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: August 19, 2017 01:52 PM Saturday; Rod Welch

Doctor Tucker letter explains regeneration occurs 4 - 6 weeks after PRP treatment.

1...Summary/Objective


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

SUBJECTS
Default Null Subject Account for Blank Record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0403 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0403 -    ..
0404 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040501 - Follow up ref SDS 21 0000. ref SDS 20 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040506 -  ..
0406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0408 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040901 - Received letter from Doctor Tucker saying...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040902 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040903 -    1.  Subject:  Re: Post-Procedure Day +3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040904 -        Date:  2017-08-19 11:23                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040908 -         ..
040909 -    2.  Hello                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040910 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040911 -        I am very happy to hear your news.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040913 -         ..
040914 -        For most people, after PRP, the symptoms that brought them in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040915 -        return after the inflammation settles down which is about 3-5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040916 -        days.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040918 -  ..
040919 - Does this apply to regeneration therapy with PRP generally, or to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040920 - plantar plate specifically?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040921 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040922 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040924 -  ..
040925 - For example, left knee symptoms of severe osteoarthritis stemming from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040926 - falling 40' into pump station in 1973, and then having knee surgery                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040927 - that cut away portions of miniscus cartelage, thus causing continual                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040928 - degeneration the past 40 years, causing the condition on 170726...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040929 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040930 -            MENISCI:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040932 -             ..
040933 -            Medial meniscus with degenerative tearing involving its                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040934 -            entirety.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040936 -             ..
040937 -            Lateral meniscus with degenerative tearing involving                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040938 -            the posterior root and horn, extrusion of the body with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040939 -            intrasubstance degeneration, and diminutive/degenerated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040940 -            appearance of the anterior horn.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040941 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040943 -             ..
040944 -            CRUCIATE LIGAMENTS:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040946 -             ..
040947 -            Anterior cruciate ligament with complete tear.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040948 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040949 - ...reported in findings of MRI at VAMCSF on 160805 0800. ref SDS 7                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040950 - PSWR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040952 -  ..
040953 - In this case, within a few days after PRP treatment (thanks to Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040954 - Tucker's kindness reported on 170726 1600. ref SDS 13 4Y8K) these                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040955 - severe deficits in the left knee seem to have completely resolved, in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040956 - that there has been pain level 0 in the left knee, despite not taking                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040957 - Glucosamine Chondroitin, previously taken the past 13 years, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040958 - despite vigorous hiking.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040960 -  ..
040961 - Somehow, pain went away, and has not returned, contrary to Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040962 - Tucker's letter today, indicating prior symptoms typically return 3 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040963 - 5 days after PRP treatment, per above. ref SDS 0 C29Q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040965 -  ..
040966 - Similarly, metatarsalgia pain in both feet also resolved within a few                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040967 - days getting PRP treatment on 170726 (thanks again to Doctor Tucker's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040968 - kindness), and has not returned.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040970 -  ..
040971 - It may be that immediate favorable response to treatment for left knee                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040972 - and both feet metatarsalgia only reflects lubricating effects that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040973 - last longer in these locations than injections into plantar plate.  As                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040974 - lubricating effects decline, regeneration effects rise providing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040975 - continuous pain relief.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040977 -  ..
040978 - However, treatment trajectory of plantar plate seems closely aligned                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040979 - with the Doctor's explanation, in that symptoms seemed fully resolved                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040980 - with pain level 0 on vigorous hikes for a week, reported for hike on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040981 - 170807, shown in case study, 160101 0700, ref SDS 5 5B4I; but later                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040982 - symptoms recurred next day on 170809, ref SDS 5 SYYR, leading to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040983 - request for a 2nd treatment on 170809 1739. ref SDS 18 0W5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040985 -  ..
040986 - Doctor Tucker's letter continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040987 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040988 -    3.  The body works internally to repair and remodel the ligaments.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040989 -        This takes 4-6 weeks, my website reviews this.  So usually it                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040990 -        is about 4-6 weeks before the problem improves significantly.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040992 -  ..
040993 - This standard of practice seems to indicate 4 - 6 weeks after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040994 - treatment on 170726, ref SDS 13 0001, pain symptoms should resolve in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040995 - right foot plantar plate, beginning OA 180223.  What effect does 2nd                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040996 - treatment on 170816, have on this target date for regenration to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040997 - manifest resolution of pain during hiking?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040999 -  ..
041000 - Intuitively, it would seem feet that carrying full body weight, would                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041001 - respond equally to knees that also carry full body weight in walking                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041002 - and running.  Is there an orthopedic theory on why in this case the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041003 - left knee responded immediately, and the right foot experienced                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041004 - delayed response to PRP injections on 170726?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041006 -  ..
041007 - Doctor Dang in Sports Medicine Specialist in Orthopedics at UCSF and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041008 - VAMCSF, said nobody knows why the left knee much more severely injured                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041009 - than the right knee, responded well to Glucosamine Chondroitin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041010 - (hyaluranic acid), for 13 years, while the right knee much less                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041011 - severely injured, did not, reported on 161212 1632. ref SDS 8 OP65                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041012 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041014 -  ..
041015 - Doctor Tucker's letter continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041016 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041017 -    4.  I know that you are on a schedule to make your goal of hiking                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041018 -        half dome. and so I understand your desire to keep hiking and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041019 -        hike vigorously.  But I really can't comment on your quick                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041020 -        improvement.  I applaud your desire to move forward but I would                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041021 -        do it sytematically and cautiously.  I have to say that there                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041022 -        are some patients who improve rapidly soon after the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041023 -        injections, I wish I understood why.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041025 -         ..
041026 -    5.  I have had a number of patients report profound fatigue for a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041027 -        few days after prolotherapy, On the surface it doesn't look                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041028 -        like much happened but we did some deep work in your foot                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041030 -         ..
041031 -    6.  I would absolutely wait 6 weeks (if you are painfree) before                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041032 -        looking at an MRI  to evaluate your plantar plate. There is no                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041033 -        point before that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041035 -  ..
041036 - So 6 weeks after 170726 will be...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041037 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041038 -                             170906                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041040 -  ..
041041 - If we achieve pain free condition in right foot plantar plate, will                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041042 - definitely, ask Doctor Thuillier for another MRI to compare with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041043 - study on 170412.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041045 -  ..
041046 - Equally, will request MRI on left knee to evaluate why pain has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041047 - resolved in a knee found on 160805, to have severe deficits.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041049 -  ..
041050 - Doctor Tucker's letter continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041051 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041052 -    7.  Also, I am not a specialist in the foot. I am a specialist in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041053 -        Proliferative Medicine. And we are trained by foot specialists.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041055 -         ..
041056 -    8.  So have fun today, but build up slowly                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041058 -         ..
041059 -        Gloria Tucker MD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041060 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041061 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041062 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041063 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041064 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0411 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
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