CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 18 0000. ref SDS 17 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Sent letter to Doctor Tucker saying...
040902 -
040903 - 1. Subject: Post-Procedure Day +1
040904 - Date: 2017-08-17 09:42
040909 - ..
040910 - 2. Dear Doctor Tucker,
040912 - ..
040913 - 3. Per your request, reporting on condition the day after
040914 - regeneration PRP treatment yesterday, on left and mostly right
040915 - foot.
040917 - ..
040918 - References telecon with Doctor Tucker yesterday evening on 170816
040919 - 1400, ref SDS 18 GO9I, requesting report today, on progress following
040920 - regeneration treatment using PRP performed by Doctor Tucker on 170816
040921 - 1400. ref SDS 18 0001
040923 - ..
040924 - Letter to Doctor Tucker continues...
040925 -
040926 - 4. Good news -- there have been no further adverse reactions to
040927 - Tramadol pain medication, reported yesterday.
040929 - ..
040930 - 5. Better news - have taken no more pain medication of any kind.
040932 - ..
040933 - References adverse side effects taking Tramadol for pain relief on
040934 - 170816 1400, ref SDS 18 RN5H, from regeneration injection treatment
040935 - with PRP performed by Doctor Tucker on 170816 1400. ref SDS 18 K65M
040937 - ..
040938 - Letter to Doctor Tucker continues...
040939 -
040940 - 6. Woke at 0455. Laying down, there was no pain in either foot.
040942 - ..
040943 - 7. More good news - plantar plate and long toe feel great - at
040944 - last, pain level 0 again, similar to after 1st treatment 3
040945 - weeks ago.
040947 - ..
040948 - Referenced initial regeneration injection treatment with PRP to
040949 - recover from right foot plantar plate tear, and performed by Doctor
040950 - Tucker on 170726 1600. ref SDS 12 GU6N
040952 - ..
040953 - Letter to Doctor Tucker continues...
040954 -
040955 - 8. There is considerable pain in right foot to stand and walk,
040956 - particularly in the arch [...and ankle...]. This is mitigated
040957 - by wearing Brooks Ghost shoes with VA new orthotic inserts
040958 - designed by Doctor Tang at the VA. Recall you examined the
040959 - shoes and inserts during the meeting yesterday. This morning,
040960 - shoes with custom inserts enable walking, going up and down
040961 - stairs at pain level 2; so, very tolerable. That's a relief.
040963 - ..
040964 - References Doctor Tucker's examination of shoes and inserts during
040965 - meeting yesterday on 170816 1400. ref SDS 18 W15K
040967 - ..
040968 - References new orthotic inserts designed by Doctor Tang, and received
040969 - from the VA on 170725 1636. ref SDS 11 KD8H
040971 - ..
040972 - Letter to Doctor Tucker continues...
040973 -
040974 - 9. Iced feet at 0640 this morning. Should icing be repeated
040975 - through the day, say at 2/3/4 hour intervals?
040977 - ..
040978 - 10. The day after treatment 3 weeks ago, you called on 170727, and
040979 - prescribed walking to reduce swelling. Should this begin
040980 - today, tomorrow - going around the block a mile, rather than 11
040981 - - how much walking should be done?
040983 - ..
040984 - References Doctor's call saying to walk to reduce swelling after 1st
040985 - regeneration injection treatment on 170727 1747. ref SDS 13 0W6V
040987 - ..
040988 - Letter to Doctor Tucker continues...
040989 -
040990 - 11. Please address in Progress Notes our experience of no pain
040991 - during injections on 170726, and multiple injections with
040992 - severe, momentary pain yesterday. Seemed at one point you
040993 - mentioned PRP injections were deeper; and, of course, more PRP
040994 - was injected, because only bottom of feet were injected. Would
040995 - more lidocaine be tried next time? For deeper injections,
040996 - could multiple lidocaine injections be helpful - 1st at initial
040997 - level, and 2nd at a deeper level? Should more time be allowed
040998 - for lidocaine to take effect? You have prescribed applying
040999 - lidocaine cream at home, before driving to your office, if
041000 - there is another phase of injections. That should be part of
041001 - the answer.
