CONTACTS
SUBJECTS
VA Podiatry Review Metatarsalgia Pain Balls of Feet Enable Physical
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 40 0000. ref SDS 39 0000.
040502 -
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040507 -
040509 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 140805 1030 meeting Doctor Tang in Podiatry. ref SDS 25 1E50 The
040902 - doctor prepared molds for orthotic inserts to resolve metatarsalgia.
040903 - ref SDS 25 1F31 ref SDS 25 NU4G Progress Notes for meeting on 140805,
040904 - call for return to clinic after receiving FFO. ref SDS 25 IJ4G
040906 - ..
040907 - On 140828 meeting with Doctor Kevin Daun and later with Doctor Mihara,
040908 - attending developed solution to blister on inside of big toe on left
040909 - foot, ref SDS 33 W74O, that required stopping 11 mile hike after 8
040910 - miles and calling for a ride home, shown in case study on 120101 0900.
040911 - ref SDS 2 BO6F
040913 - ..
040914 - On 140904 0900 meeting with Doctor Cynthia Lieu and Doctor Tang,
040915 - attending. ref SDS 36 AK6J Doctor Tang said orthotics can be trimed
040916 - to fit a smaller shoe size, if necessary; he has scheduled a meeting
040917 - after orthotics inserts are received. ref SDS 36 4M3H
040919 - ..
040920 - On 140910 1553 receive Prolab orthotic inserts ordered by VA to
040921 - resolve metatarsalgia pain side effects of endurance exercise physical
040922 - activity treatment to lower CVD risk by reression of atherosclerosis.
040923 - ref SDS 39 AK6J
040925 - ..
040926 - On 140911 1529 letter to VA notified Podiatry received Prolab orthotic
040927 - inserts. ref SDS 40 AK6J
040929 - ..
040930 - On 141008 1349 letter to VA submit agenda for meeting on 141009 0900,
040931 - ref SDS 0 AK6J; advised orthotic inserts orderedby VA were not
040932 - received in time for Half Dome, ref SDS 0 ST60; suffered pain that
040933 - prevented reaching top of Half Dome, but likely not related to delay
040934 - receiving VA orthotics. ref SDS 0 ST60 Advise VA Prolab custom
040935 - orthotic inserts significantly reduce metatarsalgia pain compared to
040936 - other measures. Enables hiking up to 3 days in a row; may support
040937 - hiking 300 miles per month, which has proven effective controlling CVD
040938 - risk by reducing atherosclerosis, based on lipid labs. ref SDS 0 ST68
040939 - Switching inserts between shoes causes debilitating injuries.
040940 - ref SDS 0 ST79 Therefore to maintain level of effort, would like to
040941 - order 3 more sets of VA Prolab orthotics so that all 4 pair of Hoka
040942 - Stinson Trail shoes have separate inserts. If there is a cost
040943 - consideration, I can pay for the work. ref SDS 0 ST92
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040947 -
040949 - ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Sent letter to Doctor Tang with copy to Doctor Alba saying...
041302 -
041303 - 1. Subject: Agenda Podiatry Meeting October 9
041304 - Date: 2014-10-08 14:12
041310 - ..
041311 - 2. Dear Doctor Tang,
041313 - ..
041314 - 3. We met on 140805, following referral on 140801, from Doctor
041315 - Alba requesting recovery from metatarsalgia side effects of
041316 - treatment with endurance exercise hiking 300+ miles per month
041317 - to recover from atherosclerosis, which was reported to the VA
041318 - in a meeting on 140519, and cited again in a letter on 140629.
041320 - ..
041321 - 4. During the meeting on 140805, we reviewed correlation in this
041322 - case between podiatry and cardiology (atherosclerosis) - see
041323 - line 110735. ref SDS 25 Y56N
041325 - ..
041326 - 5. As a result, you ordered Prolab orthotic inserts. These were
041327 - received on 140910, reported to the VA in a letter the next day
041328 - on 140911 (see below). ref SDS 40 AK6J
041330 - ..
041331 - 6. VA custom orthotics did not arrive in time for Half Dome, so
041332 - over the counter inserts were used. Subsequent experience
041333 - indicates might have gotten farther with the VA orthotics, but
041334 - not clear this would have enabled reaching the top of Half Dome
041335 - this year, see record on 140917 (line 2104. ref SDS 41 0001
041337 - ..
041338 - 7. In any case, I am grateful for the VA's efforts to support the
041339 - Half Dome initiative, including Doctor Alba's referral.
041341 - ..
041342 - 8. Since Half Dome 2 weeks ago, further hiking indicates VA Prolab
041343 - orthotics significantly reduce metatarsalgia pain compared to
041344 - other measures. On some 11 mile hikes there is pain level 0
041345 - for nearly the entire route or at most pain level 3 for a mile
041346 - or so, which is easily tolerated, especially since the feet now
041347 - recover well overnight, as they did in the past. This enables
041348 - hiking up to 3 days in a row. This level of support may get us
041349 - close to 300 miles per month, which has proven effective
041350 - controlling CVD risk by reducing atherosclerosis, based on
041351 - lipid labs, reported on 140514 (see line 760677. ref SDS 8 W25L
041353 - ..
041354 - 9. Of course establishing the correlation between physical
041355 - activity and atherosclerosis requires testing with EPC lab and
041356 - coronary CTA with calcium score.
041358 - ..
041359 - 10. In the meantime, evidence of increased hiking with VA Prolab
041360 - orthotic inserts combined with Hoka Stinson Trail shoes and
041361 - Thorlo socks (recommended by you, as well), indicates this is a
041362 - strong solution for regression of atherosclerosis through
041363 - endurance exercise. [...cited in research on 131125 0005.
041364 - ref SDS 4 8X4N; particularly at ref SDS 4 XY7L...].
041366 - ..
041367 - 11. Experience also shows that switching inserts between shoes
041368 - causes slight changes which in turn cause debilitating
041369 - injuries, see for example the record yesterday on switching
041370 - inserts from the 4th pair, where no injuries were reported over
041371 - several weeks, to the 2nd pair which caused big problems (case
041372 - study on 120101 for hike on 141007 (line 111136. ref SDS 2 GQ4G
041374 - ..
041375 - 12. If you have time to scroll back through the record, notice
041376 - energy and conditioning have begun to recover, shown by
041377 - increased frequency and falling times for 11 mile hikes. This
041378 - indicates progress recovering from metatarsalgia that prevented
041379 - hiking the past 3 months and impacted Half Dome.
041381 - ..
041382 - 13. Labs planned in a few weeks will further indicate if hiking has
041383 - increased enough to restore good numbers. Effects of reduced
041384 - physical activity is shown by an interim lab 2 months ago on
041385 - 140814, at the VA Clinic in Martinez, with HDL 55 dropping from
041386 - 67, and Triglycerides 72 rising from 58.
041388 - ..
041389 - 14. Therefore to maintain level of effort, would like to order 3
041390 - more sets of VA Prolab orthotics so that all 4 pair of Hoka
041391 - Stinson Trail shoes have separate inserts. If there is a cost
041392 - consideration, I can pay for the work.
041394 - ..
041395 - 15. Thanks again for great work by the VA. Look forward to a good
041396 - meeting tomorrow in Podiatry.
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