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: October 21, 2014 02:11 PM Tuesday; Rod Welch

VA Podiatry minor surgery severe blisters both feet received protective gear.

1...Summary/Objective
2...Podiatry Meeting Review Metatarsalgia Orthotic Inserts
3...Meeting with Doctor Robert Tang and Priya Patel
...............Mileage 2014


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CONTACTS 

SUBJECTS
VA Podiatry Review Metatarsalgia Pain Balls of Feet Enable Physical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
1303 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1303 -    ..
1304 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
1305 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
130501 - Follow up ref SDS 41 0000. ref SDS 35 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
130502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130506 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130508 -  ..
1306 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1307 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1308 - Background                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
1309 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
130901 - Meeting Doctor Tang in Podiatry on 140805 1030. ref SDS 25 NU4G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
130902 - Progress Notes for meeting on 140805, call for return to clinic after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
130903 - receiving FFO. ref SDS 25 IJ4G  A few days after meeting on 140805,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
130904 - received letter from VA scheduling follow meeting today on 140820                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
130905 - 1000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
130907 -  ..
130908 - Wound on left big toe looked infected, and may account for elevated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
130909 - WBC 12.8 on recent lab performed at Martinez VA on 140814 1530,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130910 - ref SDS 29 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
130912 -  ..
130913 - On 140819 Doctor Sandhu, Primary Care Martinez VA Clinis examined the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
130914 - wound and ordered follow up lab. 140819 0800, ref SDS 30 318I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
130916 -  ..
130917 - On 1408, 140827 follow up lab showed WBC 13.8 increased. ref SDS 32                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
130918 - RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
130920 -  ..
130921 - On 140828 meeting with Doctor Kevin Daun and later with Doctor Mihara,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
130922 - attending developed solution to blister on inside of big toe on left                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
130923 - foot, ref SDS 33 W74O, that required stopping 11 mile hike after 8                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
130924 - miles and calling for a ride home, shown in case study on 120101 0900.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
130925 - ref SDS 2 BO6F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
130927 -  ..
130928 - On 140904 0900 meeting with Doctor Cynthia Lieu and Doctor Tang,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
130929 - attending. ref SDS 35 AK6J  Doctor Tang said orthotics can be trimed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
130930 - to fit a smaller shoe size, if necessary; he has scheduled a meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
130931 - after orthotics inserts are received. ref SDS 35 4M3H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
130933 -  ..
130934 - On 140910 1553 receive Prolab orthotic inserts ordered by VA to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130935 - resolve metatarsalgia pain side effects of endurance exercise physical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
130936 - activity treatment to lower CVD risk by reression of atherosclerosis.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
130937 - ref SDS 37 AK6J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
130939 -  ..
130940 - On 140911 1529 letter to VA notified Podiatry received Prolab orthotic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
130941 - inserts. ref SDS 38 AK6J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
130943 -  ..
130944 - On 141008 1349 letter to VA submit agenda for meeting on 141009 0900,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
130945 - ref SDS 40 AK6J; advised orthotic inserts orderedby VA were not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
130946 - received in time for Half Dome, ref SDS 40 ST60; suffered pain that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
130947 - prevented reaching top of Half Dome, but likely not related to delay                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
130948 - receiving VA orthotics. ref SDS 40 ST60  Advise VA Prolab custom                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
130949 - orthotic inserts significantly reduce metatarsalgia pain compared to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
130950 - other measures.  Enables hiking up to 3 days in a row; may support                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
130951 - hiking 300 miles per month, which has proven effective controlling CVD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
130952 - risk by reducing atherosclerosis, based on lipid labs. ref SDS 40 ST68                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
130953 - Switching inserts between shoes causes debilitating injuries.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
130954 - ref SDS 40 ST79  Therefore to maintain level of effort, would like to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
130955 - order 3 more sets of VA Prolab orthotics so that all 4 pair of Hoka                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
130956 - Stinson Trail shoes have separate inserts.  If there is a cost                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
130957 - consideration, I can pay for the work. ref SDS 40 ST92                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
130958 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130959 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130961 -  ..
1310 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1311 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1312 - Progress at 0900                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
1313 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
131301 - Podiatry Meeting Review Metatarsalgia Orthotic Inserts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
131302 - 
131303 - Follow up ref SDS 41 AK6J, ref SDS 35 AK6J.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
131304 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131305 - After getting a blood draw, Kathy and I had lunch in the cafeteria.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
131306 - Considered trying to see Karen in Cardiology to say hello and follow                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
131307 - up prior discussions on standard of care testing response to treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
131308 - for atherosclerosis with coronary CTA and calcium score, reported on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
131309 - 140805 1030. ref SDS 25 0082  Further considered requesting emergency                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
131310 - care in Podiatry for treatment of persistent blister on left foot and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131311 - new blister on right foot that occurred hiking yesterday on 141020,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
131312 - reported in case study on 120101 0900. ref SDS 2 6H3L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
131313 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131315 -  ..
131316 - After meeting with Karen in Cardiology, reported on 141021 1226,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
131317 - ref SDS 43 0082, walked to ROI on 2nd floor building 202, and received                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
131318 - the report for the lab earlier morning on 141021 1150. ref SDS 42 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
