CONTACTS
SUBJECTS
VA Podiatry Review Metatarsalgia Pain Balls of Feet Enable Physical
1303 -
1303 - ..
1304 - Summary/Objective
1305 -
130501 - Follow up ref SDS 43 0000. ref SDS 37 0000.
130502 -
130503 -
130504 -
130505 -
130506 -
130507 -
130509 - ..
1306 -
1307 -
1308 - Background
1309 -
130901 - Meeting Doctor Tang in Podiatry on 140805 1030. ref SDS 27 NU4G
130902 - Progress Notes for meeting on 140805, call for return to clinic after
130903 - receiving FFO. ref SDS 27 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 31 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 32 318I
130916 - ..
130917 - On 1408, 140827 follow up lab showed WBC 13.8 increased. ref SDS 34
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 35 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 37 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 37 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 39 AK6J
130939 - ..
130940 - On 140911 1529 letter to VA notified Podiatry received Prolab orthotic
130941 - inserts. ref SDS 40 AK6J
130943 - ..
130944 - On 141008 1349 letter to VA submit agenda for meeting on 141009 0900,
130945 - ref SDS 42 AK6J; advised orthotic inserts orderedby VA were not
130946 - received in time for Half Dome, ref SDS 42 ST60; suffered pain that
130947 - prevented reaching top of Half Dome, but likely not related to delay
130948 - receiving VA orthotics. ref SDS 42 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 42 ST68
130953 - Switching inserts between shoes causes debilitating injuries.
130954 - ref SDS 42 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 42 ST92
130959 - ..
130960 - On 141009 0900 meeting with Doctor Tang to review progress wearing
130961 - prescribed Prolab orthotic inserts combined with Thorlo socks and
130962 - ibuprofen medication to prevent metatarsalgia side effects hiking 300
130963 - miles per month for treating cardiovascular disease (CVD). ref SDS 43
130964 - W69H Doctor Tang scheduled another meeting on 150113, to order
130965 - another set of Prolab orthotic inserts. ref SDS 43 KE61
130967 - ..
130968 - On 141017 1422 received call from Podiatry Department at the VA
130969 - Medical Center in San Francisco, and was told meeting scheduled with
130970 - Doctor Tang on 150113 0800 has been cancelled and scheduled for 2
130971 - days later on 150115 0845 - did not enter this call in SDS.
130973 - ..
130974 - On 150113 1049 submitted letter to Doctor Tang in Podiatry Department
130975 - at the VA Medical Center in San Francisco, and reporting progress
130976 - recovering from metatarsalgia side effects hiking 300 miles per month
130977 - for recovering from CVD. ref SDS 46 AK6J Presented agenda for next
130978 - meeting on 151015 0845. ref SDS 46 F531
130979 -
130980 -
130981 -
130982 -
130983 -
130985 - ..
1310 -
1311 -
1312 - Progress at 0900
1313 -
131301 - Podiatry Meeting Review Metatarsalgia Orthotic Inserts
131302 -
131303 - Follow up ref SDS 43 AK6J, ref SDS 37 AK6J.
131304 -
131305 - Went to Module 3 and notified of arrival for the meeting with Doctor
131306 - Tang.
131308 - ..
131309 - On the wall that separates Module 3 from the ER is a document that
131310 - presents the mission for the VA health care system. Asked the
131311 - attendant at Module 3 for a copy of the VA mission; it could not be
131312 - provided. After meeting with Doctor Tang, went to ROI on the 2nd
131313 - floor and requested the mission statement. They were not aware of
131314 - the document.
131316 - ..
131317 - Meeting with Doctor Robert Tang scheduled today, as reported in the
131318 - record on 150108 1507, ref SDS 45 QH4J, and confirmed with the agenda
131319 - for the meeting submitted in a letter on 150113 1049. ref SDS 46 AK6J
131321 - ..
131322 - Doctor Goodman also assisted in the examination today.
131324 - ..
131325 - Issues for meeting...
131326 -
131327 - 1. Prolab orthotic inserts, ibuprofen medication, and Thorlo
131328 - socks, all prescribed by Doctor Tang at the VA, and further
131329 - combined with Hoka Stinson Lite shoes have, since the end
131330 - of October, 2014, restored ability to hike 11 miles per
131331 - day, 300 miles per month, including 22 miles per day on
131332 - consecutive days, shown in the agenda for the meeting
131333 - today, submitted with the letter on 150113 1049.
131334 - ref SDS 46 F497
131336 - ..
