CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 9 0001, ref SDS 5 DV8L.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 - ..
040510 - [On 170726 1600 Doctor Tucker performed PRP injection
040511 - treatment for right foot plantar plate, metatarsaglia both
040512 - feet, and left knee osteoarthritis. ref SDS 10 0001
040513 -
040514 -
040515 -
040516 -
040517 -
040518 -
040519 -
040520 -
040521 -
040522 -
040523 -
040525 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Set Up for Meeting Doctor Darrow in Los Angeles
040902 -
040903 - Follow up ref SDS 9 4M6M, ref SDS 5 XS8H.
040904 -
040905 - On 170630 scheduled meeting with Doctor Marc Darrow, ref SDS 5 DV8L,
040906 - at...
040907 -
040908 - Darrow Sports and Wellness Institute
040909 - 11645 Wilshire Blvd Suite 120
040910 - Los Angeles, CA 90025
040911 - (310) 231-7000
040912 - 800 734 2210
040913 -
040914 - http://prolotherapyinstitute.com/payment-information/
040916 - ..
040917 - Prices... One Additional
040918 - Area Areas
040919 - Prolotherapy (Dextrose)............... $395 $395
040921 - ..
040922 - PRP (Platelet Rich Plasma)............ $800 $700
040924 - ..
040925 - Stem Cell............................. $1,950 $1,850
040927 - ..
040928 - Initial meeting discuss case,
040929 - review radiology and patient
040930 - history.............................. $295
040932 - ..
040933 - Cost of initial meeting was explained by Julia on 170630 1044.
040934 - ref SDS 5 DV8L
040936 - ..
040937 - Yesterday, drove from Concord to Nipomo and visited with Bob, reported
040938 - on 170716 1310. ref SDS 9 LA7H Had dinner with Bob, Robin and her
040939 - husband Vincent in Pismo Beach. ref SDS 9 636M During dinner, Kathy
040940 - and Vincent used cellphone to make reservations for room at Hyatt
040941 - Regency near LAX. ref SDS 9 U38R We then drove to Los Angeles and
040942 - stayed overnight near LAX. ref SDS 9 4M6M
040944 - ..
040945 - This morning, we drove on highway 405 from LAX about 11 miles to the
040946 - VA on Wilshire Boulevard. Parked the car in the VA parking lot.
040947 - There were 2 women sitting on the lawn resting and talking. Asked if
040948 - they know the way to Wilshire Boulevard going North? The ladies
040949 - couldn't help, but offered a business card for a restaraunt in Morro
040950 - Bay...
040952 - ..
040953 - The Hungry Fisherman
040954 - 399 Beach Street
040955 - Morro Bay, CA 93442
040956 - 803 772 3444
040958 - ..
040959 - Someone else gave directions. Walked out of the parking lot, and up a
040960 - driving access ramp to Wilshire Boulevard.
040962 - ..
040963 - Walked about .5 miles up the street to...
040964 -
040965 - Darrow Sports and Wellness Institute
040966 - 11645 Wilshire Blvd Suite 120
040967 - Los Angeles, CA 90025
040968 - (310) 231-7000
040969 - 800 734 2210
040971 - ..
040972 - The walk along Wilshire Boulevard is interesting. There seems to be a
040973 - large memorial grass area along most of the route, evidently part of
040974 - the VA grounds, but without office buildings. There are some large
040975 - trees with unusually thick limbs, and also big roots protruding from
040976 - the ground.
040977 -
040978 -
040980 - ..
040981 - Arrive Doctor Darrow's Office Fill-out Forms
040982 -
040983 - Doctor Darrow's office is on the ground floor, just off the lobby,
040984 - offering convenient access.
040986 - ..
040987 - We arrived about 1100. The front desk staff were very helpful. After
040988 - signing in, they printed identification and patient history documents.
040989 - Filled these out in the lobby waiting area.
040991 - ..
040992 - On handing these back to one of the women at the front desk, she said
040993 - we could do the initial meeting with Doctor Darrow's physician
040994 - assistant immediately, rather than wait until 1500, as scheduled.
040995 -
040997 - ..
040998 - Patient History and Radiology Pre-examination Meeting with Megan
040999 - Pre-examination Meeting with Megan for Patient History and Radiology
041000 -
041001 - Megan came and introduced herself.
041003 - ..
041004 - She took us into an examination room. Megan used the computer to
041005 - enter information that was just entered in the forms filled out in the
041006 - reception room. She asked questions for the same information entered
041007 - in the documents just submitted, rather than rely on the written
041008 - documents, saying it is faster to get the information verbally from
041009 - the patient.
