CONTACTS
SUBJECTS
Knee Injury ER Examination Xray Favorable Right Recurrance Hiking Se
2203 -
2203 - ..
2204 - Summary/Objective
2205 -
220501 - Follow up ref SDS 32 0000. ref SDS 30 0000.
220502 -
220503 -
220504 -
220505 - [On 170123 1530 Eugenia performed injection with Supartz
220506 - (alternate to Synvisc); there was no pain. Procedure was
220507 - simple and fast. ref SDS 35 VG6M
220509 - ..
220510 - [On 160101 0700 reporting hiking on 170125, 48 hours after
220511 - 1st treatment with Supratz; seemed to prevent pain right
220512 - knee on 6 mile hike; hours after hike right knee swelled
220513 - and stiff. ref SDS 16 X17O
220514 -
220515 -
220516 -
220518 - ..
2206 -
2207 -
2208 - Background
2209 -
220901 - Right knee history of injuries listed in the record on 160720 0505.
220902 - ref SDS 25 HV5G
220904 - ..
220905 - On 160504 0800 MRI on right knee. ref SDS 18 DE5L
220907 - ..
220908 - On 160720, meeting Orthopedics considered anthroscopic surgery to
220909 - remove debris in the knee causing pain while hiking. Doctor concerned
220910 - extended endurance training has worn away meniscus to a point that
220911 - anthroscopic surgery will remove so much material there will not be
220912 - enough to provide any cushion. In that case, the better alternative
220913 - will be knee replacement. ref SDS 26 VQ51
220915 - ..
220916 - On 160805 MRI found severe injuries to both right knee, ref SDS 29
220917 - DQ5J, and to the left knee. ref SDS 29 PSWR However, only right knee
220918 - suffers pain during hiking, event though left knee suffered much more
220919 - severe injury, and required surgery to remove cartelage.
220921 - ..
220922 - On 160810 1512 examination in Orthopedics review MRI on 160805,
220923 - compared with MRI on right knee performed on 160504. Clinical tests
220924 - found range of motion normal, and pain level 0 moving in all
220925 - directions. ref SDS 30 K05I This finding was helpful for increasing
220926 - training to hike Half Dome in Yosemite, scheduled on 160914.
220927 - ref SDS 30 MS4H The doctor consulted attending physician. She
220928 - indicated current regimen hiking 11 - 15 miles per day along with
220929 - icing before and after, is stimulating faster than normal recovery,
220930 - while taking Glucosamine Chondroitin, and Naproxen 400 mg to control
220931 - inflammation. ref SDS 30 YT9O As a result, at that time on 160805,
220932 - there was no need to implement prior planning for arthroscopic surgery
220933 - to remove torn meniscus, nor repair other injuries to the knee,
220934 - discussed with Doctor Trevor Grace on 160720 1550. ref SDS 26 VQ4M
220935 - The doctor said to notify the Orthopedic Department of any further
220936 - injuries or worsening symptoms to evaluate for medical measures.
220937 - ref SDS 30 J35N
220939 - ..
220940 - Following meeting on 160810, and beginning on 160814, increased
220941 - training for Half Dome. Hiked 208 miles, reported in case study
220942 - spreadsheet...
220943 -
220944 - F:\05\00003\SM\CC\BNKG\120216cc\130101cc\hiking_miles_3.xlsx
220945 -
220946 - ...which is cited in case study on exercise, diet, medication and
220947 - vitals, shown on 160101 0700. ref SDS 16 4X7F
220949 - ..
220950 - On 160914, hiked to top of Half Dome, 22 miles up and back. 160914
220951 - 0530, ref SDS 31 0001; suffered no evident right knee nor other
220952 - symptoms after nor following this hike.
220954 - ..
220955 - After Half Dome, continued extended endurance exercise, but with
220956 - gradual increase in right knee symptoms, e.g., reported in case study
220957 - on dates...
