THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com


S U M M A R Y


DIARY: January 24, 2000 08:30 AM Monday; Rod Welch

Meeting Doctor Yamamoto at Kaiser on MRI for right knee.

1...Summary/Objective
2...Medical Chart Omits Communication from Patient
3...Multiple Medical Charts Confuse Physicians under Team Care
4...MRI Not Required Absent Specific Acute Injury
5...Xray Shows Right Knee Suffers General Arthritis
6...Compensatory and Cartilage Wear Causes Pain in Right Knee
7...Left Knee Prognosis Replacement Surgery in 5 Years
8...Cross Training Shoes, Biking, Circular Exercise for Knees, Strength
9...Glucosamine, Chrondroitin Treatment Follow Vendors Instructions


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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 71 0000, ref SDS 70 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 arthritis. ref SDS 0 2860  The right knee can                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
140806 - become painful from compensating for loss of capability in the damaged                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
140807 - left knee.  The doctor indicated knee replacement surgery will likely                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
140808 - be needed within 5 years. ref SDS 0 HU5O  He suggested shoes and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
140809 - training methods that reduce stress and loss of cartilage which cause                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
140810 - pain in knee and ankle joints.  Vincent is taking Glucosamine and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
140811 - Chrodroitin.  He reports success for himself and patients, but no                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
140812 - evidence of restoring lost cartilage. ref SDS 0 1680  Vincent will                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
140813 - submit recommended specifications for shoes that minimize stress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
140814 - during tennis and other high stress activity. ref SDS 0 4160                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
140815 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
140816 -    [On 000226 submitted letter to Vincent. ref SDS 73 0001]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
140817 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
140819 -  ..
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 71 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 71                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
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 71 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 providing communication from patients in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
141229 - the record of medical history for review by doctors.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
141230 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
141231 -     [...today an article reports treatment is witheld for reasons of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
141232 -     adverse personality. ref SDS 72 0001]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
141234 -      ..
141235 -     [On 050311 doctors have difficulty with communication and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
141236 -     collaboration among themselves preparing timely reports,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
141237 -     distribution, review, and feedback. ref SDS 77 PB8N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
141239 -  ..
141240 - This aligns with the record on 990816 that revealed a lot of missing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
141241 - information in the Medical Chart. ref SDS 21 2601                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
141243 -  ..
141244 - The policy of shielding doctors from communication with the patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
141245 - conflicts with Kaiser's Healthwise Handbook that calls for patients to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
141246 - submit medical history, including symptoms, to doctors, reported on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
141247 - 990625. ref SDS 13 5740                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
141248 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
141249 -    1.  What happens to this history if it is not reviewed by the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
141250 -        doctor and incorporated into the record?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
141252 -         ..
141253 -    2.  Why submit information, if it is not reviewed by the doctor?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
141255 -         ..
141256 -    3.  Who reviews the record, and how is critical information passed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
141257 -        forward to the doctor?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
141259 -         ..
141260 -    4.  Who has reviewed the Welch record, and where is the record of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
141261 -        follow up action?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
141263 -  ..
141264 - Vincint advised that patient communication is maintained by Kaiser's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
141265 - administrative staff.  He is not sure where, because it is witheld                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
141266 - from doctors.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
141268 -  ..
141269 - He said patients can request inclusion of patient communication in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
141270 - Medical Chart in order to ensure the doctor sees information on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
141271 - medical history.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
141273 -  ..
141274 - Vincint will include an explanation of this policy in his letter on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
141275 - our meeting today.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
141276 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
141277 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
141279 -  ..
141280 - Multiple Medical Charts Confuse Physicians under Team Care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
141281 - 
141282 - We discussed the meeting with Christy in Physical Therapy on 990816,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
141283 - that showed the report on 8 new therapies was included in the Medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
141284 - Chart, along with a number of patient communications, called "SDS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
141285 - records." ref SDS 21 2601                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
141287 -  ..
141288 - However, this medical chart was not submitted for the meeting with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
141289 - Craig on 990910, and so the objective of meeting to obtain an opinion                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
141290 - on the 8 new therapies, was not accomplished. ref SDS 23 3038 and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
141291 - ref SDS 23 7802                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
141293 -  ..
141294 - Vincint recalled the article on 8 new therapies that came to his                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
141295 - attention from another patient.  He said it was very helpful for due                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
141296 - diligence that patients and doctors have a comprehensive checklist of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
