Glucosamine
250625 - 500 mg 3 times a day and Chondroitin 400 mg 3 times a day.
250627 - ..
250628 - Aligns with Vincent's memo per above. ref SDS 0 6S70
250630 - ..
250631 - Recommending Glucosamine Chondroitin aligns with the doctor's
250632 - examination memo, per above, ref SDS 0 6S70, and with discussion
250633 - during the meeting earlier today, per above. ref SDS 0 1680
250635 - ..
250636 - Doctor Yamamoto's letter continues...
250637 -
250638 - 6. Also, I emphasize the importance of shoe wear. I would
250639 - strongly recommend a very well cushioned sole shoe with a built
250640 - in arch support, more on the lines of a cross training type of
250641 - shoe with the maximal air cushion.
250643 - ..
250644 - Recommending well cushioned shoe wear with arch support aligns with
250645 - discussion during the meeting, per above, ref SDS 0 XH69; and, with
250646 - the doctor's memo. ref SDS 0 6S70
250648 - ..
250649 - Doctor Yamamoto's letter continues...
250650 -
250651 - 7. I also recommended that you do cross training should you want
250652 - to play tennis and this would include a regular stationary
250653 - bicycling program and even some light weight training to build
250654 - the strength in your legs and in your knees. Also, again I
250655 - would like to emphasize the importance of warming up on the
250656 - stationary bike or the elliptical machine prior to playing
250657 - tennis.
250659 - ..
250660 - 8. In terms of more long-term treatment should your left knee
250661 - symptoms not improve with these modalities, then I would
250662 - consider the Synvisc injections as had been recommended by Dr
250663 - Boulris and myself as an alternative option for treatment of
250664 - arthritis. It was not my recommendation at this point in time
250665 - to give you a cortisone injection and I would reserve this more
250666 - for acute flare-ups of your left knee arthritis.
250668 - ..
250669 - For some reason, Doctor Yamamoto's letter does not present long term
250670 - prospect of knee replacement in 5 years without interventions, e.g.,
250671 - glucosamine chondroitin, and while continuing high impact activities,
250672 - e.g., tennis; nor that continuing degenerative osteoarthritis will
250673 - likely require knee replacement in 10 years even avoiding high impact
250674 - activities, discussed during the meeting earlier today, per above.
250675 - ref SDS 0 HU5O
250677 - ..
250678 - Doctor Yamamoto's letter continues...
250679 -
250680 - 9. In reference specifically to the MRI of the right knee, it was
250681 - my opinion to you that a MRI currently would not be helpful.
250682 - At this point in time, a MRI would not change the treatment
250683 - options recommended nor would it help currently with improving
250684 - diagnosis. However, I did mention to you that if in the
250685 - future, you have a more acute injury involving your right knee
250686 - or an acute flare-up of your right knee which does not improve
250687 - in a short term, you should again be seen and a MRI may be more
250688 - beneficial at that point in time to diagnose more acute type
250689 - injuries.
250690 -
250691 - [On 160301 0528 letter to Doctor Boulris requests 2nd
250692 - opinion by Doctor Boulris or Doctor Yamamoto on severe
250693 - right knee pain, with reference to further CT or MRI
250694 - radiology studies. ref SDS 79 HR38
250696 - ..
250697 - 10. You also requested that I specifically mention in this
250698 - correspondence that I did not have any of your own personal
250699 - correspondence letters to Dr Boulris or to Ms Jean Bradley at
250700 - this office visit. Present at this office visit were your
250701 - x-rays of your knees from two prior occasions and also the
250702 - dictated outpatient consultation by Dr Boulris dated September
250703 - 10, 1999.
250705 - ..
250706 - 11. If there are any further questions or needs, please feel free
250707 - to contact this office. I have given you my professional card
250708 - with the telephone number.
250709 -
250710 - [On 160301 0528 letter to Doctor Boulris requests 2nd
250711 - opinion by Doctor Boulris or Doctor Yamamoto on severe
250712 - right knee pain, with reference to further CT or MRI
250713 - radiology studies. ref SDS 79 HR38
250715 - ..
250716 - 12. Sincerely yours,
250718 - ..
250719 - 13. Vincent amoto, M.D.
250720 - Department of Orthopedics
250721 - Kaiser Walnut Creek Medical Offices
250723 - ..
250724 - VY;rkt
250725 - DO: 1-24-00
250726 - DT: 1-27-00
250728 - ..
250729 - CC: Member Services
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Distribution. . . . See "CONTACTS"