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: July 26, 2017 04:00 PM Wednesday; Rod Welch

Doctor Tucker meeting PRP injection plantar plate tear right foot, metatarsalgia both feet and left knee.

1...Summary/Objective
2...Revise Meeting from 1530 to 1600
3...Meeting Doctor Tucker in Novato Report Preparations Completed
4...MRI and Radiologist Report Reviewed by Doctor Tucker
5...Doctor's Experience Hiking Half Dome Build Commitment to Meet Time Table
6...Experimental Injection Treatment Best Chance Hiking Half Dome This Year
7...Plantar Plate Treatment Layout Injection Sites
8...Alternative Care Injection Therapy Based on Success of Cousin
9...Doctor Tucker Expertise Personality Support Doctor Patient Partnership Model
10...Scope Expanded Include Metatarsalgia Right Foot
11...Pain Management Excellent Patient Support
12...PRP Modality Chosen for Injection Therapy Rather than Dextrose
13...Platelet Rich Plasma (PRP) Modality More Effective than Dextrose
14...Blood Draw for PRP Completed Despite Challenging Process
15...Blood Draw Finds High Viscosity Commonly Treated with Baby Aspirin
16...Metatarsalgia PRP Treatment Both Feet
17...Centrifuge Kit Produces Enough PRP Treat Metatarsalgia Both Feet
18...PRP Injections Pain Free Both Feet Excellent Patient Care
19...PRP Left Knee Compare Supartz Right Knee Assess Quality and Longevity
20...Left Knee PRP Injections Compare Supartz Treatment Scheduled 170731
21...Follow Up Treatments Not Required
22...Dressing PRP Injections Final Instructions and Payment

ACTION ITEMS.................. Click here to comment!

1...Not sure what "walking flat footed" means?

CONTACTS 
0201 - Doctor Gloria Tucker                                                                                                                                               
020101 - Dr. Gloria Tucker                                                                                                                                                
020103 - Medical Offices                                                                                                                                                  

SUBJECTS
PRP #0001 Injections Orthopedics Regenerative Therapy Osteoarthritis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0903 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0903 -    ..
0904 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0905 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090501 - Follow up ref SDS 20 0000, ref SDS 19 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090503 - Experimental PRP injection treatment for right foot planatar plate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090504 - tear, metatarsalgia in both feet, and a raft of left knee injuries.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090505 - ref SDS 0 PP4N  Treatment today, was pain free, professional,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090506 - comprehensive and fun working with Doctor Gloria Tucker at her medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090507 - clinic in Novato, California. ref SDS 0 4D6G  The doctor was kind and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090508 - generous, ref SDS 0 H14H, expanding treatment of injection therapy                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090509 - with PRP for metatarsalgia in both feet, ref SDS 0 EG7F, and to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090510 - recover from left knee osteoarthritis, at no additional charge.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090511 - ref SDS 0 4Y8K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
090512 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090513 -            [On 170727 1747 Doctor Tucker called to follow up injection                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
090514 -            therapy for plantar plate tear, metatarsalgia, and left                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090515 -            knee osteoarthritis, ref SDS 22 QV5N; advised initial                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090516 -            results excellent; doctor approved low level hiking.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090517 -            ref SDS 22 0W6V; and, she recommended metatarsal bar added                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
090518 -            to new orthotic inserts. ref SDS 22 517O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
090520 -             ..
090521 -            [On 170727 1747 at 2212 letter to Doctor Tucker confirms                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090522 -            understandings from call, ref SDS 22 RK5H, and commends her                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
090523 -            kindness and generosity and skill performing expanded scope                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090524 -            adding treatment for metatarsalgia in both feet and for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090525 -            left knee. ref SDS 22 MM51                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
090527 -             ..
090528 -            [On 170727 1747 letter asks Doctor Tucker about icing feet                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
090529 -            and applying Diclofenac gel 1% before low level hiking she                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090530 -            prescribed hiking to reduce inflammation after getting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090531 -            injection therapy with PRP 2 the day before on 170726, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090532 -            also icing feet after hiking. ref SDS 23 XM5J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
090534 -             ..
090535 -            [On 170728 1649 received letter from Doctor Tucker                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090536 -            responding to letter transmitting the record today on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090537 -            treatent with PRP, and reporting she read this record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090538 -            reporting events today. ref SDS 26 0W5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
090540 -             ..
