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: January 5, 2018 04:30 PM Friday; Rod Welch

Doctor Tucker 3rd regeneration PRP injection treatment feet and knees.

1...Summary/Objective
........Platelet-Rich Plasma (PRP) Therapy for Arthritis
........Application of Platelet-Rich Plasma to Disorders of the Knee Joint
2...Develope Scope of Work for Regeneration PRP Injection Treatments
3...PRP Treatment Layout Injection Sites
........Right Leg Injections
........Left Leg
........Right Foot
........Left Foot
4...Blood Draw for PRP Completed with One Needle Stick
5...PRP Injections Mostly Pain Free
6...Follow Up Treatments Might be Needed
7...Discharge Instructions and Payment
........PRP  POST INJECTION GUIDELINES AND EXERCISES
8...Driving from Novato to Concord


..............
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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 24 0000. ref SDS 23 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040503 - Good work today, injecting right knee, both feet, including Tailor's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040504 - Bunions, and rest into left knee. ref SDS 0 VO3F  Reviewed findings in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040505 - MRI on 171229. ref SDS 0 9J8N  Got better insight into how PRP                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040506 - resolves pain by regenerating soft tissue.  Post procedure research                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040507 - found support for PRP increasing collagen, ligaments, etc. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040508 - T14I  Another article in PMC relates research finding PRP increases                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040509 - cartilage at 6 months.  This indicates subsequent measurements in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040510 - Welch, may yield comparable findings. ref SDS 0 JX67  Scope of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040511 - treatment today, was limited by lack of driver. ref SDS 0 HP5O  As a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040512 - result, only 12 injections were made. ref SDS 0 VO3F  Doctor Tucker                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040513 - injected right knee for first time, and with full protocol amount.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040514 - ref SDS 0 K65M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040515 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040516 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040517 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040518 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040520 -  ..
0406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0408 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040901 - Arrived OA 1500, so worked for 90 minutes in one of the spare                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040902 - offices.  This was helpful to review the record preparing for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040903 - productive meeting.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040905 -  ..
040906 - The 3nd PRP treatment performed today, was scheduled with Connie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040907 - earlier this morning, during a call intended to schedule treatment on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040908 - 180221, reported on 180105 1118. ref SDS 40 5P4L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040910 -  ..
040911 - During this 90-minute period, a patient took ill in the waiting room.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040912 - She was with her husband.  He coordinated with Jane, and partly with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040913 - Doctor Tucker to provide interim care until they could drive to a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040914 - hospital.  At one point, Doctor Tucker authorized the patient to lie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040915 - down on an examination table to recover.  Turned out this patient did                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040916 - not receive PRP treatment today, so her illness was unrelated.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040918 -  ..
040919 - Doctor Tucker's other patients required care until about 1650.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040920 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040922 -  ..
0410 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0411 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0412 - 1700                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0413 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041301 - Jane came and said a treatment room is ready, so stopped working, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041302 - went into the procedure room.  Removed shoes and waited for the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041303 - doctor.  Within a few minutes she came into the room.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041304 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041341 -  ..
041342 - Discussed scope of treatment today, presented in a letter to Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041343 - Tucker on 171208 1242. ref SDS 34 CJ60                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041345 -  ..
041346 - Scope was reviewed again in another letter on 171227. ref SDS 38 FN52                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041348 -  ..
041349 - On 171227 1300, Doctor Thuillier in VA Orthotpedics ordered MRI                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041350 - studies on both feet and both knees, to find changes in anatomy that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041351 - reconcile clinical improvement reducing severe osteoarthritis pain.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041352 - 171227 0915, ref SDS 37 E54H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041354 -  ..
041355 - On 171229 0615 went to Radiology at VAMCSF.  Jonus did MRI scans on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041356 - both knees to evaluate recovery osteoarthritis. ref SDS 39 FZ5L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041358 -  ..
041359 - Doctor Tucker said earlier today, she read the MRI findings on left                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041360 - knee shown in the record on 171229 0745, ref SDS 39 ZG6H, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041361 - referenced in the copy she received of the letter sent to Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041362 - Thuiller earlier today on 180105 1321. ref SDS 41 O46F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041364 -  ..
041365 - The doctor said there is not a lot of reporting on MRI studies finding                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041366 - regeneration of cartiage in joints.  This aligns with results of MRI                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041367 - on 171229 0745, ref SDS 39 PSWR, which says in part...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041368 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041369 -            Unchanged complete degenerative tearing of the medial                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041370 -            meniscus and partial tearing of the lateral meniscus with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041371 -            extrusion of the body with intrasubstance degeneration.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041373 -  ..
