CONTACTS
SUBJECTS
VA Podiatry Review Metatarsalgia Pain Balls of Feet Enable Physical
1303 -
1303 - ..
1304 - Summary/Objective
1305 -
130501 - Follow up ref SDS 50 0000. ref SDS 47 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 ordered by 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 -
130983 - ..
1310 -
1311 -
1312 - Progress at 0900
1313 -
131301 - Podiatry Meeting Review Metatarsalgia Orthotic Inserts
131302 -
131303 - Follow up ref SDS 50 AK6J, ref SDS 47 AK6J.
131304 -
131305 - Meeting scheduled by Donna on 150514 1003. ref SDS 49 PRQR
131307 - ..
131308 - Agenda...
131309 -
131310 - 1. Metatarsalgia seems fully recovered with prescribed care
131311 - wearing Prolab orthotic inserts with Hoka shoes.
131313 - ..
131314 - Past 6 months on daily 11 mile hikes suffer breakthrough pain
131315 - level 1-3 a few times that lasts 10 yards to 100 yards. This
131316 - is very tolerable for purposes of maintaining extended
131317 - endurance exercise for resolving and preventing atherosclerotic
131318 - plaques.
131320 - ..
131321 - 2. New Prolab orthotic ordered by Doctor Tang on 150115 0845.
131322 - ref SDS 47 BG6I They were received on 150207 0845. ref SDS 48
131323 - AK6J
131325 - ..
131326 - This second pair of orthotics seems to cause pain in both
131327 - feet, so stopped wearing them, and only now use 1st pair.
131328 - Doctor Tang can investigate 2nd pair to assess the problem.
131330 - ..
131331 - 3. New injury to bottom of right foot that occurred on 150511,
131332 - reported in case study on 140101 0600. ref SDS 7 KR3G
131333 - Recovered 4 days later, and resumed hiking.
131335 - ..
131336 - On 150514 called Doctor Tang to request examination. Meeting
131337 - was scheduled for today on 150619.
131339 - ..
131340 - 4. On 150530 same injury to left foot; recovered after taking 1
131341 - day off hiking. ref SDS 6 E75M
131343 - ..
131344 - 5. Feet have recovered to some degree from dehydration caused by
131345 - resuming treatment with statins, reported on 150601.
131346 - ref SDS 6 RG5F
131348 - ..
131349 - 6. At that time on 150601, bottom both feet progressively dry
131350 - day-to-day and mouth very dry during the night from
131351 - dehydration. Peeling and cracking; sores tear open slightly
131352 - dragging feet across floor mat in kitchen. Frequent urniation
131353 - from taking statins causing dehydration; research today found
131354 - correlation with high blood pressure that has increased by
131355 - order of magnitude the past few weeks. Medical authorities
131356 - seem further to associate dizziness with dehydration caused by
131357 - frequent urniation.
131359 - ..
131360 - 7. Left foot has more blister problems than right foot.
131362 - ..
131363 - 8. There is currently some kind of cracked skin between little toe
131364 - and adjacent toe on left foot.
131365 -
131366 -
131367 -
131368 -
1314 -
SUBJECTS
Default Null Subject Account for Blank Record
1403 -
140401 - ..
140402 - Progress Notes for Podiatry Examination 150619
140403 -
140404 - VA Progress Notes obtained from...
140405 -
140406 - https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel=mhvHome
140407 -
140414 - ..
140415 - Progress Notes stored in...
140416 -
140417 - F:\05\00003\SM\CC\AGMJ\20150619-125721\mhv_WELCH_20160418_1119.txt
140419 - ..
140420 - This is a test.
140421 -
140422 -
140423 - 1. Date/Time: 19 Jun 2015 @ 1257
140424 - Note Title: PODIATRY CLINIC F/U
140425 - Location: San Francisco CA VAMC
140426 - Signed By: TANG,ROBERT E
140427 - Co-signed By: TANG,ROBERT E
140428 - Date/Time Signed: 19 Jun 2015 @ 1651
140430 - ..