041011 - ..
041012 - Megan was efficient and professional. After 20 minutes entering
041013 - patient history in the computer, she asked for radiology studies.
041015 - ..
041016 - Submitted CD with MRI scans showing plantar plate tear on right foot,
041017 - performed on 170412 0800. ref SDS 3 JG52 Megan examined the scans,
041018 - and then asked for the radiology report by the doctor. Explained it
041019 - should also be on the CD, since I thought it was copied before leaving
041020 - Concord yesterday. Turned out the radiologist's report was not on the
041021 - CD.
041023 - ..
041024 - Explained will get from the computer that is in the car at the VA
041025 - parking lot down the street. Proposed that after this early meeting,
041026 - will go back to the VA and get the cpu, so it is available during the
041027 - meeting with Doctor Darrow at 1500.
041029 - ..
041030 - Megan then did an examination.
041031 -
041033 - ..
041034 - Plantar Plate Very Sensitive to High Pressure During Examination
041035 -
041036 - She pressed on areas of the right forefoot. She held the foot with
041037 - her left hand, and pressed with the thumb, asking with each press if
041038 - this was the plantar plate? She pressed harder with each pass across
041039 - the foot, until finally she pressed on the plantar plate very hard,
041040 - and this caused a pain level 10, similar to Doctor Hewitson, when he
041041 - pressed harder and harder asking for pain response, and then pain was
041042 - excruiating, reporting on 170213 1133. ref SDS 2 HL5M When Megan
041043 - pressed hard on the plantar plate the pain was so severe that in
041044 - reaction pulled the leg and foot violently from her hand.
041046 - ..
041047 - Apologized for this action, smiling while saying she obviously found
041048 - the location of the injury.
041050 - ..
041051 - Megan apologized also, and said she was okay - didn't hit her when
041052 - quickly pulling foot from her grasp.
041053 -
041055 - ..
041056 - Meeting with Doctor Advanced 2 Hours to 1300 from 1500
041057 -
041058 - Megan asked if we could go get the radiologist's report on the MRI,
041059 - and return immediately, rather than wait until 1500, because today the
041060 - doctor can see the patient after lunch at 1300?
041062 - ..
041063 - Agreed to this.
041065 - ..
041066 - Asked if the patient can walk .5 miles back to the car after the
041067 - injection procedure today, by Doctor Darrow?
041069 - ..
041070 - Megan said the patient shouldn't walk that far. She suggested, Kathy
041071 - could walk back and then drive the car to the doctor's office, in
041072 - order to save $24 parking fee.
041074 - ..
041075 - Thanked Megan for scheduling us at 1300, rather than waiting until
041076 - 1500, because that may make driving a little easier through LA traffic
041077 - toward home, with less commute traffic than at at 1800.
041079 - ..
041080 - We walked back to the car at the VA parking lot. Decided to have the
041081 - meal Doctor Darrow prescribes for an hour before the procedure,
041082 - reported on so went into the VA main lobby. An Information Assistant
041083 - at the front entrance explained how to find the cafeteria. Walked
041084 - through the halls, however, on reaching the cafeteria, realized there
041085 - would not be enough time to order and eat a meal and then return to
041086 - Doctor Darrow's office at 1300.
041088 - ..
041089 - We went back to the car and drove up Wilshire Boulevard to the
041090 - Doctor's office. Entered the Parking garage, and drove down to the
041091 - 3rd level below ground level. An attendant said to leave the car for
041092 - valet parking.
041094 - ..
041095 - Took an elevator to the ground floow. Kathy went into a small cafe
041096 - off the lobby to order a sandwich for eating before the procedure.
041097 - By this time it was nearing 1300.
041098 -
041100 - ..
041101 - Radiologist's Report Obtained by Doctor's Front Office from VAMCSF
041102 -
041103 - In the doctor's office, used the front office counter top to locate
041104 - the radiologist's report for the MRI on 170412 0800. ref SDS 3 JG52
041105 - Megan looked at the report and asked another person to print the
041106 - report for the doctor. C23 wireless function could not connect with
041107 - the printer.
041109 - ..
041110 - Megan read through the radiologist's report from c23. She decided the
041111 - doctor should have a copy. Another woman behind the front counter
041112 - contacted requested me to fill out a form and sign it authorizing
041113 - VAMCSF to release the radiology report for the MRI on 170412, to
041114 - Doctor Darrow's office. She then called VAMC in San Francisco. While
041115 - speaking by telephone, she faxed the patient ROI request to the VA.
