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: December 16, 2015 11:30 AM Wednesday; Rod Welch

VA Radiology fracture right wrist injury hiking Half Dome and both knees.

1...Summary/Objective
2...Xray Right Wrist and Both Knees 151216
3...Knees Xray Study and Xray Right Wrist 151216
4...Medical Chart Radiology Report Imaging Files CCTA Scan on 151216
5...CCTA Scan on 151216 Medical Chart Radiology Report Imaging Files
........KNEE ORTHO OA, BILAT: ROSENBERG, STANDING AP, LAT, MERCHANT
........WRIST, RIGHT, 3 OR MORE VIEWS


..............
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CONTACTS 

SUBJECTS
Yosemite Half-Dome Hike 9 Hours Reached Beginning Swishbacks to Top                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2103 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2103 -    ..
2104 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
2105 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
210501 - Follow up ref SDS 13 0000. ref SDS 11 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
210502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210506 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210508 -  ..
2106 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2107 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2108 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2109 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
210901 - Met with Alex in Radiology Administration.  She checked me in for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
210902 - xray on both knees and right wrist.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
210904 -  ..
210905 - Placed order for CD with these xray studies, and the doctor's report.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
210906 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210907 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210909 -  ..
2110 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2111 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2112 - 1133                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
2113 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
211301 - Met with Mike.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
211302 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211303 - He performed xrays on both knees and the right wrist, which were                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
211304 - ordered by Doctor Chu in Orthopedics during the meeting at the VA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
211305 - Medical Center in San Francisco on 151104 1315. ref SDS 13 FL52                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
211307 -  ..
211308 - Was surprised these were xray studies instead of CT technology, since                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
211309 - xray study on 151005 failed to identify a fracture, ref SDS 11 WE9J,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
211310 - but a supplemental CT scan clearly showed the fracture of the right                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
211311 - wrist. ref SDS 11 469H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
211313 -  ..
211314 - Also surprised xray of left knee does not seem to show significant                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
211315 - cartelage missing with bone from upper leg growing down to fill the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
211316 - gap with the lower bone which was clearly shown in the xray done at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
211317 - Kaiser on 990910 1410. ref SDS 2 OE68  At that time on 990910, the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
211318 - condition was similar but worse than shown by xray 10 years earlier on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
211319 - 881010. ref SDS 1 6295                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
211320 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211321 -            [...below on 151216 1130 Radiology report on xray says                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
211322 -            "...left knee shows moderate medial compartmental and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
211323 -            medial patellofemoral joint space narrowing and moderate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
211324 -            tricompartmental marginal osteophytes." ref SDS 0 BO5O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
211326 -  ..
211327 - This seemingly miraculous recovery from severe degenerative arthritis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
211328 - diagnosed on 881010, and worsening on 990910, may result from hiking                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
211329 - 11 miles per day (10,000 miles past 4 years, and combined with taking                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
211330 - Glucosamine Chondroitin.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
211332 -  ..
211333 - Should ask Craig Boulris in Orthopedics at Kaiser in Walnut Creek for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
211334 - xray study on 990910                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
211335 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211336 -            [On 151223 1013 went to Kaiser - requested xray study                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
211337 -            performed on 990910 that showed severe degenrative                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
211338 -            arthritis. ref SDS 16 XJ6L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
211339 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211340 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211341 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211342 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211343 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211344 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211345 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2114 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Default Null Subject Account for Blank Record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2203 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
220401 -  ..
220402 - Xray Right Wrist and Both Knees 151216                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
220403 - Knees Xray Study and Xray Right Wrist 151216                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
220404 - Medical Chart Radiology Report Imaging Files CCTA Scan on 151216                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
220405 - CCTA Scan on 151216 Medical Chart Radiology Report Imaging Files                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
220406 - 
220407 - Radiology studies for both right wrist, and both knees were performed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
220408 - at same time and submitted by VA on same CD...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
220409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220410 - Stored Radiology Imaging Fiies...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
220411 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220412 -              F:\05\00003\SM\CC\GMPF\GFJ\20151216-111755\                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
220414 -  ..
220415 - The file that launches radiology imaging is...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
220416 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220417 -              F:\05\00003\SM\CC\GMPF\GFJ\20151216-111755\GEARView.exe                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
220419 -  ..
220420 - Radiology issued written report analysing findings and impressions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
220421 - stored in...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
220422 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220423 -              F:\05\00003\SM\CC\GMPF\GFJ\20151216-111755\w0144_welch_12 15 15.pdf                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
220425 -  ..
220426 - This radiology report was reviewed with Doctor Choo in a meeting later                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
220427 - today, reported in another record on 151216 1315. ref SDS 14 JN3J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
220428 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220430 -         ..
220431 -        KNEE ORTHO OA, BILAT: ROSENBERG, STANDING AP, LAT, MERCHANT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
220432 -        
220433 -        Exm Date: DEC 16, 2015@11:08                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
220434 -        Req Phys: CHOO,KEVIN J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
220436 -         ..
220437 -        Pat Loc: ORTHO-TRAUMA (Req'g Loc)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