041003 - ..
041004 - References pain experienced during regeneration injection treatment
041005 - yesterday on 170816 1400. ref SDS 18 1H6M
041007 - ..
041008 - Letter to Doctor Tucker continues...
041009 -
041010 - 12. In any case, I am not put off by unexpected pain yesterday. I
041011 - am very pleased with the treatment, and greatly enjoyed working
041012 - with you.
041014 - ..
041015 - References comments during the procedure for the doctor to procede
041016 - despite patient experiencing evident significant pain, reported
041017 - yesterday on 170816 1400. ref SDS 18 1A3I
041019 - ..
041020 - Letter to Doctor Tucker continues...
041021 -
041022 - 13. Explain theory of injecting hallux valgus. What result should
041023 - occur? Do we expect the big toe to straighten?? That would
041024 - prevent further pressure on long toe, avoiding the mess Doctor
041025 - Tang treated in May.
041027 - ..
041028 - References work yesterday, injecting hallux valgus, reported on 170816
041029 - 1400. ref SDS 18 IM7N
041030 -
041031 - [...below on 170817 0836 at 1207 letter from Doctor Tucker
041032 - says hallux valgus is symptom of weakening arch; injecting
041033 - PRP to ligaments of the 1st mtp (big toe) in association
041034 - with treating the arch, we are hoping to help heal that and
041035 - more importantly, keep it from worsening. ref SDS 0 9F5H
041037 - ..
041038 - Letter to Doctor Tucker continues...
041039 -
041040 - 14. Equally, injections to ankle and arch. Was this to avoid
041041 - impending plantar fasciitis, evidenced by very occasional and
041042 - momentary sharp pain in the arch during hikes the past few
041043 - months, which I mentioned during the meeting? Does it treat
041044 - the plantar plate tear, or both?
041046 - ..
041047 - References to discussion yesterday on 170816 1400, ref SDS 18 C95L,
041048 - and record of injections. 170816 1400, ref SDS 18 EY3N
041050 - ..
041051 - Letter to Doctor Tucker continues...
041052 -
041053 - 15. Thanks again for great work. Please call when time permits to
041054 - follow up later today.
041055 -
041062 -
041063 -
041065 - ..
0411 -
0412 -
0413 - 1207
0414 -
041401 - Received letter from Doctor Tucker saying...
041402 -
041403 - 1. Subject: Re: Post-Procedure Day +1
041404 - Date: 2017-08-17 12:13
041408 - ..
041409 - 2. Hello,
041410 -
041411 - I was so happy to hear this morning when I called you that the
041412 - fever and chills and dizziness had completely stopped. And you
041413 - discontinued the Tramadol.
041415 - ..
041416 - Aligns with letter this morning, reporting Tramadol symptoms fully
041417 - resolved, and no more pain medication of any kind has been needed, per
041418 - above. ref SDS 0 U48X
041420 - ..
041421 - Letter from Doctor Tucker continues...
041422 -
041423 - 3. The pressure on the plantar plate can be ameliorated by
041424 - strengthening the ligaments of the arch. This is why, not only
041425 - did I inject the arch directly on the bottom of the foot, but
041426 - also deeply from the inside and outside.
041428 - ..
041429 - This may relate to injecting ankle on inside and outside, and so
041430 - responds to question in the letter earlier today, per above.
041431 - ref SDS 0 U459
041433 - ..
041434 - Seems to align with Sharlene's recommendations to add two (2)
041435 - stretching protocols to post-hike regimen, and for the purpose of
041436 - protecting plantar plate against injury, reported on 170425 0830.
041437 - ref SDS 8 GY5J
041439 - ..