041116 - The radiology department at VAMCSF then faxed the report to Doctor
041117 - Darrow's office.
041118 -
041120 - ..
041121 - Doctor Darrow's Medical Practice Supports Weight Loss
041122 -
041123 - Megan said we could wait in the doctor's examination room, while the
041124 - front office team obtained the radiologist's report.
041126 - ..
041127 - Kathy pointed out pictures on the wall indicating the doctor supports
041128 - weight loss care. There was a stack of books on the counter. Glanced
041129 - through. Doctor Darrow came by and commented the book is out of date.
041130 - He said the Stem Cell book presented in the orientation letter
041131 - represents his current practice, received on 170710 1708. ref SDS 8
041132 - WA4I
041133 -
041135 - ..
0412 -
0413 -
0414 - 1310
0415 -
041501 - Meeting Doctor Darrow Initial Review Radiologist Report
041502 -
041503 - Doctor Darrow came into the office. He was accompanied by a small,
041504 - energetic dog. He said the dog's name is Mia. Kathy commented one
041505 - of her granddaughters is named Mia.
041507 - ..
041508 - While reading through the radiologist's report for the MRI on 170412
041509 - 0800, ref SDS 3 JG52, the doctor asked if we recognized the breed? I
041510 - said chimpanzie - thinking it was c-something.
041512 - ..
041513 - Doctor Darrow corrected saying Chihuahua. He said to remove both
041514 - shoes and socks. On doing so, the dog grabbed one sock and ran off.
041515 - The doctor called the dog back. Was able to pull the sock away, but
041516 - then the dog grabbed the other sock. Went through the same exercise.
041517 - Finally, the doctor got Mia to leave the room, and he closed the door
041518 - to prevent further issues.
041520 - ..
041521 - Allowing the dog to roam freely around the medical office, indicated
041522 - the doctor is very proud of his dog.
041523 -
041525 - ..
041526 - Examination Found Painful Right Foot Plantar Plate Tear
041527 -
041528 - Doctor Darrow made an examination.
041530 - ..
041531 - Like Megan earlier in the pre-examination review, the doctor pressed
041532 - on areas of the right forefoot. He pressed with the thumb, asking if
041533 - this was the plantar plate? Pressing harder with each pass across the
041534 - foot he pressed on the plantar plate very hard, and this caused a pain
041535 - level 10 again, as Megan did earlier, per above, ref SDS 0 Q86L, and
041536 - like Doctor Hewitson, causing severe pain, reported on 170213 1133.
041537 - ref SDS 2 HL5M As with Doctor Hewitson in February, and Megan earlier
041538 - today, there was an immediate reaction pulling the leg and foot from
041539 - the doctor's hand.
041541 - ..
041542 - Doctor Darrow next examined both knees by placing his left hand behind
041543 - the knee, and using his right hand at the ankle to bend the leg,
041544 - saying to just relax the muscles. After doing this for both knees,
041545 - he seemed to say they are in "good shape."
041546 -
041547 -
041549 - ..
041550 - Weight Control Reduces Risk Injury Plantar Plate, Knees Hips
041551 -
041552 - The doctor next said the paitient is significantly overweight, and
041553 - explained losing weight will reduce pressure on feet that reduces risk
041554 - of plantar plate injury recurrence, and lowers risk of injury to feet,
041555 - knees and hips.
041557 - ..
041558 - Reviewed patient history of lowering weight by controlling diet and
041559 - increasing hiking, shown in patient history on 160101 0700.
041560 - ref SDS 1 MS3H, and summarized in summary correlating mileage with
041561 - weight, blood pressure, pulse, HDL cholesterol to past 7 years...
041562 -
041563 - F:\05\00003\SM\CC\BNKG\120216cc\130101cc\hiking_miles_3.xlsx
041565 - ..
041566 - Have lost 10 pounds the past few weeks with hiking, but plantar plate
041567 - injury is a restraint. Fixing this problem with the doctor's
041568 - injection therapy today, will aide losing another 15 pounds, toward
041569 - goal of hiking Half Dome at 165 on 170913.
041571 - ..
041572 - Doctor Darrow said the patient can lose weight without hiking, by
041573 - avoiding grains in the diet. He seemed to say weight will drop simply
041574 - laying in bed, when grains are avoided.
041576 - ..