140431 - 2. LOCAL TITLE: PODIATRY CLINIC F/U
140432 - STANDARD TITLE: PODIATRY OUTPATIENT NOTE
140433 - DATE OF NOTE: JUN 19, 2015@12:57 ENTRY DATE: JUN 19, 2015@12:57:21
140434 - AUTHOR: TANG,ROBERT E EXP COSIGNER:
140435 - URGENCY: STATUS: COMPLETED
140437 - ..
140438 - 3. The attending physician of record for this patient care
140439 - encounter is Dr Tang
140441 - ..
140442 - 4. S Mr Welch is a 70 Y.O. man who RTC to f/u on resolving
140443 - metatarsalgia after receiving new orthoses. Patient states
140444 - that his feet will occasionally be sore after his daily hike in
140445 - the new orthoses. He thinks that he may need to break them in
140446 - more. Patient also complains of cracked skin in his left 4th
140447 - webspace. .
140449 - ..
140450 - 5. O Lower extremity examination:
140451 -
140452 - DERM: Skin warm, dry and supple, b/l. No ulcerations or
140453 - abrasions noted. Mild medial pinch calluses, b/l. Mild
140454 - scaling noted left 4th webspace. VASC: DP and PT pulses
140455 - palpable, bil. CFT<3 sec, all digits. No edema b/l. Skin
140456 - temp warm to touch. NEURO: Bilaterally Protective sensation
140457 - intact via 5.07 SWMF test. Sensation intact to light touch
140458 - over sural, saphenous, deep peroneal, superficial peroneal and
140459 - tibial nerve distributions. MSK: Rectus foot. B/l 5/5 muscle
140460 - strength with all LE muscle groups. No TTP b/l plantar
140461 - metatarsal heads. Mild pain at medial hallux pinch calluses
140462 - which resolved post debridement of hyperkeratotic skin.
140464 - ..
140465 - 6. A 70-year-old gentleman with CAD and hyperlipidemia presents to
140466 - the clinic with painful medial pinch calluses of hallux, b/l.
140467 - Metatarsalgia has resolved with orthotic use.
140468 -
140469 - 1. Debridement of HPK on medial hallux IPJ, b/l.
140471 - ..
140472 - This helps fix problem with big toe on left foot, reported for meeting
140473 - today, per above. ref SDS 0 653N
140474 -
140475 - [On 150729 0800 Doctor Rao references Doctor Tang's
140476 - Progress Notes here reporting debridement of HPK on
140477 - medial halux. ref SDS 51 299K
140479 - ..
140480 - 2. Continue wearing new orthotics as directed.
140482 - ..
140483 - 3. Cont Urea 20% cream. Patient to apply to hyperkeratotic
140484 - lesions
140486 - ..
140487 - 4. Cont ammonium lactate lotion; patient to apply to dry skin
140489 - ..
140490 - 5. Educated patient on daily foot care and recommneded
140491 - changing shoes after 600 miles of use.
140493 - ..
140494 - 6. Patient to RTC prn
140496 - ..
140497 - 7. Clinical Reminder Activity
140498 - MED REC NON PRIMARY CARE:
140499 -
140500 - Current medications reviewed with patient/caregiver and
140501 - reconciliation of medications related to today's visit
140502 - completed, including non-VA medications and discrepancies,
140503 - if identified, were addressed.
140505 - ..
140506 - Medication changes and the importance of medication
140507 - management were reviewed with the patient/caregiver today
140508 - based on individual needs.
140510 - ..
140511 - Patient/caregiver acknowledged understanding of
140512 - instructions as stated. An updated list of reconciled
140513 - medications has been provided to the patient/caregiver.
140514 -
140515 - 8. /es/ ROBERT E TANG,DPM/VA13252
140516 - ATTENDING PODIATRIST
140517 - Signed: 06/19/2015 16:51
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