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: May 16, 2016 08:30 AM Monday; Rod Welch

VA Podiatry Biometrics Doctor Hewitson adjust orthotic inserts and ordered ankle braces.

1...Summary/Objective


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CONTACTS 

SUBJECTS
VA Podiatry Review Metatarsalgia Pain Balls of Feet Enable Physical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0403 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0403 -    ..
0404 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040501 - Follow up ref SDS 69 0000. ref SDS 59 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040506 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040507 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040508 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040509 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040510 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040512 -  ..
0406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0408 - Background                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040901 - Meeting Doctor Tang in Podiatry on 140805 1030. ref SDS 36 NU4G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040902 - Progress Notes for meeting on 140805, call for return to clinic after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040903 - receiving FFO. ref SDS 36 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 44 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 9 BO6F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040914 -  ..
040915 - On 140904 0900 meeting with Doctor Cynthia Lieu and Doctor Tang,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040916 - attending. ref SDS 47 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 47 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 52 BG6I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040925 -  ..
040926 - On 151215, met with Doctor Hewitson in Podiary. ref SDS 58 AK6J  He                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040927 - modified the Prolab orthotic inserts applied with Hoka Stinson Lite                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040928 - shoes size 10 worn today, and for the purpose of improving routine                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040929 - walking gait. ref SDS 58 9B6I  Observation of walking tests, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040930 - placing the doctor's hands on the patient's hips while standing to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040931 - evaluate body alignment, indicated to Doctor Hewitson that this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040932 - initial modification did not correct defect in walking gait, so he                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040933 - removed that modification and instead raised the heel of the left                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040934 - orthotic. ref SDS 58 NC7M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040936 -  ..
040937 - Doctor Hewitson said to bring in the other pair of orthotic inserts on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040938 - the next meeting in Podiatry for adding modifications that make both                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040939 - pair the same. ref SDS 58 1J98                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040941 -  ..
040942 - On 151215 1000 Progress Notes explain modifications to orthotics -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040943 - Improved gait by decreasing early heel off L, increased L knee                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040944 - extension, and decreased R recurvatum. ref SDS 59 ZA9I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040946 -  ..
040947 - On 151215, Doctor Hewitson and his team made molds of the feet to make                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040948 - new orthodic inserts.  They will be shipped in a few weeks.  When new                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040949 - orthotics are received, notify VA to schedule follow with Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040950 - Hewitson to review effectiveness, and to make modifications as needed,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040951 - and as done on 151215.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040953 -  ..
040954 - On 151215 1000 Progress Notes confirm follow up meeting will occur                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040955 - after receiving orthotic inserts. ref SDS 59 PK6L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040957 -  ..
040958 - On 140101 0600 case study reporting on 151222, developed new blister                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040959 - on left side little toe left foot, possibly related to changed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040960 - orthotics. ref SDS 15 IE9O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040962 -  ..
040963 - On 160202 1540 reported injury to right knee, very painful; Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040964 - Tang recommended not using adjusted orthotic inserts, until meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040965 - with Doctor Hewitson in Podiatry Biomechanics can evaluate adjustments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040966 - to avoid right knee injury. ref SDS 65 WG59                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040968 -  ..
040969 - On 160325 0443 letter to VA notifies Doctor Tang that orthotic inserts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040970 - ordered by Doctor Hewitson on 151215, have been received, so meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040971 - can be scheduled for Doctor Hewitson to configure the new inserts,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040972 - ref SDS 66 AK6J, as planned by the doctor during the prior meeting on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040973 - 151215. ref SDS 58 HM8J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040975 -  ..
040976 - On 160503 1130 encountered Doctor Hewitson in the cafeteria; he agreed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040977 - to provide care after lunch at 1300 in Podiatry. 160503 1256,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040978 - ref SDS 69 9A34                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040980 -  ..
040981 - On 160503 1300 meeting Doctor Hewitson in Podiatry.  Since this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040982 - meeting was ad hoc, we did not have the 3 sets of orthotic inserts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040983 - which he planned to modify, shown in the record on 151215 1000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040984 - ref SDS 58 1J98  Scheduled another meeting on 160516, for Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040985 - Hewitson to improve alignment of ankles, knees and hips. 160503 1256,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040986 - ref SDS 69 TN94                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040987 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040988 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040989 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040991 -  ..
0410 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0411 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0412 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0413 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041301 - Meeting with Doctor Hewitson and his team of medical students, planned                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041302 - in the meeting on 160503 1256. ref SDS 69 JQ44                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041304 -  ..
041305 - Brought 3 pair orthotic inserts for meeting.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041307 -  ..
041308 - The doctor examined the orthotic inserts and removed prior                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041309 - adjustments which had caused right knee MCL injury.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041311 -  ..
041312 - Doctor Hewitson also submitted 2 sets of spongy inserts to provide                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041313 - better cushioning in the shoes that prevents injury to feet and knees.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041314 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041315 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041316 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041317 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041318 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041319 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041320 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041321 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041322 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041323 -