220958 -
220959 - Right Knee
220960 - Date Miles Naproxen Pain
220961 -
220962 - 160922.....11....400 mg....no..... 160101 0700, ref SDS 16 SWPS
220963 - 160923.....11....400 mg....no..... 160101 0700, ref SDS 16 G48N
220964 - 160924.....13....400 mg....no..... 160101 0700, ref SDS 16 8Q4I
220965 - 160925.....15....400 mg....no..... 160101 0700, ref SDS 16 ZI9O
220966 - 160926.....10....400 mg....no..... 160101 0700, ref SDS 16 JX5J
220967 - 160927.....11....400 mg....no..... 160101 0700, ref SDS 16 EE4F
220968 - 160928.....15....400 mg....no..... 160101 0700, ref SDS 16 6L6G
220969 - 160929.....15....400 mg....no..... 160101 0700, ref SDS 16 O55G
220970 - 160930.....15....400 mg....no..... 160101 0700, ref SDS 16 PC6G
220971 - 161001.....14....400 mg....no..... 160101 0700, ref SDS 16 3N5F
220972 - 161002.....15....400 mg....no..... 160101 0700, ref SDS 16 TX6G
220973 - 161003.....14....400 mg....no..... 160101 0700, ref SDS 16 ZR5G
220974 -
220975 -
220976 -
220977 -
220978 -
220980 - ..
2210 -
2211 -
2212 - Progress
2213 -
221301 - Today, meeting with...
221302 -
221303 - Alexis Dang, MD
221304 - Title Assistant Professor
221305 - UCSF School of Medicine
221306 - Department Orthopaedic Surgery
221307 - Address 1500 Owens St.
221308 - San Francisco CA 94158
221309 - Phone 415-353-7566
221310 -
221311 - http://profiles.ucsf.edu/alexis.dang
221313 - ..
221314 - Doctor Dang specializes in orthopedic surgery, shown in his published
221315 - credentials at UCSF and VAMCSF, including orthopedic research...
221317 - ..
221318 - Alexis Dang, MD
221319 - SAN FRANCISCO VA MEDICAL CENTER
221320 - 4150 Clement Street
221321 - San Francisco, CA 94121
221322 - Phone: 415-221-4810
221323 -
221324 - http://orthosurg.ucsf.edu/home/faculty/biography/alexis-dang-md/
221325 -
221327 - ..
221328 - Innovating in Models of Musculoskeletal Disease
221329 - Alexis Dang, MD
221330 - Staff Surgeon, Orthopaedic Sports Medicine, SFVAMC
221331 - Assistant Professor in Residence, Department of Orthopaedic Surgery, UCSF
221332 -
221333 - https://www.ncire.org/research/researchers_by_name/Alexis-Dang-MD/
221335 - ..
221336 - Dr Dang is a clinician-scientist focused on sports medicine
221337 - and orthopaedic surgery. His clinical interest revolve
221338 - around restoring and preserving musculoskeletal function,
221339 - with a research focus on cartilage injury and repair.
221341 - ..
221342 - Since cartilage repair is the central objective of current orthopedic
221343 - care, Doctor Dang's education, training, and experience focusing on
221344 - cartilege repqair aligns well with knee requirements.
221346 - ..
221347 - On 161121 1221 visited Betty in Orthopedics. She said to meet with
221348 - Module 2, and schedule meeting with Doctor Alexis Dang, the sports
221349 - medicine specialist. Went downstairs to Module 2. Met with Moses.
221350 - He scheduled meeting with Doctor Alexis Dang on 161212 1600, and
221351 - planned to ask the doctor about ordering another right knee MRI to
221352 - compare with the study on 160805 0800. ref SDS 29 FZ5L
221354 - ..
221355 - Doctor Dang said this afternoon, that Moses asked him about ordering
221356 - another MRI to test for increased injury to right knee. He did not
221357 - order it, because another MRI is only needed if there has been a
221358 - significant new injury, since the prior study on 160805 0800.
221359 - ref SDS 29 FZ5L
221361 - ..
221362 - Reviewed the record showing another major injury occurred to the right
221363 - knee on 161026, reported in case study of exercise, diet, vitals, and
221364 - medication on 160101 0700. ref SDS 16 UTUR This injury recurred again
221365 - 2 weeks later, which required calling a cab for a ride home the last 4
221366 - miles. ref SDS 16 T46N
221368 - ..
221369 - Doctor Dang showed on the computer screen in the examination room, MRI
221370 - scan images performed on left knee, 160805 0800, ref SDS 29 193K, and
221371 - below he displayed images on the right knee. ref SDS 29 FZ5L He lined
221372 - up these images to compare conditions at the same location in both
221373 - knees.
221375 - ..
221376 - He explained both knees have severe osteoarthritis, also,
221377 - "degenerative arthritis," with significant portions of knee cartilege
221378 - missing through surgery and ordinary wear from age. He said the left
221379 - knee is worse, but the right knee is severe.