131320 -  ..
131321 - Walking down the main hallway returning from ROI, knocked on the door                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131322 - of Podiatry, rather than check in at the Module 3 counter, and request                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
131323 - a meeting.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
131325 -  ..
131326 - The main Podiatry secretary, Laura, listened to the explanation of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
131327 - treatment by Doctor Tang and Priya last week on 141009 0900,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
131328 - ref SDS 41 EL3K, and that yesterday had more problems with same                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131329 - blister on left foot, and new problem on big toe of right foot,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131330 - reported yesterday on 14102 shown in case study 120101 0900.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
131331 - ref SDS 2 6H3L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
131333 -  ..
131334 - Laura checked her computer and found the record of recent treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
131335 - last week on 141009 0900. ref SDS 41 AK6J  She left her desk to find                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
131336 - and consult with Doctor Tang.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
131338 -  ..
131339 - About 2 minutes later she returned and said the doctor agreed to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
131340 - provide emergency care.  Laura created a record in the medical chart                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
131341 - setting up immediate treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131342 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131344 -  ..
131345 - Meeting with Doctor Robert Tang and Priya Patel                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
131346 - 
131347 - Follow up ref SDS 41 LS9T.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
131348 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131349 - Objective is removing more hardened tissue since the prior meeting on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131350 - 141009, along the length of blisters on the inside of both big toes,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
131351 - that act like a knife cutting into softer underlying tissue after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
131352 - hiking 4 miles or so.  This causes severe injury and pain over the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
131353 - next 7 miles.  Doctor Tang was disappointed that rework is required                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
131354 - today, less than 2 weeks after treatment on 141009 0900. ref SDS 41                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
131355 - LS9T  This occurred, because successful Podiatry care for metatasalgia                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
131356 - enabled hiking to increase following a periord of significant decline                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131357 - due to metatasalgia, shown in patient history...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
131359 -                ..
131360 -               Mileage 2014                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
131361 -               
131362 -               Follow up ref SDS 41 V15F.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
131363 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131364 -               130902....Aug................. 297     4916 ...... ref SDS 2 554N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131365 -               130929....Sep................. 225     4305 ...... ref SDS 2 419J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131366 -               131103....Oct................. 373     5757 ...... ref SDS 2 6F9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131367 -               131201....Nov................. 172     2899 ...... ref SDS 2 XRPV                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131368 -               131229....Dec................. 234     3324 ...... ref SDS 2 XXQY                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131369 -               140202....Jan................. 347     5393 ...... ref SDS 2 YWST                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131370 -               140302....Feb................. 234     3681 ...... ref SDS 2 PYWS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131371 -               140330....Mar................. 207     3313 ...... ref SDS 2 RXPR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131372 -               140427....Apr................. 310     4402 ...... ref SDS 2 RXVV                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131373 -               140601....May................. 322     5338 ...... ref SDS 2 SXWV                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131374 -               140629....Jun................. 156     2337 ...... ref SDS 2 ZW4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131375 -               140803....Jul.................  81     1023 ...... ref SDS 2 I37G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131376 -               140831....Aug................. 140     1998 ...... ref SDS 2 236I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131377 -               140928....Sep................. 136     2855 ...... ref SDS 2 XWUY                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131379 -  ..
131380 - Successful care of blisters today, combined with resolving                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
131381 - metatrsalgia pain that began at the end of June, enables resuming                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
131382 - physical activity hiking 300 miles per month that yielded significant                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131383 - improvement of lipid management toward regression of atherosclerosis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
131384 - to lower CVD risk, planned in the meeting with VA on 140519 0800.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
131385 - ref SDS 10 YM5N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131387 -  ..
131388 - Priya used a scaple to shave more crusted tissue from blister on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
131389 - inside of big toe left foot, continuing prior work on 141009 0900.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
131390 - ref SDS 41 EL3K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131392 -  ..
131393 - This effort resulted in a smoother surface with less noticable                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
131394 - crusted remaining tissue.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
131396 -  ..
131397 - Priya did the same procedure to remove crusted tissue from the new                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
131398 - blister on the right foot.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
131400 -  ..
131401 - Doctor Tang issued several pair of protective cuffs that can be worn                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
131402 - during hikes that increase pressure on these areas.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
131404 -  ..
131405 - The doctor will submit Geri-hydrolac 12 Urea lotion that will soften                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
131406 - these blister areas to aid recovery.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
131407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131408 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131410 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131411 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131412 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131413 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131414 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131415 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131416 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131417 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131418 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131419 -