041374 - This finding indicates PRP did not regnerate cartilage.  Why then has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041375 - there been no pain in the left knee?  The right knee was treated with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041376 - Supartz on 170731 1500, ref SDS 20 0001, 5 days after PRP treatment on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041377 - 170726.  It's known that hyaluronic acid in Supartz lubricates the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041378 - joint to reduce pain.  This worked well in the right knee for about 4                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041379 - months, then pain began to recur, so Glucosamine Chondroitin has been                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041380 - taken to continue lubricating the right knee joint for pain                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041381 - management.  Since PRP does not inject hyaluronic acid, how has it                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041382 - prevented pain in the left knee for over 5 months and counting?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041384 -  ..
041385 - Doctor Tucker seemed to say PRP eliminated pain hiking 630 miles since                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041386 - injections on 170726, cited in the letter to Doctor Thuillier on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041387 - 180105 1321, ref SDS 41 I48O, by regenerating (healing??) soft tissue.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041388 - The doctor mentioned specifically collagen, ligaments, muscles, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041389 - further indicated MRI technology cannot assess these soft tissue                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041390 - improvements.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041392 -  ..
041393 - After the meeting, research found on the Internet...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041394 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041395 -        Arthritis-Health                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041397 -         ..
041398 -        Platelet-Rich Plasma (PRP) Therapy for Arthritis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041399 -        
041400 -        By John J Wilson, MD, MS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041401 -        Updated................................ 2014 01 07 | Peer Reviewed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041402 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041403 -              https://www.arthritis-health.com/treatment/injections/platelet-rich-plasma-prp-therapy-arthritis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041405 -  ..
041406 - The article says in part...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041408 -        PRP injections are formulated from your own immune system's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041409 -        platelets, which are extracted from a blood sample, then                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041410 -        concentrated to make the injection.  This seems to stimulate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041411 -        healing through the production of collagen and to alter pain                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041412 -        receptors, which reduces pain.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041414 -  ..
041415 - This seems to support Doctor Tucker's theory, per above. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041416 - T14I  Would be helpful to have study measuring collagen before and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041417 - after PRP treatment.  What signals increased collagen?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041419 -  ..
041420 - Article continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041421 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041422 -        What Does Platelet-Rich Plasma Therapy Do?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041424 -         ..
041425 -        Experts are unsure exactly how PRP therapy may alleviate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041426 -        symptoms for certain orthopedic conditions.  Doctors who use                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041427 -        PRP therapy to treat osteoarthritis theorize that the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041428 -        platelet-rich plasma might:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041429 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041430 -        1.  Inhibit inflammation and slow down the progression of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041431 -            osteoarthritis1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041433 -  ..
041434 - MRI study may support this explanation.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041436 -  ..
041437 - Article continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041438 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041439 -        2.  Stimulate the formation of new cartilage2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041441 -  ..
041442 - MRI study seems not to support this explanation.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041444 -  ..
041445 - Article continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041446 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041447 -        3.  Increase the production of natural lubricating fluid in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041448 -            joint, thereby easing painful joint friction3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041450 -  ..
041451 - MRI study seems silent on this.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041453 -  ..
041454 - Article continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041455 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041456 -        4.  Contain proteins that alter a patient's pain receptors and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041457 -            reduce pain sensation                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041459 -         ..
041460 -        It could be that platelet-rich plasma does all of these things,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041461 -        or none.5 More large-scale, high-quality clinical studies are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041462 -        needed before scientists can know.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041463 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041465 -  ..
041466 - Pubmed article sounds promising...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041467 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041468 -        NCBI                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041469 -        PMC                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041470 -        US National Library of Medicine                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041471 -        National Institutes of Health (NIH)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041473 -         ..
041474 -        Cartilage                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041475 -        Cartilage: 2013 Oct, 4 (4) 295-312                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041477 -         ..
041478 -        PMCID:  PCM4297162                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041479 -        doi:  10.1177/1947603513497553                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041481 -         ..
041482 -        Application of Platelet-Rich Plasma to Disorders of the Knee Joint                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041483 -        
041484 -        Omitted - authors and copyright and license information                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041485 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041486 -              https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4297162/                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041488 -         ..
041489 -        Abstract                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041491 -         ..
041492 -        Importance. The promising therapeutic potential and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041493 -        regenerative properties of platelet-rich plasma (PRP) have                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041494 -        rapidly led to its widespread clinical use in musculoskeletal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041495 -        injury and disease. Although the basic scientific rationale                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041496 -        surrounding PRP products is compelling, the clinical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041497 -        application has outpaced the research.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041499 -         ..
041500 -        Objective. The purpose of this article is to examine the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041501 -        current concepts around the basic science of PRP application,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041502 -        different preparation systems, and clinical application of PRP                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041503 -        in disorders in the knee.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041505 -  ..