221380 -
221381 - [On 170327 1430 another meeting in Orthopedics to primarily
221382 - resolve severe pain in right forefoot; Doctor Thuillier
221383 - also examined MRI on 160805 again, and noted, like Doctor
221384 - Dang, left knee shows more severe osteoarthritis than right
221385 - knee. ref SDS 39 HG8M
221387 - ..
221388 - Doctor Dang asked what happened to the left knee that required
221389 - surgery?
221391 - ..
221392 - In July 1973, patient fell 40' into a pump station on a construction
221393 - project, and landed on the left foot. Only the left knee was injured.
221394 - The left ankle wasn't even sprained. Miraculously, the patient fell
221395 - between 2 pumps rising 4' and only about 2' apart. Falling 40' and
221396 - remaining vertical to precisely miss these two steel objects avoided
221397 - certain death. The right knee was not injured, and has never
221398 - sustained a comparable, or even significant traumatic event.
221400 - ..
221401 - Doctor Dang noted the patient is fortunate that liquid Glucosamine
221402 - Chondroitin has been effective preventing injury to the right knee,
221403 - and preventing further injury to the left knee for 13 years, since
221404 - starting this line of care in about 2003. Prevention to knee injuries
221405 - for 13 years is particularly noteworthy on increasing extended
221406 - endurance exericse hiking and running 13,000 miles the past 5 years.
221408 - ..
221409 - Doctor Dang asked why the knees have been treated with Glucosamine
221410 - Chondroitin?
221412 - ..
221413 - Glucosamine Chondroitin case study is reported on 030807 2138.
221414 - ref SDS 5 FN9N
221416 - ..
221417 - On 990925, Doctor Craig Boulris with Orthopedics Department at Kaiser
221418 - in Walnut Creek, explained Glucosamine Chondritin might relieve severe
221419 - pain in left the knee from playing tennis from the prior 10 years.
221420 - ref SDS 2 3120 On 000124, Doctor Vincent Yamomoto, a sports medicine
221421 - specialist in orthopedics at Kaiser in Walnut Creek, reported
221422 - favorable results from personally using Glucosamine Chondroitin for
221423 - over 2 years. ref SDS 4 1680
221425 - ..
221426 - Glucosamine was then tried. The pills were too big to swallow due to
221427 - achalasia, diagnosed years later in July 2005. So, Glucosamine
221428 - Chondroitin had no effect. Exercise declined to avoid pain, and for
221429 - several years, weight increased.
221431 - ..
221432 - In May 2004, Doctor Johnson in Oncology at Kaiser in Walnut Creek,
221433 - advised that elevated white blood cell count (WBC) was required for
221434 - Millie to get chemotherapy treatments to recover from breast cancer
221435 - (IBC). He encouraged Millie to increase hiking because exercise
221436 - stimulates bone marrow to produce WBC, reported on
221437 - Millie increased hiking at
221438 - Lafayette reservoir. We hiked 3 mile laps with moderate hills, 1 - 4
221439 - per day, 5 times per week. This increased exercise maintained Mil's
221440 - WBC, so she never missed treatement, surviving stage 4 cancer for 10
221441 - years. Increased hiking quickly caused severe pain in both her and my
221442 - knees. One day, Millie brought home Glucosamine Chondroitin in liquid
221443 - form which she found at Costco. This solved the earlier swallowing
221444 - problem. Within a few days we both recovered, explained in the record
221445 - on 040529 0248. ref SDS 6 MZ40
221447 - ..
221448 - Until October of this year, Glucosamine Chondroitin in liquid form has
221449 - Prevented pain in the left knee, enabling hiking nearly 13,000 miles
221450 - the past 5 years. There has never been pain in the right knee until
221451 - this year. However, Glucosamine Chondroitin has not prevented pain in
221452 - the right knee.
221454 - ..
221455 - Doctor Dang advised the patient is fortunate that Glucosamine
221456 - Chondroitin has sustained both knees for all these years.
221458 - ..
221459 - We reviewed NIH Complementary and Alternative Medicine (CAM) study
221460 - found Glucosamine Chondroiten not effective for mild osteoarthritis
221461 - (OA), and also found this treatment provides significant relief for
221462 - patients suffering severe knee pain, reported on 090306 0800.
221463 - ref SDS 7 8Q8G
221465 - ..