090541 -            [On 170730 1831 letter to Doctor Lee with copy to Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090542 -            Tucker and to Doctor Stewart, submitting record getting PRP                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090543 -            injection therapy by Doctor Tucker, and initial response to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090544 -            treatment may suggest this line of care can maintain LESV                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090545 -            dilation for closer to 6 months. ref SDS 28 0Y5N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090547 -             ..
090548 -            [On 170816 1400 for 2nd PRP injection treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
090549 -            regeneration therapy; Doctor Tucker used pain management                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090550 -            protocol similar to 1st phase, when no pain was experience,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090551 -            but on this 2nd phase there was considerable pain, because                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090552 -            injections were deeper and more PRP was injected to achieve                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090553 -            benefits of regenerating (healing) plantar plate tear,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090554 -            which were not achieved with 1st phase of treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090555 -            ref SDS 29 S543                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090557 -             ..
090558 -            [On 170819 1352 letter from Doctor Tucker says injury                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090559 -            symptoms return 3 - 5 days after treatment, ref SDS 30                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090560 -            0W5I, and regeneration healing from PRP injection treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090561 -            becomes manifest about 4 - 6 weeks after treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
090562 -            ref SDS 30 C29V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090564 -             ..
090565 -            [On 170929 1010 Mark Wachter, CEO On-the-Run proposed Hoka                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
090566 -            Bondi wide width 2E shoes to relieve pressure on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
090567 -            metatarsals and on plantar plate injury, and he offered                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090568 -            orthotic inserts with small groove to relieve pressure on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090569 -            plantar plate, and also a small protrusion, which may                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090570 -            correlate with Doctor Tang's design at VAMCSF received on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090571 -            170725, and further implement Doctor Tucker's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
090572 -            recommendations for a "metatarsal bar" on 170727.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
090573 -            ref SDS 34 124L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090574 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090575 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090576 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090577 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090579 -  ..
0906 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0907 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0908 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0909 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090901 - Revise Meeting from 1530 to 1600                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090902 - 
090903 - Jane called this morning OA 0927.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090905 -  ..
090906 - She said that the office will be closed until she and the doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090907 - return from offsite meeting.  They feel now that with possible traffic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090908 - congestion, better to plan meeting for 1600, rather than 1530.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
090910 -  ..
090911 - Jane asked if the customer has read the doctor's requirements to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090912 - prepare for getting injecton treatments.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
090914 -  ..
090915 - Advised this was reviewed and implemented, reported on 170721 0848.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090916 - ref SDS 18 KT7K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090918 -  ..
090919 - Jane said not necessary to eat a meal before injection treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090921 -  ..
090922 - Said will see them at 1600.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
090923 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090925 -  ..
0910 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0911 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0912 - 1345                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0913 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
091301 - Left the house for drive to Novato.  Took 680 over Benecia Martinez                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091302 - bridge and took 750 into Vallejo.  Used GPS to wander through town to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091303 - eventually reach 37.  Could more easily have taken 80 East to 37, but                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091304 - this ride was interesting.  Traffic was stopped on 37, for 30 minute                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091305 - delay.  Finally got through, and reached the doctor's office in Novato                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
091306 - OA 1525.  We walked around the building for exercise.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091307 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091309 -  ..
091310 - Meeting Doctor Tucker in Novato Report Preparations Completed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
091311 - 
091312 - Doctor Tucker and Jane arrived OA 1555.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
091314 -  ..
091315 - In the office, Jane asked if Doctor Tucker's preparation steps have                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091316 - been performed, listed in attachment to Connie's letter on 170721                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
091317 - 0848, received at 1627? ref SDS 18 KT7K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
091319 -  ..
091320 - Advised that Vitamin C was taken at 1300, reported in case study on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091321 - 160101 0700. ref SDS 9 ZS6F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
091323 -  ..
091324 - She asked about protien.  Said yes, citing the record for today in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091325 - case study on 160101 0700. ref SDS 9 RYXV                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091327 -  ..
091328 - Jane asked about soaking fee.  Advised this was done OA 1230, also                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091329 - reported in case study. ref SDS 9 ZS6F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
091331 -  ..
091332 - Jane had printed identification documents and patient health review.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091333 - Filled this out.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091334 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091336 -  ..