141297 - issues to consider in evaluating treatment choices.  This aligns with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
141298 - Doctor Sylvia Connolly's recommendation to obtain expert opinion on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
141299 - application of these 8 new therapies in the Welch case, during the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
141300 - meeting on 990625. ref SDS 13 5400  At that time, review of Kaiser's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
141301 - Healthwise Handbook found a comprehensive checklist for communication                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
141302 - that makes the doctor/patient partnership effective. ref SDS 13 0806                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
141304 -  ..
141305 - The fact that the medical chart at Park Shadelands has a lot of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
141306 - information that is not contained in the chart Vincent showed today,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
141307 - per above, ref SDS 0 3862, suggests there are multiple medical charts,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
141308 - each with a different body of information.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
141310 -  ..
141311 - Who is responsible for reviewing the record and coordinating to ensure                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
141312 - that each doctor sees needed information for effective Team Care.  Who                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
141313 - reviews for conflicting information?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
141315 -  ..
141316 - Jeanne is the Site Coordinator, and so may be involved in this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
141317 - process.  She reported on 000121 that Kaiser will roll out in late                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
141318 - 2001 a technology solution. ref SDS 71 7654  She directly coordinated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
141319 - the medical chart issue to help Doctor Yamamoto, yet the complexity of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
141320 - the process caused another failure. ref SDS 0 3862                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
141321 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
141322 -     [On 000207 submitted letter on this. ref SDS 73 0004]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
141323 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
141324 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
141325 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
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 33 5820                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
221037 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
221038 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
221040 -  ..
221041 - Left Knee Prognosis Replacement Surgery in 5 Years                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
221042 - 
221043 - The doctor said that after 2 surgeries (1974, 1988), and now                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
221044 - continuing pain from tennis and running, left knee replacement surgery                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
221045 - will likely be needed in 5 years.  He feels this might be stretched                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
221046 - out with remedial measures, including Glucosamine Chondroitin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
221047 - explained below. ref SDS 0 1680                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
221048 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
221049 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
221051 -  ..
221052 - Cross Training Shoes, Biking, Circular Exercise for Knees, Strength                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
221053 - 
221054 - Vincint says he wears cross-training shoes for tennis because they                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
221055 - have greater cushioning in the sole than regular tennis shoes.  He                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
221056 - advised that increased cushioning in shoes for tennis reduces strain                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
221057 - on knees and so helps slow down the natural wear and loss of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
221058 - cartilage.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
221060 -  ..
221061 - Vincint will submit suggestions on athletic shoes to minmize stress,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
221062 - in his report and indicate the style or vendor that might be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
221063 - considered.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
221065 -  ..
221066 - He recommends against a vertical stair master type exercise, because                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
221067 - it places a lot of stress on the knee joint.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
221069 -  ..
221070 - Biking, stationary bikes, or other circular motion exercise, is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
221071 - recommended to build strength and maintain motion in the knee joint.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
221073 -  ..
221074 - Vincint confirmed Christy's suggestion on 990816 to build strength in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
221075 - the leg muscles to further reduce stress on the knee joint.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
221076 - ref SDS 21 5612                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
221077 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
221078 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
221079 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
221080 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2211 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Glucosamine Chondroitin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
Rosacia, 940624                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2404 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
240501 -  ..
240502 - Glucosamine, Chrondroitin Treatment Follow Vendors Instructions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
240503 - 
240504 - Follow up ref SDS 71 1680, ref SDS 28 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 71 1680                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
240512 -  ..
240513 - We reviewed reports in the Medical Letter submitted to Craig that,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
240514 - seem to relate cartilage growth. ref SDS 33 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 29 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 73                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
240547 -    0001]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
240549 -     ..
240550 -    [On 000216 received letter from Kory indicating there is no                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
240551 -    evident conflict. ref SDS 74 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 75                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
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 76 MN9P                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
240566 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240567 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
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240573 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240574 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
Distribution. . . . See "CONTACTS"