221466 - Asked why the left knee, which has more severe injuries than the right
221467 - knee, shown in MRI study of both knees on 160805 0800. ref SDS 29
221468 - PSWR, does not hurt hiking and running 11 - 15 miles with Glucosamine
221469 - Chondroitin, but the right knee suffers rising pain while incurring
221470 - identical forces?
221472 - ..
221473 - The doctor said both knees on everyone have slightly different
221474 - architecture and biology. This partly explains why Glucosamine
221475 - Chondroitin has varying effects on each knee. He smiled and said the
221476 - patient has been lucky to get such favorable response to such severe
221477 - injuries on the left knee for such a long time.
221479 - ..
221480 - Doctor Dang pointed to a horizontal fracture seen as a thin, white
221481 - line across the top of the tibial plateau on the right knee, shown in
221482 - the MRI scan performed on 160805. ref SDS 29 DR55 This aligns with
221483 - the analyst's report for the MRI, which says in part...
221484 -
221485 - New subchondral insufficiency fractures involving the central
221486 - weightbearing aspect of the medial femoral condyle, as well as
221487 - the posterior aspect of the medial tibial plateau, with
221488 - surrounding bone marrow edema.
221490 - ..
221491 - Redemonstrated additional subchondral insufficiency fracture at
221492 - the posterior meniscal weightbearing aspect of the medial
221493 - femoral condyle, with interval resolution of surrounding bone
221494 - marrow edema, and new adjacent focal chondral thinning. Small
221495 - tricompartmental osteophytosis.
221497 - ..
221498 - Doctor Dang explained these fractures and swollen bone marrow edema in
221499 - the right knee cannot respond to treatment with Glucosamine
221500 - Chondroitin. There are no comparable injuries to the left knee,
221501 - possibily suggesting the patient has favored the right leg for a long
221502 - time, due to severe injury to the left knee that required surgery in
221503 - 1973. Even slight emphasis may over time have caused fractures to the
221504 - femoral condyle and tibial plateau, particularly hiking hills that
221505 - required increased pressure on weight bearing knee elements, and more
221506 - so hiking with speed going uphill, reported throughout case study on
221507 - 160101 0700. ref SDS 16 TTPX
221509 - ..
221510 - Explained these new and different injuries on the right knee, as shown
221511 - in MRI on 160805, likely compounded when sprinting on 160622, shown in
221512 - case study on 160101 0700, ref SDS 16 RN9N, and then re-injured 3
221513 - weeks later on 160715. ref SDS 16 PQSX These new injuries to the
221514 - right knee were originally reported as MCL strain or tear, because at
221515 - the time, as on 160622, the immediate high pain level 10+ and location
221516 - of pain seemed to fit past MCL injuries.
221518 - ..
221519 - On 160720 1550 meeting with Doctor Trevor Grace in VA Orthopecics at
221520 - Medical Center in San Francisco; the doctor preliminarily diagnosed
221521 - pain in right knee due to increased tear in meniscus. Ordered MRI to
221522 - evaluate for other injuries comparing with prior MRI on 160504,
221523 - expects may require anthroscopic surgery to repair injured meniscus,
221524 - or possibly knee replacement, will return on 160803 to review MRI
221525 - results and decide next steps. ref SDS 26 WI9I
221527 - ..
221528 - The doctor asked for history of injuries to right knee...
221529 -
221530 - On 150326 0700 twisted ankle sprinting
221531 - across street in dark during rush hour
221532 - traffic. This torqued right knee
221533 - MCL.................................. 140101 0600, ref SDS 8 6O6F
221535 - ..
221536 - On 150421 1210 reported pain due to
221537 - right knee MCL injury, during meeting
221538 - with VA Medical Center............... ref SDS 11 6Y8K
221540 - ..
221541 - On 150523 substantial recovery MCL
221542 - injury right knee.................... 140101 0600, ref SDS 8 NN8F
221544 - ..
221545 - On 151016 15 mile hike right knee pain level
221546 - 3 first time pain right knee hurt since recovery
221547 - on 150523, ref SDS 8 NN8F, from MCL injury
221548 - on 150326, ref SDS 8 6O6F, reported in
221549 - case study on........................ 140101 0600, ref SDS 8 BB6G
221551 - ..
221552 - On 151021 15 mile hike right knee pain
221553 - pain level 3 beginning mile 9 after 2 mile
221554 - slight downhill grade, reported in
221555 - case study on ....................... 140101 0600, ref SDS 8 SG8G
221557 - ..