091337 - MRI and Radiologist Report Reviewed by Doctor Tucker                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091338 - 
091339 - Doctor Tucker requested radiologist's report for MRI on 170412 0800.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091340 - ref SDS 12 JG7N   She asked Jane to print the VA's report previously                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
091341 - submitted to Doctor Tucker on 170724 1507. ref SDS 19 WO9M  Jane had                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
091342 - difficulty finding the letter to print the report.  Doctor Tucker                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
091343 - looked at the report on customer's computer, c23.  She took                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
091344 - handwritten notes on particular findings and impressions.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
091346 -  ..
091347 - Doctor Tucker reviewed MRI scan files using a CD delivered by the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
091348 - patient today...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091349 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091350 -              F:\05\00003\SM\CC\AGMJ\20170412-080000\GEARView.exe                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091352 -  ..
091353 - After a few minutes, Jane found the letter dated 170724, and printed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091354 - the attached radiologist report for MRi on 170412.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091356 -  ..
091357 - Concurrently, Jane submitted the doctor's schedule of charges showing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091358 - $125 for consultation, and $350 for prolotherapy dextrose injection                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091359 - treatments.  If treatment is switched to PRP the charge will be $850.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091360 - These charges align with understandings from telecon with Connie on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091361 - 170721 0848. ref SDS 18 E28L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091362 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091364 -  ..
091365 - Doctor's Experience Hiking Half Dome Build Commitment to Meet Time Table                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
091366 - Experimental Injection Treatment Best Chance Hiking Half Dome This Year                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
091367 - 
091368 - The doctor mentioned that she and her husband are hikers.  She related                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
091369 - having done half Dome years ago.  Explained there are 2 permits, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091370 - that she is welcome to use the 2nd, since my age augars for partnering                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
091371 - to hike Half Dome.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091373 -  ..
091374 - Doctor Tucker hiked Half Dome when permits were not required.  Many                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091375 - people passing each other going up and down the subdome switchbacks                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091376 - was very dicy because the trail is very narrow and steep for about .25                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
091377 - miles.  Concurred this was the condition my first try on 940917 0742,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091378 - ref SDS 1 0J9F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091380 -  ..
091381 - The doctor feels the permit system increases safety, but significantly                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
091382 - limits hikers flexibility, as in this case, where it would be better                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091383 - to do the hike a few weeks later, so injection therapy today has more                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091384 - time to take effect.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091386 -  ..
091387 - Agreed that the work plan today, is getting this injection therapy                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091388 - line of care done and healing in time for high-level training that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091389 - enables best possible effort on Half Dome.  Critical objective is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
091390 - restoring hiking at high level that lowers weight and blood pressure,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091391 - and raises HDL, shown in spreadsheet of patient history...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
091392 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091393 -              F:\05\00003\SM\CC\BNKG\120216cc\130101cc\hiking_miles_3.xlsx                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
091395 -  ..
091396 - Half Dome is fun, and good health metric, but less important than                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
091397 - healing the body for daily 11 - 15 mile hikes at 15-minute miles with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091398 - some running and sprinting along the way, e.g., on 140302, shown in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091399 - case study on 140101 0600. ref SDS 7 DX8I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091400 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091401 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091402 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091403 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091404 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091406 -  ..
0915 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0916 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0917 - 1620                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0918 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
091801 - Plantar Plate Treatment Layout Injection Sites                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091802 - Alternative Care Injection Therapy Based on Success of Cousin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
091803 - Doctor Tucker Expertise Personality Support Doctor Patient Partnership Model                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
091804 - 
091805 - In procedure room laying on treatment table, Doctor Tucker marked                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
091806 - plantar plate outline on the bottom of the right foot to layout                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091807 - location of injections.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
091809 -             ..
091810 -            [On 170727 1747 followed up, ref SDS 25 QV5N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
091811 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091812 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091814 -  ..
091815 - Doctor Tucker asked how she was selected for this work?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
091816 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091817 -            [On 170728 1649 received letter from Doctor Tucker                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
091818 -            responding to letter transmitting the record today on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091819 -            treatent with PRP, and reporting she read this record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091820 -            reporting events today. ref SDS 26 0W5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
091822 -  ..