041506 - Many articles mention varying results based on "different preparation                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041507 - systems, as here.  In this case, where results seem favorable after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041508 - only 5 months on the left knee, and both feet, specifications on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041509 - "preparation" and "product composition" should be reported to evaluate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041510 - repetitive results.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041512 -  ..
041513 - Article continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041514 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041515 -        Basic Scientific Rationale of Platelet-Rich Plasma Use in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041516 -        Articular Cartilage Degradation and Repair                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041518 -         ..
041519 -        On a molecular level, results have indicated a beneficial                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041520 -        effect of PRP on chondrocytes and mesenchymal stem cells.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041521 -        Increased cell proliferation and synthesis of proteoglycans and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041522 -        collagen type II has been demonstrated when cell cultures of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041523 -        chondrocytes56,57 and mesenchymal stem cells58 are treated with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041524 -        PRP compared with controls treated with platelet-poor plasma or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041525 -        fetal bovine serum.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041527 -  ..
041528 - This seems to align with Doctor Tucker's explanation that PRP                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041529 - increases collagen, per above. ref SDS 0 T14I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041531 -  ..
041532 - Article continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041533 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041534 -        Clinical Application of Platelet-Rich Plasma Use in Articular                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041535 -        Cartilage Degradation and Repair in the Knee                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041537 -         ..
041538 -        Osteoarthritis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041540 -         ..
041541 -        In an uncontrolled prospective study, 14 patients with knee OA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041542 -        were treated with PRP produced using anticoagulated blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041543 -        processed in the GPS III system.61 These authors reported                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041544 -        reduced pain and improved functional outcome after a series of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041545 -        injections with PRP.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041547 -  ..
041548 - This aligns with Welch case on left knee.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041550 -  ..
041551 - Article continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041552 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041553 -        They also reported improvement in the ultrasonographic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041554 -        measurement of femoral articular cartilage thickness in 6 out                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041555 -        of 13 patients at 6 months and in the satisfaction survey at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041556 -        the 1-year follow-up examination, 8 of 13 patients reached                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041557 -        their goals at 1 year (Table 3).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041559 -  ..
041560 - There is no evidence of cartilage thickness improvement in Welch,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041561 - after 5 months, at least using measurements applied by radiologists                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041562 - for MRI study on 171229.  Conceivably, more refined measurement                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041563 - methodology might register either increase or decrease in cartilage of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041564 - left knee joint.  Since PRP injected on 170726, was deminimus, i.e.,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041565 - less than protocol, per Doctor Tucker below, ref SDS 0 TR68, perhaps                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041566 - another MRI in 6 months after treatment today, will show increased                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041567 - miniscus.  If so, this would further reconcile clinical improvement                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041568 - feeling no pain in left knee hiking 630 miles between MRI on 170726,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041569 - and recent follow up MRI on 171229.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041570 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041571 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041573 -  ..
041574 - Develope Scope of Work for Regeneration PRP Injection Treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041575 - 
041576 - Follow up ref SDS 24 PPVQ.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041577 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041578 - Doctor Tucker asked about pain medication.  How long since taking                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041579 - NSAID drugs?  She said these should have been stopped for at least                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041580 - the past 7 days.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041582 -  ..
041583 - Cited letter to the medical team (including Doctor Tucker) on 171103,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041584 - reported all pain medication was stopped 4 weeks earlier ref SDS 33                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041585 - S273  Ending pain medication actually began on 171018, shown in diary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041586 - listing daily exercise, diet, vitals and medication in case study                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041587 - beginning on 160101 0700. ref SDS 9 PM5F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041589 -  ..
041590 - Based on understanding for rational basis that PRP in left knee                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041591 - reduced pain through improving multiple joint deficits, made                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041592 - following decisions...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041593 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041594 -        Because the meeting today, was scheduled ad hoc from a call                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041595 -        this morning, reported on 180105 1118, ref SDS 40 GO9L, it was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041596 -        not possible to have a driver.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041598 -         ..
041599 -        Driver is needed when injections require strong medication to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041600 -        manage pain, which then impairs ability to drive, based on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041601 -        prior care, reported on 170816 1400, ref SDS 24 J97M  On that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041602 -        occasion, the body suffered severe side effects from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041603 -        post-procedure pain medication. ref SDS 24 RN5H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041605 -         ..
041606 -        Without driver, should not do deep injections to left and right                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041607 -        feet plantar plate tears, nor to arches, which both caused                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041608 -        severe pain and so required pain medication for prior PRP                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041609 -        injections on 170816 1400. ref SDS 24 1H6M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041611 -         ..