221558 - On 151022 11 mile hike right knee pain
221559 - level 2 40% of route, reported in
221560 - case study on ....................... 140101 0600, ref SDS 8 I45G
221562 - ..
221563 - On 151023 8 mile hike over hills with
221564 - very fast pace right knee pain level 0
221565 - entire route, reported in case
221566 - study on............................. 140101 0600, ref SDS 8 WPPR
221568 - ..
221569 - On 151024 11 mile hike right knee pain
221570 - level 0 entire route, reported in
221571 - case study on ....................... 140101 0600, ref SDS 8 U65N
221573 - ..
221574 - On 151025 15 mile hike right knee pain
221575 - level 2 40% of route, reported in
221576 - case study on ....................... 140101 0600, ref SDS 8 A26M
221578 - ..
221579 - On 151026 15 mile hike right knee pain
221580 - level 2 40% of route, reported in
221581 - case study on ....................... 140101 0600, ref SDS 8 VXXU
221583 - ..
221584 - On 151026 6 mile hike over hills right
221585 - knee pain level 0 entire route,
221586 - reported in case study on ........... 140101 0600, ref SDS 8 VXXU
221588 - ..
221589 - On 151027 15 mile hike right knee pain
221590 - level 0 entire route, reported in
221591 - case study on ....................... 140101 0600, ref SDS 8 1S7H
221593 - ..
221594 - On 151027 3 mile hike over hills right
221595 - knee pain level 0 entire route,
221596 - reported in case study on ........... 140101 0600, ref SDS 8 1S7H
221598 - ..
221599 - On 151028 15 mile hike right knee pain
221600 - level 2 40% of route, reported in
221601 - case study on ....................... 140101 0600, ref SDS 8 VXXU
221603 - ..
221604 - On 151029 15 mile hike right knee pain
221605 - level 1 30% of route, reported in
221606 - case study on ....................... 140101 0600, ref SDS 8 L49M
221608 - ..
221609 - On 151030 15 mile hike right knee pain
221610 - level 3 40% of route, reported in
221611 - case study on ....................... 140101 0600, ref SDS 8 XG4K
221613 - ..
221614 - On 151031 15 mile hike right knee pain
221615 - level 2 20% of route, reported in
221616 - case study on ....................... 140101 0600, ref SDS 8 318M
221618 - ..
221619 - On 151101 15 mile hike right knee pain
221620 - level 2 30% of route, hurts more going
221621 - downhill reported in
221622 - case study on ....................... 140101 0600, ref SDS 8 HQ3F
221624 - ..
221625 - On 151102 6 mile hike right knee pain
221626 - level 0 entire route reported in
221627 - case study on ....................... 140101 0600, ref SDS 8 YY8J
221629 - ..
221630 - On 151103 15 mile hike right knee pain
221631 - level 3 30% of route reported in
221632 - case study on ....................... 140101 0600, ref SDS 8 B16M
221634 - ..
221635 - On 151104 1315 no hiking - meeting
221636 - Orthopedics VAMCSF reported new problem
221637 - of pain in right knee despite continuing
221638 - Glucosamine Chondroitin that prevented
221639 - knee pain for 12 years; pain started
221640 - OA 151016, after increasing hikes
221641 - from 11 to 15 miles.................. ref SDS 8 BB6G
221642 - Doctor Chu ordered xray studies
221643 - to evaluate both knees............... ref SDS 13 EG31
221645 - ..
221646 - On 151105 no hiking rest knee reported
221647 - in case study on..................... 140101 0600, ref SDS 8 WY9F
221649 - ..
221650 - On 151106 no hiking rest knee reported
221651 - in case study on..................... 140101 0600, ref SDS 8 QZ5L
221653 - ..
221654 - On 151107 11 mile hike right knee pain
221655 - level 2 50% of route, hurts more going
221656 - downhill reported in
221657 - case study on ....................... 140101 0600, ref SDS 8 FU5I
221659 - ..
221660 - On 151108 15 mile hike right knee pain
221661 - level 2 10% of route reported in
221662 - case study on ....................... 140101 0600, ref SDS 8 6E8K
221664 - ..
221665 - On 151109 no hiking due to injury big
221666 - toe left foot shown
221667 - in case study on..................... 140101 0600, ref SDS 8 463N
221669 - ..
221670 - On 151110 15 mile hike right knee pain
221671 - level 2 10% of route reported in
221672 - case study on ....................... 140101 0600, ref SDS 8 WURY
221674 - ..