091823 - Explained some months ago my cousin and step dad investiged injection                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091824 - therapy.  Robin had prolotherpay 20+ years ago in the 1980s with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091825 - Doctor Ongley, for her knee and back or somthing.  This brought                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091826 - recovery which other modalities failed to achieve, and lasted until                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091827 - recent months.  Doctor Ongley moved his pratctice to Mexico, so Robin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091828 - consulted Doctor Darrow and also Doctor Kochen for herself, and her                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091829 - uncle.  She is leaning toward prolotherapy.  Doctor Kochen proposed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091830 - stem cell therapy to relieve episodic pain in Bob's back, who is 90.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091831 - He works out at the gym, and gets good care at the VA, but these have                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091832 - not resolved severe back pain, so he is considering stem cell                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
091833 - treatments Doctor Kochen proposed.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091835 -  ..
091836 - Doctor Tucker smiled and noted she knows Doctor Kochen well, and may                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091837 - have collaborated with him on cases.  Throughout the entire procedure,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
091838 - the doctor's engaging personality advanced the work significantly.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091839 - She was enlightening, skilled, focused, timely and fun to work with,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091840 - essential for doctor patient partnership.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
091841 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091843 -               ..
091844 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091846 -  ..
091847 - Advised that Kathy and I met with Doctor Darrow on 170717, at his                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
091848 - office in Los Angeles, intending to get PRP to recover from plantar                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091849 - plate tear. ref SDS 17 US6H  The doctor and staff were very helpful                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
091850 - providing better understanding treating plantar plate injury with PRP.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
091851 - Decided against treatment in Los Angeles, and to investigate injection                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
091852 - therapy services in the Bay Area with more convenient travel and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091853 - logistics.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
091855 -  ..
091856 - This past Friday, research on the Internet found health care providers                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
091857 - in the Bay Area offering injection therapy services, reported on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091858 - 170721 0848, ref SDS 18 F18F  Connie suggested sending a letter to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
091859 - Doctor Tucker explaining scope of work. ref SDS 18 TV8J  Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091860 - Tucker's response indicated appreciation for solving issues in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091861 - case, and that there was good liklihood of forming effective doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091862 - patient partnership. ref SDS 18 PW9H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
091863 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091864 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091866 -  ..
091867 - Scope Expanded Include Metatarsalgia Right Foot                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091868 - 
091869 - Doctor Tucker explained she will make 2 injections on each side of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091870 - the plantar plate, shown by mark on bottom of right foot below long                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091871 - toe.   The doctor offered valium and another pill to moderate anxiety                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091872 - from needle injections..                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
091873 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091875 -               ..
091876 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091877 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091879 -  ..
091880 - At some point, Doctor Tucker offered that she loves working with feet,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
091881 - because they present very complex, interconnected systems that make                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091882 - achieving effective care a significant challenge.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
091883 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091884 -            [On 170727 1747 Doctor Tucker called to follow up injection                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
091885 -            therapy for plantar plate tear, metatarsalgia, and left                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091886 -            knee osteoarthritis, ref SDS 22 QV5N; advised initial                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
091887 -            results excellent; doctor approved low level hiking.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091888 -            ref SDS 22 0W6V; and, she recommended metatarsal bar added                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
091889 -            to new orthotic inserts. ref SDS 22 517O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
091891 -             ..
091892 -            [On 170727 1747 at 2212 letter to Doctor Tucker confirms                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
091893 -            understandings from call, ref SDS 22 RK5H, and commends her                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
091894 -            kindness and generosity and skill performing expanded scope                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
091895 -            adding treatment for metatarsalgia in both feet and for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091896 -            left knee. ref SDS 22 MM51                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
091898 -  ..
091899 - Doctor Tucker advised she could make injections on top of the right                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091900 - foot to treat related metatarsalgia injuries described in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
091901 - radiologist's report for MRI on 170412. ref SDS 12 JG52  This was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
091902 - offered at no additonal charge, and so agreed to this scope.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
091904 -  ..
091905 - The doctor marked the top of the foot for injections...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
091906 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091907 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091908 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091909 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091910 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091912 -  ..
091913 - Pain Management Excellent Patient Support                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
091914 - 
091915 - Doctor Tucker applied cream and Cold Spray to numb area before making                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091916 - injection with lidocaine that prevents pain from PRP injections...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091917 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091918 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091919 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091921 -  ..
091922 - Wrapped both feet with ice packs...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091923 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091924 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091925 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091926 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091928 -  ..
091929 - After a few minutes, the doctor tested for numbness of injection                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091930 - area...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
091931 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091932 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091933 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091934 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091936 -  ..
