CONTACTS
SUBJECTS
VA Podiatry Review Metatarsalgia Pain Balls of Feet Enable Physical
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 50 0000. ref SDS 49 0000.
040502 -
040503 -
040504 -
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040506 -
040507 -
040508 -
040510 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - Meeting Doctor Tang in Podiatry on 140805 1030. ref SDS 26 NU4G
040902 - Progress Notes for meeting on 140805, call for return to clinic after
040903 - receiving FFO. ref SDS 26 IJ4G A few days after meeting on 140805,
040904 - received letter from VA scheduling follow meeting today on 140820
040905 - 1000.
040907 - ..
040908 - On 140828 meeting with Doctor Kevin Daun and later with Doctor Mihara,
040909 - attending developed solution to blister on inside of big toe on left
040910 - foot, ref SDS 34 W74O, that required stopping 11 mile hike after 8
040911 - miles and calling for a ride home, shown in case study on 120101 0900.
040912 - ref SDS 2 BO6F
040914 - ..
040915 - On 140904 0900 meeting with Doctor Cynthia Lieu and Doctor Tang,
040916 - attending. ref SDS 37 AK6J Doctor Tang said orthotics can be trimed
040917 - to fit a smaller shoe size, if necessary; he has scheduled a meeting
040918 - after orthotics inserts are received. ref SDS 37 4M3H
040920 - ..
040921 - On 150115 0845 meeting with Doctor Tang and Doctor Goodman, the doctor
040922 - ordered a 2nd set of orthotic inserts to recover from and prevent
040923 - recurrance of metatarsalgia. ref SDS 42 BG6I
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040929 -
040931 - ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - While at VA Medical Center today for lab, reported in another record,
041302 - visited briefly with Podiatry to follow up letter from Doctor Tang on
041303 - 160122 1158. ref SDS 50 AK6J
041305 - ..
041306 - There are 3 issues...
041307 -
041308 - 1. Receive new orthotic inserts ordered by Doctor Hewitson on
041309 - 151215 1000. ref SDS 48 HM8J
041311 - ..
041312 - Letter to Doctor Tang reported orthotic inserts have not
041313 - been received after 5 weeks, which conflicts with prior
041314 - delivery of inserts in 3 weeks, shown in the letter on
041315 - 160121 2128. ref SDS 49 A26F
041317 - ..
041318 - Letter from Doctor Tang saying he would notify Doctor
041319 - Hewitson to check on delivery of orthotics, reported on
041320 - 160122 1158. ref SDS 50 PZ57
041322 - ..
041323 - 2. Orthopedic referral implement Doctor Hewitson's
041324 - recommendation to consider injection hyaluronic acid
041325 - (Synvisc) to protect against continuing damage to knees
041326 - suffering osteoarthritis (degenerative arthritis), reported
041327 - on 151215 1000. ref SDS 48 RI6H
041329 - ..
041330 - This suggestion was not set out in Progress Notes.
041332 - ..
041333 - 3. Modifications orthotic inserts performed by Doctor Hewitson
041334 - on 151215 1000, ref SDS 48 9B6I, may be causing pain in
041335 - right knee that did not occur prior 20 years before changes
041336 - to orthotic inserts on 151215.
041337 -
041339 - ..
041340 - Initially, the admin agent inquired and found that new orthotic
041341 - inserts ordered on 151215, were shipped by Prolab on 151225, to the
041342 - VA. Previous inserts were received by the patient at home on 140910
041343 - 1553. ref SDS 40 AK6J Second pair of orthotic inserts were also
041344 - received at home on 150207 0845. ref SDS 43 AK6J
041346 - ..
041347 - The record is unclear why inserts were shipped to the VA instead of
041348 - the customer.
041350 - ..
041351 - Doctor Brooke Goodman was helpful explaining that the inserts have
041352 - likely been received at the VA Medical Center and initially stored in
041353 - a warehouse, pending distribution to Podiatry, who will then notify
041354 - the patient on scheduling a meeting.
041356 - ..
041357 - Doctor Tang joined the meeting and concurred that orthotic inserts
041358 - ordered on 151215, are likely stored in the VA Medical Center
041359 - warehouse. He suggested waiting another few weeks. If there is no
041360 - notice at that time for patient to visit the hospital to receive the
041361 - inserts, then contact Podiatry again to follow up.
041363 - ..
041364 - Doctor Goodman further advised that Doctor Hewitson's patient
041365 - consultant schedule is booked for next 6 months.
041367 - ..
041368 - Doctor Goodman seemed to say that Doctor Hewitson does not require
041369 - meeting with patients to modify new orthotic inserts. He and his
041370 - staff take careful, thorough notes of the meeting on 151215, and he
041371 - can use those notes to modify the new inserts when they are received.
041373 - ..
041374 - We reviewed the record meeting with Doctor Hewitson in Podiatry on
041375 - 151215. The doctor asked the patient to bring the 2nd set of orthotic
041376 - inserts for meeting with him to make modifications he performed on the
041377 - first set of inserts, reported on 151215 1000. ref SDS 48 HM90
041379 - ..
041380 - There is now an additional concern right knee has suffered severe
041381 - pain, since customized changes trying multiple configurations to
041382 - orthotic inserts based on extensive observations of patient walking to
041383 - assess body alignment, reported on 151215 1000. ref SDS 48 9B6I Since
041384 - the new inserts will be different from prior inserts that were
041385 - modified, this presents high risk for achieving effective changes
041386 - based on reading notes of prior changes, particularly since the prior
041387 - changes need to be modified to avoid inuries caused to right knee.
041389 - ..
041390 - Doctor Goodman seemed further to say that in this case, since Doctor
041391 - Hewitson will meet with the patient to consider modifications to
041392 - changes made on orthotic inserts on 151215, and which may be causing
041393 - injury to right knee.
041395 - ..
041396 - Doctor Tang asked about left knee pain - does only the right kee hurt
041397 - when hiking?
041399 - ..
041400 - Explained that thankfully, only the right knee hurts. This may
041401 - reflect that 40 years ago, left knee was injured falling into a pump
041402 - station about 40'. Fortunate to have lived, and only left knee was
041403 - injured. Recovery required stadard surgical removal of damaged
041404 - cartalege. Since that time, despite physical therapy, patient has
041405 - unconsciously favored the right leg. With the right leg doing more
041406 - work on for extended endurance exercise (e.g., 11 mile and 15 mile
041407 - hikes), the right leg may be more susceptible to injury than the left.
041409 - ..
041410 - Doctor Tang commented that changing prior modifications to inserts on
041411 - 151215, will likely resolve new pain occurring in right knee. He
041412 - suggested not wearning the orthotic inserts that were modified on
041413 - 151215, until Doctor Hewitson can meet and assess adjustments to
041414 - prevent further injury to the right knee.
041416 - ..
041417 - This indicates meeting with orthopedics for injecting hyaluronic acid
041418 - (Synvisc) to protect against continuing damage to knees should be
041419 - deferred until after Doctor Hewitson has a chance to modify changes
041420 - made to orthotic inserts on 151215.
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