041577 - Asked if this correlates to a low carbohydrate diet, like avoiding
041578 - bread, pasta, etc? Requested listing in Progress Notes common "grain"
041579 - foods that should be avoided.
041581 - ..
041582 - The doctor said the patient can independently research to find foods
041583 - that correlate to avoiding "grains."
041585 - ..
041586 - There was no discussion today of fasting, which is presented in the
041587 - doctor's Stem Cell book for maintaining healthy weight, promote
041588 - immunity from disease, longevity, and to trigger beneficial effects of
041589 - stem cell therapy, reviewed on 170710 1708. ref SDS 8 PU3K
041591 - ..
041592 - Doctor Darrow said vegatables, and protein like meat, avocados, etc,
041593 - are a good diet to lose weight.
041595 - ..
041596 - Explained avocados are a mainstay of patient diet, shown in case study
041597 - on 160101 0700. ref SDS 1 XZ3H
041599 - ..
041600 - Doctor Darrow noted that at some point he was carrying a backpack full
041601 - of avocados.
041603 - ..
041604 - The doctor's Stem Cell book does not list avocados for healthy diet,
041605 - shown on 170710 1708. ref SDS 8 G56K
041606 -
041608 - ..
041609 - Doctor Darrow Proposes 3 - 4 Injection Phases 2 Week Intervals
041610 - Both Feet Treated for Plantar Plate Injury Total Cost $2,400 - $3,200
041611 -
041612 - Asked about recommended protocol to treat plantar plate tear shown in
041613 - MRI scans and cited in the radiologist's report on 170412 0800.
041614 - ref SDS 3 JG52
041616 - ..
041617 - The doctor proposed 3 - 4 injections of PRP on 2 week intervals, and
041618 - further said the foot should be protected in a "boot" for 6 weeks.
041620 - ..
041621 - Asked about treating both feet, since the MRI radiologist's report
041622 - found left foot plantar plate "degeneration," 170412 0800, ref SDS 3
041623 - JI37, and during hiking, occasionally there is distinct pain in the
041624 - left foot, indicating impending failure. Treatment at this time would
041625 - protect against further wear leading to injury. Asked if this would
041626 - cost another $800, in accordance with the doctor's pricing schedule,
041627 - per above? ref SDS 0 BK5I
041629 - ..
041630 - The doctor said he would inject both feet as "one area," costing $800
041631 - for each injection phase. Therefore, 3 - 4 injection phases would
041632 - cost $2,400 - $3,200 for total project.
041634 - ..
041635 - Explained the purpose of treatment is to enable training 3 - 4 weeks
041636 - for hiking Half Dome on 170913. Might there be another line of care
041637 - that will better align with patient objectives?
041639 - ..
041640 - Doctor Darrow commented that the patient is not listening.
041642 - ..
041643 - Apologized for not listening. Explained the doctor's advice is highly
041644 - regarded, and very important. The Stem Cell book has a wealth of
041645 - valuable insights that offer promising new directions in health care,
041646 - even beyond musculoskeletal applications. New ideas and innovative
041647 - practice take time to absorb, and correlate with existing practice.
041648 - Questions provide a direct avenue to test understanding. Of course
041649 - this is tedious to an expert, like the doctor.
041651 - ..
041652 - The doctor noted he has been teaching injection therapy for many years
041653 - at the VA Medical Center down the street on Wilshire Boulevard.
041654 - Todate, the VA has never treated anyone with this line of care. Must
041655 - be very frustrating, like teaching SDS, POIMS, Communication Metrics,
041656 - et al.
041658 - ..
041659 - Thanked the doctor for considering this case. Requested he submit
041660 - Progress Notes via email for evaluating his proposal today. Advised
041661 - will make further inquiries for injection therapy protocol that may
041662 - better meet objectives to train for Half Dome on 170913.
041663 -
041664 -
041666 - ..
0417 -
0418 -
0419 - 1346
0420 -
042001 - Paid $295 for Meeting, Commend Front Office, Megan Submit Progress Notes
042002 -
042003 - Met with the team at the front desk. Paid the doctor's bill of $295,
042004 - per schedule above.
042006 - ..
042007 - Post expense ledger...
042011 - ..
042012 - Megan was there, so thanked her, saying it was a pleasure working with
042013 - her. Thanked the rest of the front office staff who all contributed
042014 - to making this medical visit efficient, helpful and fun.
042016 - ..
042017 - Megan said she will submit the doctor's progress notes to the email
042018 - address on file in the office.
042019 -
042020 -
042021 -
042022 -
042023 -
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042029 -
0421 -