091937 - Patient requested further lidocaine.  While this was taking effect,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091938 - there was discussion about modality.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091939 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091940 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091941 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091943 -  ..
091944 - PRP Modality Chosen for Injection Therapy Rather than Dextrose                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091945 - Platelet Rich Plasma (PRP) Modality More Effective than Dextrose                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
091946 - 
091947 - Doctor Tucker seemed to say that platelet rich plasma (PRP) would be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091948 - more effective than dextrose for faster, longer lasting recovery from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091949 - plantar Plate injury, and preventing recurrance of metatarsalgia.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
091950 - Doctor Shunk made similar analysis for having heart surgery, rather                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091951 - than stents, after angiogram discovered several arterial blockages on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091952 - 091021 0716. ref SDS 2 WB3K  Over the past 7 years, Doctor Shunk's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
091953 - expectation has proven accurate.  There have been no recurrent CVD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091954 - events.  Possibly PRP will prove similarly more robust than dextrose.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091956 -  ..
091957 - Asked the doctor if she has had PRP treatment?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
091959 -  ..
091960 - She said yes, and so part of her recommendation is based on personal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091961 - experience; but, more so on the many patients she has treated with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091962 - PRP in recent years.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091964 -  ..
091965 - Since Doctor Darrow recommended PRP during the meeting on 170717, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091966 - since Robin advised that Doctor Kochen also recommended PRP, ordered                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
091967 - injection therapy with PRP, hoping for stronger, recovery, and in time                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
091968 - to resume heavy training within 3 - 6 weeks, essential for hiking Half                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
091969 - Dome on 170913, planned in the letter to Doctor Tucker on 170721 0848.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
091970 - ref SDS 18 V667                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091971 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091972 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091974 -  ..
091975 - Blood Draw for PRP Completed Despite Challenging Process                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
091976 - 
091977 - Doctor Tucker drew blood for PRP platlete extraction...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
091978 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091979 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091980 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091981 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091983 -  ..
091984 - This required 4 sticks due to frequency of blood draws this past year                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
091985 - for EGD procedures, which cause adhesions that inhibit blood flow.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091986 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091987 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091988 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
091990 -  ..
091991 - To ease tensions that accompany multiple blood draw sticks, Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091992 - Tucker suggested the patient sing.  This was such a terrible effort                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091993 - that everyone laughed, accomplishing the objective.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091995 -  ..
091996 - Kathy took a break from taking pictures, to hold my hand providing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
091997 - emotional support, while the doctor drew blood.  This is common                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
091998 - practice in medical work.  Gracie, Mimi, Rodalie, Denis, Hazel, all                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
091999 - the nurses in the GI Clinic at VAMC Sacramento are sensitive when                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
092000 - blood draws are complicated.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
092002 -  ..
092003 - Most recently, Grace needed only 1 stick to set IV for conscious                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092004 - sedation during EDG dilation on 170711 0800. ref SDS 16 544G  But that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
092005 - has been the exception in recent months, shown by case study on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092006 - multiple sticks reported in the record on 110429 1230. ref SDS 5 UO3G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
092008 -  ..
092009 - Kathy switched hats at one point, applying maternity expertise drawing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092010 - blood the past 30 years at Sutter General, to find a good vein on the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092011 - lower left arm.  Doctor Tucker found the final vein on the outer side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092012 - of the left arm left elbow, that yielded sufficient blood for the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
092013 - centrifuge equipment to extract platelets...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
092014 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092016 -               ..
092017 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092018 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092020 -  ..
092021 - Thanked Doctor Tucker for persistence working with a difficult                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
092022 - customer.  She mentioned several times that on difficult cases, she                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
092023 - draws on outside consultants.  This would have required standing down                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092024 - today, and returning perhaps in days or weeks when everyone could be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092025 - assembled again.  Since the doctor knew time is of the essence                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
092026 - completing the work today, if only for patient collateral interests,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092027 - reported in the engagement letter on 170721 0848, ref SDS 18 4R4K, her                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
092028 - generosity and kindness was greatly appraciated making extended                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092029 - effort, which thankfully was successful.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
092030 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092031 -            [On 170727 1747 at 2212 letter to Doctor Tucker confirms                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
092032 -            understandings from call, ref SDS 22 RK5H, and commends her                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
092033 -            kindness and generosity and skill performing expanded scope                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092034 -            adding treatment for metatarsalgia in both feet and for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092035 -            left knee. ref SDS 22 MM51                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
092036 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092037 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092039 -  ..
