CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 20 0000. ref SDS 19 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Meeting today, with Doctor Tang and his assistant, Christina, in
040902 - Podiatry, and IAW planning shown in the letter to Doctor Tang on
040903 - 170815 1743. ref SDS 20 6M4O
040905 - ..
040906 - Doctor Tang examined orthotic inserts, which he ordered on 170623
040907 - 0830. ref SDS 7 M23H The inserts were received on 170725 1636.
040908 - ref SDS 10 KD8H Letter to the doctor notifies they work beautifully,
040909 - sent later the same day, just walking around, ref SDS 10 6S40, and that
040910 - further testing doing normal 11-mile hikes will occur after PRP
040911 - injection treatments to heal plantar plate injury. ref SDS 10 6S46
040913 - ..
040914 - On 170809 1710 notified Doctor Tang of inital success trying
040915 - modification of blue pad supplemental inserts hiking 6 miles pain
040916 - level 0; but next day had to call cab for ride home after only 4
040917 - miles. ref SDS 18 DV9Q
040919 - ..
040920 - Doctor Tang was aware of 2nd phase regeneration PRP injection
040921 - treatment performed by Doctor Tucker on 170816 1400. ref SDS 21 0001
040922 - The doctor appreciated hearing that prior treatment has improved left
040923 - knee osteoarthritis, and metatarsalgia in both feet. Patinet hopes
040924 - this recovery will also occur for right foot plantar plate injury,
040925 - reported in a copy he received for a letter to Doctor Tucker on
040926 - 170820. The same letter notified that innovative orthotic inserts
040927 - designed by Doctor Tang at VAMCSF will help prevent recurrence of
040928 - metatarsalgia and plantar plate injury. ref SDS 22 EO48
040930 - ..
040931 - Reported that this morning hiked 12 miles beginning at 0430 from the
040932 - VA through Golden Gate Park, and back to the VA. Was surprised how
040933 - well handled steep hill from Great Highway along the ocean up Point
040934 - Logos avenue to the Cliff House, and then to 42nd street, finally
040935 - returning to the VA.
040937 - ..
040938 - Doctor Tang will enter in Progress Notes for the encounter today, that
040939 - patient hiked 12 miles with minimal discomfort to knees and feet,
040940 - following regeneration PRP treatments on 170726, ref SDS 11 0001, and
040941 - more recently 2 weeks ago on 1710816. ref SDS 21 0001
040943 - ..
040944 - The new orthotic inserts worked well to prevent further feet injuries
040945 - complemented with Hydrofera Blue Bacteriostatic dressing supplied by
040946 - Lana in VA Wound Care to treat injuries. Doctor Tang noticed this
040947 - dressing before it was removed for feet examination.
040949 - ..
040950 - Asked if there might be any modifications to new orthotic inserts that
040951 - would prevent further blistering on inside of both feet below big
040952 - toes, as seen this morning?
040954 - ..
040955 - The doctor indicated continued care with Hydrofera Blue Bacteriostatic
040956 - dressing is the best solution.
040958 - ..
040959 - Reported to Doctor Tang minimal plantar plate pain taking 1800 mg (56
040960 - ml) acetaminophen (Tylenol) this morning at 0250, shown in case study
040961 - on 160101 0700. ref SDS 2 NV5I Asked how much to safely increase
040962 - acetaminophen (Tylenol) above 1000 mg, basic adult dose for 8 hours,
040963 - reported on 170826 2204? ref SDS 23 KT6P
040965 - ..
040966 - Doctor Tang cautioned not to exceed 1000 mg for adult dose.
040968 - ..
040969 - This aligns with VA Pharmacist. Before meeting with Doctor Tang,
040970 - visited the VA Pharmacist across the hall. He also insisted 1000 mg
040971 - is maximum for acetaminophen.
040973 - ..
040974 - Yesterday, taking acetaminophen 1000 mg was not enough to get through
040975 - 11 miles. Could not do last mile because of plantar plate pain.
040976 - During the hike this morning and after taking 1800 mg of acetaminophen
040977 - had plantar plate pain level 0 for 80% of 12 miles, pain level 1 - 2
040978 - for 15%, but level 4 - 5 for 5% of hike. Interestingly, coming up the
040979 - steep, long hill at the end had pain level 0 all the way. This record
040980 - seems to align with Doctor Thuillier's notice that plantar plate heals
040981 - with varying pain levels, reported on 170417 1330. ref SDS 6 8A6N
040983 - ..
040984 - Asked for additional measures to control pain without exceeding
040985 - acetaminophen 1000 mg?
040987 - ..