041440 - Letter from Doctor Tucker continues...
041441 -
041442 - 4. I numbed every where that I injected, in some places very
041443 - deeply, but the cause of the pain is that these are small
041444 - spaces where we put up to 2cc of PRP. It is the pressure of
041445 - all of that fluid that hurts and takes time to come down.
041447 - ..
041448 - References the letter to Doctor Tucker asking why there was no pain
041449 - for 1st PRP injection treatment on 170726, and there was a lot of pain
041450 - for the 2nd treatment yesterday, per above. ref SDS 0 U449
041452 - ..
041453 - Does putting up to 2cc of PRP increase regeneration and so healing of
041454 - plantar plate tear, along with increasing pain from the injection?
041456 - ..
041457 - What precisely is the regeneration process, that benefits from more
041458 - PRP?
041460 - ..
041461 - Letter from Doctor Tucker continues...
041462 -
041463 - 5. We can use all the lidocaine we want, but it also takes up
041464 - space and so a lot of lidocaine can contribute to the initial
041465 - pain for the deep injections.
041467 - ..
041468 - 6. For the less deep injections along the plantar plate, we could
041469 - numb you more. I know some of the injections you did not feel
041470 - and other ones you did, and so I went back and numbed a few of
041471 - them, and the others, I heard you say, it's alright just keep
041472 - going.
041474 - ..
041475 - Doctor Tucker correctly relates patient experience, where many
041476 - injections were pain free, reported in the record on 170816 1400.
041477 - ref SDS 18 IM7N As well, the patient at all times encouraged the
041478 - doctor to continue injections despite significant pain, and in order
041479 - to benefit from recovery of plantar plate tear, also reported on
041480 - 170816 1400. ref SDS 18 1A3I
041482 - ..
041483 - Letter from Doctor Tucker continues...
041484 -
041485 - 7. The hallux valgus is also a symptom of weakening of the arch.
041486 - By injecting the ligaments of the 1st mtp, in association with
041487 - treating the arch, we are hoping to help heal that and more
041488 - importantly, keep it from worsening.
041490 - ..
041491 - Responds to question in the letter earlier today, per above.
041492 - ref SDS 0 U456
041494 - ..
041495 - Clarifies explanation during the meeting with the doctor yesterday, on
041496 - 170816 1400. ref SDS 18 C95L
041498 - ..
041499 - Letter from Doctor Tucker continues...
041500 -
041501 - 8. In terms of icing, I would ice when the pain is bothering you.
041502 - The ice is just for symptoms.
041504 - ..
041505 - 9. I WOULD like you to wear an ace wrap or elastic ankle support
041506 - for 6 weeks while this is healing and at minimum of 5 days
041507 - while the soft tissue is swollen. This is to keep the
041508 - ligaments from loosening up from all the fluid that we put in.
041510 - ..
041511 - 10. In terms of walking, every patient is different in their rate
041512 - of healing, so I suggest beginning very short walks and
041513 - progressing as pain allows. Please wear the ankle support with
041514 - the walking.
041516 - ..
041517 - 11. I am happy that you are happy and in retrospect I think it was
041518 - a good idea of you to take those pictures so you know where to
041519 - put the lidocaine creame for next time. (Although I hope this
041520 - is the last time)
041522 - ..
041523 - References pictures she took showing record of where PRP injections
041524 - occurred, reported on 170816 1400. ref SDS 18 EY3N
041526 - ..
041527 - Letter from Doctor Tucker continues...
041528 -
041529 - 12. I agree with the idea of more lidocaine in the ball of the
041530 - foot, but when I have used lots of it in the deeper structures
041531 - it took a long time for the pain to come down, and I would
041532 - rather use that space for PRP.
041534 - ..
041535 - 13. As always it was a pleasure to work with you
041537 - ..
041538 - Gloria Tucker MD
041539 -
041540 -
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0416 -