221675 - On 151111 12 mile hike right knee pain
221676 - level 1 10% of route reported in
221677 - case study on ....................... 140101 0600, ref SDS 8 WXRX
221679 - ..
221680 - On 151111 3 mile hike right knee pain
221681 - level 1 last mile reported in
221682 - case study on ....................... 140101 0600, ref SDS 8 WXRX
221684 - ..
221685 - On 151112 no hiking rest body reported
221686 - case study on ....................... 140101 0600, ref SDS 8 4C6G
221688 - ..
221689 - On 151113 no hiking rest body reported
221690 - case study on ....................... 140101 0600, ref SDS 8 X18K
221692 - ..
221693 - On 151114 14 mile hike right knee pain
221694 - level 2 30% of route hurts more going
221695 - downhill reported in
221696 - case study on ....................... 140101 0600, ref SDS 8 Q14G
221698 - ..
221699 - On 151115 15 mile hike right knee pain
221700 - level 2 10% of route reported in
221701 - case study on ....................... 140101 0600, ref SDS 8 MP9F
221703 - ..
221704 - On 151116 15 mile hike right knee pain
221705 - level 0 entire hike reported in
221706 - case study on ....................... 140101 0600, ref SDS 8 RI4H
221708 - ..
221709 - On 151117 11 mile hike right knee pain
221710 - level 0 entire hike reported in
221711 - case study on ....................... 140101 0600, ref SDS 8 6Q4G
221713 - ..
221714 - On 151118 no hiking rest body reported
221715 - case study on ....................... 140101 0600, ref SDS 8 E36J
221717 - ..
221718 - On 151119 no hiking rest body reported
221719 - case study on ....................... 140101 0600, ref SDS 8 3U6K
221721 - ..
221722 - On 151120 no hiking rest body reported
221723 - case study on ....................... 140101 0600, ref SDS 8 BK3H
221725 - ..
221726 - On 151121 no hiking rest body reported
221727 - case study on ....................... 140101 0600, ref SDS 8 TC7O
221729 - ..
221730 - On 151122 3 mile hike right knee pain
221731 - level 0 entire lap reported in
221732 - case study on ....................... 140101 0600, ref SDS 8 YK5I
221734 - ..
221735 - On 151123 no hiking rest body reported
221736 - case study on ....................... 140101 0600, ref SDS 8 746G
221738 - ..
221739 - On 151124 11 mile hike right knee pain
221740 - level 2 10% of route reported in
221741 - case study on ....................... 140101 0600, ref SDS 8 4I3O
221743 - ..
221744 - On 151125 no hiking rest body reported
221745 - case study on ....................... 140101 0600, ref SDS 8 XQWQ
221747 - ..
221748 - On 151126 no hiking rest body reported
221749 - case study on ....................... 140101 0600, ref SDS 8 GT6G
221751 - ..
221752 - On 151127 no hiking rest body reported
221753 - case study on ....................... 140101 0600, ref SDS 8 XRPX
221755 - ..
221756 - On 151128 no hiking rest body reported
221757 - case study on ....................... 140101 0600, ref SDS 8 XRSY
221759 - ..
221760 - On 151129 no hiking rest body reported
221761 - case study on ....................... 140101 0600, ref SDS 8 4B8N
221763 - ..
221764 - On 151130 no hiking rest body reported
221765 - case study on ....................... 140101 0600, ref SDS 8 UB4K
221767 - ..
221768 - On 151201 no hiking rest body reported
221769 - case study on ....................... 140101 0600, ref SDS 8 T56H
221771 - ..
221772 - On 151202 no hiking rest body reported
221773 - case study on ....................... 140101 0600, ref SDS 8 IZ4F
221774 -
221775 -
221776 -
221777 -
221778 -
221779 -
221780 -
221781 -
221782 -
221783 -
221784 -
221785 -
221786 -
221787 -
221788 -
221789 -
221790 -
221792 - ..
221793 - On 151216 1130 xray report says "...left
221794 - knee has "moderate medial compartmental
221795 - and medial patellofemoral joint space
221796 - narrowing and moderate tricompartmental
221797 - marginal osteophytes."............... ref SDS 15 BO5O
221798 - "right knee shows mild tricompartmental
221799 - osteophytes.......................... ref SDS 15 965H
221800 -
221801 -
221802 -
221803 -
221804 -
221805 -
221806 -
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221820 -
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221822 -
221823 -
221824 -
221825 -
221826 -
221828 - ..