040988 - Doctor Tang suggested going back to Diclofenac gel NSAID topical agent
040989 - applied locally, which he prescribed 9 months ago, shown in a letter
040990 - received on 161220 0927, ref SDS 5 0657 This line of care was
040991 - proposed to replace taking naproxen pills, which seemed to be causing
040992 - severe ulceration of LESV, reported on 161215 1100. ref SDS 4 HY8M
040994 - ..
040995 - Doctor Tang will order acetaminophen liquid from the pharmacy to take
040996 - with Diclofenac gel.
040998 - ..
040999 - After the first regeneration PRP injection treatment on 170726, Doctor
041000 - Tucker recommended taking acetaminophen (Tylenol) for pain management,
041001 - reported on 170726 1600. ref SDS 11 656F Several days later she
041002 - recommended not using of Diclofenac medication, reported on 170728
041003 - 1649. ref SDS 13 FE7X
041005 - ..
041006 - Will ask Doctor Tucker about Doctor Tang's idea to add Diclofenac
041007 - treatment to acetaminophen.
041009 - ..
041010 - Doctor Tang explained considerations to switch from Brooks Ghost shoes
041011 - to shoes with stiffer forefoot. He seemed to say stiffer forefoot
041012 - would reduce pressure on plantar plate injury, and so reduce pain
041013 - during recovery with PRP injections. The doctor suggested
041014 - visiting...
041015 -
041016 - On the Run
041017 - 1310 9th Street (9th and Irving)
041018 - San Francisco, CA
041019 - 415 682 2042
041021 - ..
041022 - The doctor said that On the Run has a podiatrist on staff, who can
041023 - consult on the best shoes to protect against plantar plate tear
041024 - injuries. He said to mention this is a VA Podiatry referral.
041025 -
041026 - [On 170918 0324 letter to Doctor Tang reports attempt to
041027 - implement recommendation on getting help from On-the-Run
041028 - for recovering from feet injuries. ref SDS 24 HJ68
041030 - ..
041031 - [On 170924 1346 visited On-the-Run and met with General
041032 - Manager Eric, who inspected and approved orthotic inserts
041033 - Doctor Tang developed, and recommended meeting following
041034 - Friday with Eric for further ideas on resolving feet pain
041035 - from distance hiking. ref SDS 25 PO9N
041037 - ..
041038 - [On 170929 1010 visited Mark Wachter, owner of On-the-Run
041039 - ref SDS 26 SM4M; he proposed Hoka Bondi 5 Wide shoes,
041040 - ref SDS 26 FV6O, which had plush cushioning like walking on
041041 - pillows with optimum rebound energy, ref SDS 26 TZ5H, he
041042 - proposed Satallite Elite orthotic inserts, ref SDS 26 TZ56,
041043 - Mark grooved a small opening on bottom of right insert at
041044 - plantar plate location, and this relieved pain walking with
041045 - the inserts in the shoes. ref SDS 26 DH8F
041047 - ..
041048 - [On 171110 1042 Hoka Bondi 5 Wide shoes superior cushioning
041049 - and rebound energy, and better width enabled hiking 336
041050 - miles without metatarsalgia pain, so bought 6 more pair to
041051 - rotate shoes every day on 11 to 15 mile hikes. ref SDS 27
041052 - SM4M
041054 - ..
041055 - Asked what shoes the doctor wears for running and hiking? Not sure
041056 - what was presented.
041058 - ..
041059 - At some point the doctor mentioned that he has bench pressed 350
041060 - pounds.
041062 - ..
041063 - Doctor Tang finally proposed elevating the heel with new inserts, as a
041064 - means to relieve pressure on plantar plate from pronating the toes.
041065 - He placed an order with Orthopedics and Prosthetics Department.
041066 -
041067 - [On 160101 0700 case study reporting on hike 170831, had to
041068 - stop on side of road and remove heel elevator pads due to
041069 - pain level 8. ref SDS 3 945M
041071 - ..
041072 - After consulting on these issues, the doctor left the procedure room.
041074 - ..
041075 - Christina, who had been entering Progress Notes of the examination,
041076 - used a surgical knife to cut away calluses that have formed on the
041077 - inside of each big toe. She could not fully remove the callus on the
041078 - right big toe, because a blister has formed beneath the callus, and so
041079 - must resolve without further care.
041080 -
041082 - ..
0411 -
0412 -
0413 - 0912
0414 -
041401 - After meeting with Doctor Tang and Christina, went to Orthopedics and
041402 - Prosthetics.
041404 - ..
041405 - The attendant had received the order for heel lifts. He explained
041406 - these can be modified to apply varying amount of heel lift, based on
041407 - experimenting to determine the best solution.
041408 -
041409 - [On 160101 0700 case study reporting on hike 170831, had to
041410 - stop on side of road and remove heel elevator pads due to
041411 - pain level 8. ref SDS 3 945M
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