092040 - Blood Draw Finds High Viscosity Commonly Treated with Baby Aspirin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
092041 - 
092042 - While she worked, Doctor Tucker commented that her practice includes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092043 - sports medicine.  She feels viscosity of the blood drawn today, is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092044 - higher than expected for age 72, and so presents elevated risk of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
092045 - myocardial infarction, which is commonly lowered by taking baby                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092046 - asperin.  This aligns with Doctor Egan's analysis at the VA on 110309                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092047 - 0900. ref SDS 4 O43I  This was reviewed previously on 101223 1030.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
092048 - ref SDS 3 J64I  Recently, on 170412 Doctor Simpson at VAMCSF discussed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
092049 - opportunity for reducing coronary risks by taking Baby Aspirin and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092050 - increasing statins. ref SDS 13 OP5M  Today, Doctor Tucker seemed to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
092051 - say thicker blood found in the blood draw increases risk with age for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092052 - CVD events, because statistics show that older people suffer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
092053 - atherosclerosis that narrows and hardens blood vessels.  Aspirin thins                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092054 - the blood, so it flows better, rather than clot up in narrow,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
092055 - inelastic blood vessels.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
092056 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092057 -            [On 170905 2350 blood draw at San Joaquin General reported                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
092058 -            INR 1.1, indicating thinner blood. ref SDS 32 2B4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
092060 -             ..
092061 -            [On 170911 1040 Lab Tech commented blood looks excellent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
092062 -            drawn during lab at VAMCSF. ref SDS 33 A56O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
092064 -  ..
092065 - Blood plasma is commonly presented as 92% water.  Patient has been                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092066 - dehydrated the past year taking elevated dose proton pump inhibitor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
092067 - (PPI) to resolve fundoplication issues treating achalasia.  Elevated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092068 - PPI increased urination.  On 170725, PPI protocol was reduced by 75%.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092069 - Over time normal hydration should follow, and thereon normalize blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092070 - viscocity.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
092072 -  ..
092073 - We reviewed the record hiking 13K miles the past 5 years, shown in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092074 - the spreadsheet file...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
092075 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092076 -              F:\05\00003\SM\CC\BNKG\120216cc\130101cc\hiking_miles_3.xlsx                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
092078 -  ..
092079 - This experimental line of care seems to maintain elasticity of blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092080 - vessels, shown by low blood pressure, and raises HDL and EPCs to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092081 - remove and prevent plaque build up through reverse cholesterol                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
092082 - transport (RCT), reported in the record on 131125 0005. ref SDS 6 HG7N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
092083 - Stastically, few have raised HDL 30 at the time of CABG on 091022, to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092084 - HDL 73, 6 years later.  On 151019, CCTA evaluated response to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
092085 - treatment, and found no evidence of plaque buildup. ref SDS 8 SU62  On                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
092086 - 160715 1630 Doctor Yoo Neurology Progress Notes say in part given that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092087 - MRI on 160618 shows complete absence of vertebrobasilar disease, is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
092088 - another way of saying there is no evidence of plaque in blood vessels                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092089 - of the brain. ref SDS 10 TV4F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
092091 -  ..
092092 - Favorable unexpected result based on statistics comes from innovation                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092093 - hiking 11 - 15 miles per day, enabled by great care at the VA, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092094 - supplemented today, by Doctor Tucker's innovative PRP injection                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092095 - treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
092097 -  ..
092098 - The doctor urged taking baby aspirin.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092099 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092101 -  ..
092102 - Metatarsalgia PRP Treatment Both Feet                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092103 - Centrifuge Kit Produces Enough PRP Treat Metatarsalgia Both Feet                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
092104 - 
092105 - Doctor Tucker explained she will use a "centrifuge kit" to extract                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092106 - platelets for PRP injections.  The equipment requires a minimun amount                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092107 - of blood and produces a fixed amount of PRP plasma.  This will be more                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092108 - than needed for the plantar plate injury.  She offered to inject the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092109 - right and left foot at no additional charge to treat metatarsalgia, in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092110 - addition to treating the plantar plate injury.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
092112 -  ..