220438 -        Img Loc: RADIOLOGY*                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
220439 -        Service: Unknown                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
220440 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220441 -        (Case 976 COMPLETE) KNEE ORTHO OA, BILAT: ROSENBERG, (RAD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
220442 -        Detailed) CPT:73565                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
220444 -         ..
220445 -        Reason for Study: knee pain                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
220446 -        Clinical History:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
220447 -        knee pain                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
220448 -        Report Status: Verified                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
220450 -         ..
220451 -        Date Reported: DEC 16, 2015                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
220452 -        Date Verified: DEC 16, 2015                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
220454 -         ..
220455 -        Verifier E-Sig:/ES/MARCIA J. MCCOWIN, M.D.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
220457 -         ..
220458 -        Report:   Comparison: None                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
220460 -         ..
220461 -        Impression:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
220462 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220463 -        1.  4 weightbearing views of both knees show findings of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220464 -            diffuse osteopenia and degenerative joint disease.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
220466 -             ..
220467 -        2.  The left knee shows moderate medial compartmental and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
220468 -            medial patellofemoral joint space narrowing and moderate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
220469 -            tricompartmental marginal osteophytes.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
220471 -  ..
220472 - Seems like good news - how did "severe" degenerative arthritis with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
220473 - missing cartilage, reported by Doctor Boulris at Kaiser on 990910                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
220474 - 1410. ref SDS 2 OE68, improve to "moderate" and "marginal"                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
220475 - osteophytes?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
220476 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220477 -               [On 151216 1315 during meeting in Orthopedics                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220478 -               Department, Doctor Lau advised that both knees look                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
220479 -               normal for 70 year old with no symptoms. ref SDS 15 E16F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
220480 -               Progress Notes report "Left knee: mild degenerative                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
220481 -               changes" rather than "moderate joint narrowing" in xray                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
220482 -               findings. ref SDS 14 U658                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
220484 -                ..
220485 -               [on 151216 1315 Doctor Lau Progress Notes report -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
220486 -               Bilateral knees: reassured patient that clinically and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
220487 -               radiographically no signficant disease that would                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220488 -               require any intervention particularly because he is not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
220489 -               symptomatic. ref SDS 15 U669                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
220491 -                ..
220492 -               [On 151223 1013 went to Kaiser - requested xray study                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
220493 -               performed on 990910 that showed severe degenrative                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
220494 -               arthritis. ref SDS 16 XJ6L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
220496 -  ..
220497 - VA Xray study on 151216 continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
220498 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220499 -        3.  The right knee shows mild tricompartmental osteophytes.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
220501 -         ..
220502 -        Primary Diagnostic Code:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220504 -         ..
220505 -        Primary Interpreting Staff:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
220506 -        MARCIA J. MCCOWIN, M.D., Staff Radiologist UC# 25632                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
220507 -        (Verifier)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
220508 -        /MJM                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
220509 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220511 -         ..
220512 -        WRIST, RIGHT, 3 OR MORE VIEWS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
220513 -        
220514 -        Exm Date: DEC 16, 2015@11:08                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
220515 -        Req Phys: CHOO,KEVIN J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
220516 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220517 -        Pat Loc: ORTHO-TRAUMA (Req'g Loc)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
220518 -        Img Loc: RADIOLOGY*                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
220519 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220520 -        (Case 977 COMPLETE) WRIST, RIGHT, 3 OR MORE VIEWS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
220521 -        (RAD Detailed) CPT:73110                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220523 -         ..
220524 -        Reason for Study: right drf                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
220525 -        Clinical History:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
220526 -        right drf                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
220527 -        Report Status: Verified                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
220529 -         ..
220530 -        Date Reported: DEC 16, 2015                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
220531 -        Date Verified: DEC 16, 2015                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
220533 -         ..
220534 -        Verifier E-Sig:/ES/MARCIA J. MCCOWIN, M.D.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
220535 -        Report:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
220536 -        Comparison: 10/5/2015                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
220538 -         ..
220539 -        Impression:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
220540 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220541 -        1.  Mild callus formation is seen at the distal radius                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
220542 -            fracture.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
220544 -         ..
220545 -        Primary Diagnostic Code:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220546 -        Primary Interpreting Staff:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
220547 -        MARCIA J. MCCOWIN, M.D., Staff Radiologist UC# 25632                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
220548 -        (Verifier)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
220549 -        /MJM                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
220550 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220551 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220552 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220553 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220554 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220555 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220556 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220557 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220558 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220559 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220560 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
220561 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2206 -