221829 - Today, Doctor Dang seemed say the major injury is bone marrow edema,
221830 - and that no surgical remedies are available to recover.
221832 - ..
221833 - The doctor explained a brace would not be effective for present
221834 - injuries caused by repetitive stress from hiking and running.
221836 - ..
221837 - The doctor advised that severe injuries to the right knee cannot be
221838 - repaired with surgery.
221840 - ..
221841 - He said no specific condition is evident from MRI studies and clinical
221842 - examination to explain why Glucosamine Chondroitin does not prevent
221843 - pain in right knee, as it does in the left knee.
221845 - ..
221846 - On 161026, for the first time, since the prior major injury on 160715.
221847 - It may have been compounded 2 weeks later last month on 161105,
221848 - discussed initially today, per above. ref SDS 0 MF9J
221850 - ..
221851 - The doctor said this injury cannot be treated with surgery, nor other
221852 - modalities. It can heal with rest over a period of about 1 year. He
221853 - clarified this means the patient can hike, but not sprint nor run.
221855 - ..
221856 - Kathy asked about using a knee brace to reduce risks of re-injury.
221857 - Doctor Dang advised that injuries causing pain to the right knee
221858 - cannot be repaired nor assuaged by wearing a brace. He clarified that
221859 - knee braces are prescribed for patients who need help with daily
221860 - activities, e.g., walking around the house, at the store, etc.
221861 - Injuries in this case arise from repetitive verticle stress hiking
221862 - long distance, generally beyond 5 miles, and in this case 11 - 15
221863 - miles. Knee braces are not effective for these injuries. Doctor Dang
221864 - checked VA formulary and found liquid Naproxen can be prescribed, but
221865 - that his Department cannot make the prescription. He suggested
221866 - contacting Doctor Lee in Sacramento, or the Primary Care provider.
221868 - ..
221869 - Doctor Dang noted that MRI scans on 160805, show left knee has more
221870 - severe degenerative arthritis than the right knee.
221872 - ..
221873 - Asked if surgery can be performed on right knee, as done on left knee
221874 - in 1973, so that Glucosamine Chontroitin will prevent pain in right
221875 - knee, as it does in left knee when hiking, running and sprinting?
221931 - ..
221932 - Asked about solutions...
221934 - ..
221935 - 1. Prolotherapy
221937 - ..
221938 - Doctor Dang said he is not familiar with Prolotherapy. Does not know
221939 - of any VA patients at the Medical Center who have been treated with
221940 - this protocol.
221941 -
221942 -
221943 - 2. Synvisc researched on 990910 1410. ref SDS 1 OG61
221945 - ..
221946 - Reviewed background On 991011, When Doctor Craig Boulris with
221947 - Orthopedics Department at Kaiser in Walnut Creek, CA, suggested
221948 - Synvisc might be effective in this case. However, he recommended
221949 - initially trying Glucosamine Chondroitin. At that time on 991011,
221950 - Craig advised that the rate of success with Synvisc treatment has not
221951 - been as high as he would like to see. ref SDS 3 3942
221953 - ..
221954 - Doctor Dang said the Orthopedics Department can provide treatment with
221955 - Synvic using hyaluronate. He explained this line of care is
221956 - typically prescribed for patients with severe mobility difficulty
221957 - walking around the house, getting from the car into a store. It is
221958 - not commonly prescribed for patients who experience knee pain the last
221959 - few miles hiking 11 and 15 miles a day.
221961 - ..
221962 - [On 170314 0930 in Podiatry Doctor Tang drew a curve
221963 - illustrating this case is for foot injuries that occur from
221964 - activity outside the standard of care for VA Podiatry,
221965 - where patient has excessive pain in the last few miles
221966 - hiking 11 - 15 miles per day. ref SDS 38 XR66
221968 - ..
221969 - [On 170206 1240 in Orthopedics Gina commented after
221970 - providing 3rd Supartz injection treatment that patient
221971 - history hiking 11 - 15 miles per day the past 5 years is
221972 - very high compared to other patients treated with Supartz.
221973 - ref SDS 36 ZO5K
221975 - ..
221976 - [On 170710 1708 hyaluronate injection treatment with
221977 - synvisc is not prescribed for patients over 70; because
221978 - knee replacement is more cost effective, reported in the
221979 - journal American Health and Drug Benefits, cited by Doctor
221980 - Darrow in his book. ref SDS 41 195F
221981 -
221983 - ..