092113 - Agreed to this offer.  There has been 0 - minimal pain doing hikes in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092114 - left foot since January.  However, due to injuries hiking is only                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
092115 - about 20% of normal.  Since recovery from plantar plate tear, will                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092116 - enable normal hiking, this will increase stress on feet causeing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092117 - increased risk of metatarsalgia.  The new orthotics Doctor Tang                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092118 - designed and ordered, and now received yesterday 170725 1636,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
092119 - ref SDS 21 KD8H, will reduce stress and so resist further injury.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
092120 - Adding injection therapy with PRP for metatarsalgia aligns with this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092121 - objective.  The work plan for today, was to experiment treating the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
092122 - platar plate tear in the right foot, and if that was successful, then                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092123 - would return and treat the left foot.  Doctor Tucker's offer to inject                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092124 - left foot today, was great news, and a big help.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092125 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092126 -            [On 170929 1010 Mark Wachter, CEO On-the-Run proposed Hoka                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
092127 -            Bondi wide width 2E shoes to relieve pressure on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
092128 -            metatarsals and on plantar plate injury, and he offered                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092129 -            orthotic inserts with small groove to relieve pressure on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092130 -            plantar plate, and also a small protrusion, which may                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092131 -            correlate with Doctor Tang's design at VAMCSF received on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092132 -            170725, and further implement Doctor Tucker's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
092133 -            recommendations for a "metatarsal bar" on 170727.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
092134 -            ref SDS 34 124L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092135 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092137 -  ..
092138 - PRP Injections Pain Free Both Feet Excellent Patient Care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
092139 - 
092140 - Doctor Tucker injected PRP into left foot metatarsals.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092141 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092142 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092143 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092145 -               ..
092146 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092147 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092149 -  ..
092150 - Asked when she would inject the right foot plantar plate and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
092151 - metatarsals?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
092153 -  ..
092154 - The doctor smiled and said that is already completed.  Realized this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092155 - went unnoticed, because while we talked, I was looking up at the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092156 - ceiling.  The 4 point array of injections to bottom of right foot are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092157 - barely noticable...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
092158 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092159 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092160 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092162 -             ..
092163 -            [On 170816 1400 for 2nd phase of regeneration injection                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092164 -            treatment with PRP Doctor Tucker used pain management                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092165 -            protocol similar to 1st phase, when no pain was experience,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092166 -            but on this 2nd phase there was considerable pain, because                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092167 -            injections were deeper and more PRP was injected to achieve                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092168 -            benefits of regenerating (healing) plantar plate tear,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
092169 -            which were not achieved with 1st phase of treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092170 -            ref SDS 29 S543                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092172 -             ..
092173 -            [On 170819 1352 letter from Doctor Tucker says injury                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092174 -            symptoms return 3 - 5 days after treatment, ref SDS 30                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
092175 -            0W5I, and regeneration healing from PRP injection treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092176 -            becomes manifest about 4 - 6 weeks after treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
092177 -            ref SDS 30 C29V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092179 -  ..
092180 - Injections of PRP in the top of both feet between metatarsals caused                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092181 - only minor inflammation...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
092182 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092183 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092184 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092185 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092186 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092188 -  ..
092189 - PRP Left Knee Compare Supartz Right Knee Assess Quality and Longevity                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092190 - Left Knee PRP Injections Compare Supartz Treatment Scheduled 170731                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092191 - 
092192 - After completing injections for left foot metatarsals, Doctor Tucker                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092193 - advised there was still a small amount of PRP plasma available.  She                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092194 - asked if there is another area where this might be used?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
092196 -  ..
092197 - Explained that on Monday, 170731, Joan in Orthopedics at VAMCSF is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092198 - scheduled to inject Supartz in both knees.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
092200 -  ..
092201 - The doctor recalled that the right knee was previously treated with 3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092202 - injections completed on 170206. ref SDS 11 LL5N, shown in the letter to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
092203 - Doctor Tucker on 170721 0848. ref SDS 18 V730  Today, she suggested                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
092204 - injecting PRP in the left knee, and continuing planned line of care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
092205 - with Supartz on Monday in the right knee.  Performance can then be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092206 - compared.  If the left knee fails, then Supartz can be tried, along                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
092207 - with the right knee as currently planned.  She seems to expect PRP                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092208 - injection today, may last for a year or more.  In that case                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
092209 - consideration might be given to injecting both knees with PRP.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
092211 -  ..
092212 - Agreed to this work plan.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
092214 -  ..