131337 - This recovery seems to exceed prognosis discussed during
131338 - the meeting in Podiatry on 140805 1030, ref SDS 27 1E65,
131339 - and implements planning in the letter to the VA on 141008
131340 - 1349. ref SDS 42 ST68
131342 - ..
131343 - 2. Ordered another pair of Prolab orthotic inserts to
131344 - supplement initial order on 140805 size 9, ref SDS 27 1F31,
131345 - and received on 140910 1553, ref SDS 39 AK6J; and, as
131346 - discussed during follow up meeting on 141009 0900,
131347 - ref SDS 43 KE61, and as set out in the lettter to the VA on
131348 - 150113 1049. ref SDS 46 F531
131350 - ..
131351 - [On 140101 0600 case study reports orthotic inserts
131352 - received on 140207. ref SDS 7 TR5I
131354 - ..
131355 - [On 150207 0845 received 2nd set Prolab orthotic inserts
131356 - ordered on 150115, by Doctor Tang in Podiatry Department
131357 - VA Medical Center in San Francisco. ref SDS 47 AK6J
131359 - ..
131360 - Reviewed existing orthotic inserts today for distortion
131361 - from wear and tear hiking 1000 miles. Estimate requirement
131362 - for ordering another set in addition to the order planned
131363 - for today.
131365 - ..
131366 - Doctor Goodman said her Prolab orthotic inserts lasted 7 years. She
131367 - advised that the degree of wear and tear on the inserts appears
131368 - moderate after 5 months hiking 1000 miles.
131370 - ..
131371 - Feet seem to improve everyday Prolab orthotic inserts are
131372 - worn. During hike yesterday there was near pain level 0
131373 - entire 11 mile hike with only 2 breakthrough episodes over
131374 - 3 hours, and lasting only a few minutes each, and despite
131375 - significantly increased speed including some running and
131376 - sprinting. (see case study on 140101 0600, ref SDS 6 8D4N).
131378 - ..
131379 - 3. Sore big toe left foot, treated in ER on 140828 0833.
131380 - ref SDS 35 WS3H, still prevented completing hike to top of
131381 - Half Dome had to turn back, reported on 140917 0540.
131382 - ref SDS 41 U342 This condition was treated effectively by
131383 - Doctor Pryia in Doctor Tang's office on 141009 0900,
131384 - ref SDS 43 EL3K; but, the problem required exigent care
131385 - again on 141021 1411. ref SDS 44 X66O
131387 - ..
131388 - This experience observing care provided by the VA has
131389 - enabled self-care at home for maintaining relief from
131390 - severe blisters, so that hiking 300 miles per month can be
131391 - maintained to lower CVD risks.
131393 - ..
131394 - Today, Doctor Goodwin did more treatment cutting away interim callus
131395 - buildup.
131397 - ..
131398 - 4. Cuffs to protect blisters on big toes need assistance
131399 - reordering, shown in agenda letter yesterday on 150113
131400 - 1049. ref SDS 46 F53T
131402 - ..
131403 - Doctor Tang submitted 4 sets of tube protective cuffs, which when cut
131404 - to length could last at least for the next year or so.
131406 - ..
131407 - 5. Feet suffered severe cracking, peeling with minor bleeding
131408 - from dryness beginning several weeks ago, but have nearly
131409 - recovered with increased hiking and using Geri-Hydrolac 12
131410 - lotion ordered by Doctor Tang during the emergency meeting
131411 - in Podiatry on 141021 1411. ref SDS 44 H24G
131413 - ..
131414 - Cause of dry feet historically in patient history has been
131415 - inactivity. About 3 months or so after patient began doing
131416 - 11 mile daily hikes in 2012, this "dry-feet" problem seemed
131417 - to resovle. More recently, dehydration may have been
131418 - caused by taking statin drugs that increase urination,
131419 - e.g., 8 times per night, following a period when treatment
131420 - was suspended and the body unajusted, and then treatment
131421 - resumed 10 days later, when delays getting drugs was
131422 - corrected. Accordingly, this may not be an issue for
131423 - Podiatry, but is submitted for the record in that the
131424 - problem seems now nearly resolved.
131426 - ..
131427 - No treatment was provided, since the patient already has previously
131428 - prescribed medical lotion.
131430 - ..
131431 - Doctor Tang scheduled next meeting in 6 months. After leaving the
131432 - meeting in Podiatry, visited the Schedule Department in Module 3.
131433 - The attendant entered a task in the VA system to notify the customer
131434 - in 5 months to call the VA and schedule a meeting within the next
131435 - month.
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