221984 - Synvisc is presented on the Internet at...
221985 -
221986 - Synvisc one
221987 -
221988 - http://www.synviscone.com/what-is-synvisc-one.aspx?utm_campaign=Google-Display&utm_source=google&utm_medium=cpc&utm_content=Content-Treatment&src=google+content_treatment&content=gg&gclid=CNvOzI2_h9ECFRG2wAodHwIGPQ
221989 -
221991 - ..
221992 - We reviewed the record of severe knee pain occurring for days walking
221993 - around the house, etc., after hiking 11 - 15 miles. Once the knee
221994 - recovers, can then do another hike, and pain may occur at mile 2, 5,
221995 - 10, 15, so it varies. This level of hiking was prescribed by the VA
221996 - to maintain coronary health by raising HDL 30, at the time of CABG x4,
221997 - on 091022, to HDL > 60, during the meeting with Doctor Alba on 140213
221998 - 0830. ref SDS 9 GU4J
222000 - ..
222001 - [On 160101 0700 reporting hiking on 170125, 48 hours after
222002 - 1st treatment with Supratz; seemed to prevent pain right
222003 - knee on 6 mile hike; hours after hike right knee swelled
222004 - and stiff. ref SDS 16 X17O
222006 - ..
222007 - Doctor Dang seemed to comment that Orthopedics supports extended
222008 - endurance exercise that elevates HDL cholesterol for maintaining
222009 - coronary health.
222011 - ..
222012 - Doctor Dang ordered treatment with Synvisc (sodium hyaluronic acid
222013 - injection) on right knee. It will be scheduled sometime in the next 2
222014 - weeks. We decided to defer treatment for left at this time while
222015 - Glucosamine Chondroitin continues to protect against pain for extended
222016 - endurnce hiking.
222017 -
222018 - [On 170710 1708 hyaluronate injection treatment with
222019 - synvisc is not prescribed for patients over 70; because
222020 - knee replacement is more cost effective, reported in the
222021 - journal American Health and Drug Benefits, cited by Doctor
222022 - Darrow in his book. ref SDS 41 195F
222024 - ..
222025 - This aligns with analysis observed by Doctor Hewitson in Podiatry
222026 - Biomechanics during meeting on 151215 1000. ref SDS 14 RI6H
222028 - ..
222029 - The treament entails injecting synvisc liquid into the knee.
222031 - ..
222032 - It will be performed by physician assistant (PA).
222034 - ..
222035 - Requires 3 injection treatment over 3 week period.
222036 -
222037 - [On 170123 1530 Gina performed injection with Supartz
222038 - (alternate to Synvisc); there was no pain. Procedure was
222039 - simple and fast. ref SDS 35 VG6M
222040 -
222041 - [On 160101 0700 reporting hiking on 170125, 48 hours after
222042 - 1st treatment with Supratz; seemed to prevent pain right
222043 - knee on 6 mile hike; hours after hike right knee swelled
222044 - and stiff. ref SDS 16 X17O
222046 - ..
222047 - [On 170619 1500 Doctor Dang pleases treatment with Supartz
222048 - on right knee, has been effective enough to try on both
222049 - left and right knees. ref SDS 40 0O4O
222051 - ..
222052 - The patient has to go to the Pharmacy, and checkout the synvisc
222053 - treatment medication, and bring it to the Orthopedic Department for
222054 - the treatment.
222056 - ..
222057 - The doctor advised that side effects are mainly some swelling around
222058 - treated knee area. He emphasized this is rare.
222059 -
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SUBJECTS
Default Null Subject Account for Blank Record
2303 -
230401 - ..
230402 - Request records on CD from ROI for this medical encounter due to
230403 - continual difficulties downloading medical records from VA website
230404 - at...
230405 -
230406 - https://www.myhealth.va.gov/mhv-portal-web/track-health
230407 -
230409 - ..
230410 - Customer....
230411 -
230412 - User ID..................... rodwelch
230413 - Password.................... Poims&7cm
230415 - ..
230416 - Downloaded Progess Notes for meeting on 160810, and stored in...
230417 -
230418 - F:\05\00003\SM\CC\AGMJ\20160810-150000\... no file
230420 - ..
230421 - Have checked VA records several times and find no Progress Notes for
230422 - this meeting, as recently as 161121.
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