092215 - PRP injection in the knee was similar to the feet, with initially                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
092216 - spraying the area for numbness, and then inject lidocaine for pain                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092217 - control getting the larger injection...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
092218 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092219 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092220 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092221 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092223 -  ..
092224 - The doctor then injected the remaining amount of platelet rich plasma                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092225 - (PRP) into the knee joint.  There was no pain during this process, as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092226 - occurred Injecting for plantar plate tear, and into metatarsals of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092227 - both feet, per above. ref SDS 0 HS7H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092228 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092229 -            [On 170929 1010 biomechanics review by Mark Wachter, CEO                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
092230 -            On-the-Run, reported normal gait, possibly indicating                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092231 -            recovery from prior findings on 151215, of early lift off                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092232 -            on left foot due to long-standing osteoarthritis in left                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
092233 -            knee - indicating recovery with PRP treatment from severe                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092234 -            injury decades earlier. ref SDS 34 VW50                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
092236 -  ..
092237 - Small bandaid is the only dressing for the knee.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092238 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092239 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092241 -  ..
092242 - Follow Up Treatments Not Required                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092243 - Dressing PRP Injections Final Instructions and Payment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
092244 - 
092245 - Doctor wrapped both feet with loose gause and ace bandages.  She                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092246 - explained this helps hold injected plazma in place.  She further said                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092247 - to walk flat footed for a day or so, to avoid pressure on metatarsals                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092248 - while regeneration of tissue occurs.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092249 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092250 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092252 -  ..
092253 - Not sure what "walking flat footed" means?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092255 -  ..
092256 - On completing the work, Doctor Tucker indicated loose bandaging can be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092257 - removed in a few days.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092259 -  ..
092260 - The doctor recommended acetaminophen (Tylenol) for pain management, as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092261 - needed.  Do not take anti-inflammatory drugs (NSAIDS), such as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
092262 - ibuprofen, naproxen (Aleve), because these drugs prevent collagen                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
092263 - growth.  This aligns with Doctor Darrow's documentation reviewed in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
092264 - the record on 170710 1708. ref SDS 15 EP4L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092265 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092266 -            [On 170728 1649 letter from Doctor Tucker saying to avoid                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
092267 -            Diclofenac gel topical treatment to feet, since it                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
092268 -            restricts blood flow, and that will harm PRP treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092269 -            ref SDS 27 EE4F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092271 -  ..
092272 - Patient should avoid hiking for 2 - 4 weeks.  She would prefer 6                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092273 - weeks.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092274 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092275 -            [On 170727 1747 Doctor Tucker called and said walking 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092276 -            mile 2 days after feet injections, and then slow for about                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092277 -            3 miles helps distribute PRP in the feet. ref SDS 22 0W6V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
092278 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092280 -  ..
092281 - Hugged Doctor Tucker, and said thank you for terrific care.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
092283 -  ..
092284 - Jane prepared the bill...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
092285 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092286 -                             $975                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092288 -  ..
092289 - Paid with credit card.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092291 -  ..
092292 - Post expense ledger...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092293 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092297 -  ..
092298 - Doctor Tucker said no further treatment seems required at this time.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092299 - This single injection process today, should regenerate (heal) torn                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
092300 - plantar plate, and other injuries listed in radiologist's report on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
092301 - MRI performed 170412 to fully relieve metatarsalgia pain in both feet.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092302 - Equally, the left knee should recover from degenerative arthritis for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092303 - months, if not years depending on level of activity.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092304 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092305 -            [On 170816 1400 for 2nd phase of regeneration injection                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092306 -            treatment with PRP Doctor Tucker used pain management                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092307 -            protocol similar to 1st phase, when no pain was experience,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092308 -            but on this 2nd phase there was considerable pain, because                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
092309 -            injections were deeper and more PRP was injected to achieve                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
092310 -            benefits of regenerating (healing) plantar plate tear,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
092311 -            which were not achieved with 1st phase of treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092312 -            ref SDS 29 S543                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
092314 -  ..
092315 - She said progress notes for work performed today, will be submitted                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
092316 - tomorrow.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
092318 -  ..
092319 - Advised will submit understandings for the doctor to review.  Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
092320 - Tucker said to include a summary.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
092322 -  ..
092323 - Thanked her again for best possible care.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
092324 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092325 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092326 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
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092328 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092329 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
092330 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
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0924 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
Distribution. . . . See "CONTACTS"