041612 -        Doctor Tucker agreed to defer injections into the arch today,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041613 -        but noted efficacy to relieve hallus valgus in both feet.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041615 -         ..
041616 -        We noted simple procedure of placing felt pad spreaders between                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041617 -        toes has been successful preventing feet pain and increased                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041618 -        blisters caused by hallus valgus injuries, as recommended by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041619 -        Doctor Thuillier during the meeting at the VA on 171227 0915.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041620 -        ref SDS 37 3B3H  This reduces urgency for injecting hallus                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041621 -        valgus today, so that PRP can be injected in left knee.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041623 -         ..
041624 -        Will consider PRP injecting hallus valgus during subsequent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041625 -        treatments, when a driver is available and/or conscious                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041626 -        sedation can be performed.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041628 -         ..
041629 -        Primary PRP injection objective is right knee, presented in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041630 -        letter on 171208 1242, ref SDS 34 YM3I, and to achieve pain                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041631 -        relief comparable to total relief experienced with left knee                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041632 -        during hiking, reported in the letter to the medical team on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041633 -        171103 1141, ref SDS 33 S293, further presented in the letter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041634 -        to Doctor Tucker on 171208 1242. ref SDS 34 CK36  This was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041635 -        confirmed in recent letter on 171227 1328. ref SDS 38 FN52                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041637 -         ..
041638 -        Next inject both feet metatarsals only, and not inject bottom                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041639 -        of feet to specifically treat plantar plate.  These seem                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041640 -        largely healed.  Injecting metatartsals today, may also                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041641 -        additonally treat plantar plate area without direct injections.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041643 -         ..
041644 -        Tailor's bunion inject PRP on both feet.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041646 -         ..
041647 -        Remaining PRP plasma, if any, can be injected into left knee.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041649 -  ..
041650 - Doctor Tucker said she was surprised the left knee responded so well                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041651 - to PRP injection on 170726, which used less than standard protocol for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041652 - knee injections.  She explained this occurred, because at that time,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041653 - the left knee was injected last with only what remained after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041654 - injecting both feet metatarsals and plantar plate tear on bottom of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041655 - right foot.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041657 -  ..
041658 - Longevity of recovery was discussed.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041660 -  ..
041661 - Doctor Tucker seemed to say the single injections into both feet and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041662 - left knee could last 1 - 5 years.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041664 -  ..
041665 - Discussed research indicating some patients get injections every 6                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041666 - months or at least annually.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041668 -  ..
041669 - The doctor seemed to say that properly applied PRP injection                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041670 - treatments should last at least multiple years.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041672 -  ..
041673 - Since the left knee did not receive a full amount of PRP injection,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041674 - supplementing the first injection today, is good insurance for longer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041675 - results.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041677 -  ..
041678 - Finally, most patients don't hike 2,500 miles per year, with running                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041679 - and sprinting included.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041681 -  ..
041682 - The doctor seemed to indicate that running and sprinting in particular                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041683 - reduce longevity of PRP care.  She recommended agains it.  This                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041684 - conflicts with reporting that many professional atheltes are extending                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041685 - their careers by getting PRP injections, cited in the letter to Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041686 - Tucker on 171212 1657. ref SDS 35 RX52  These athletes run and sprint,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041687 - endemic to tennis, baseball, et al.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041689 -  ..
041690 - As a result, multiple PRP injections to feet and knees are required to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041691 - achieve longevity normally expected for patients who receive only                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041692 - single injections.  Hopefully, injections today, will last 2 - 5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041693 - years.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041694 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041696 -  ..
041697 - PRP Treatment Layout Injection Sites                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041698 - 
041699 - Follow up ref SDS 24 VO3F, ref SDS 17 PP4N.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041700 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041701 - In procedure room laying on treatment table, Doctor Tucker again                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041702 - marked locations on both feet and both knees to be injected.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041704 -         ..
041705 -        Right Leg                                     Injections                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041706 -        
041707 -        Knee joint...........................................  1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041708 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041710 -         ..
041711 -        Left Leg                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041712 -        
041713 -        Knee joint...........................................  1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041714 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041716 -         ..
041717 -        Right Foot                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041718 -        
041719 -        Follow up ref SDS 24 0108.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041720 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041721 -        Metatarsalgia                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041722 -        Between little toe and ring toe................. 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041723 -        Between ring toe and middle toe................. 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041724 -        Between middle and long toe..................... 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041725 -        Between long toe and big toe.................... 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041727 -         ..
041728 -        Tailor's bunion................................. 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041730 -         ..
041731 -        Total right foot...............................  5      5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041733 -         ..
041734 -        Left Foot                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041735 -        
041736 -        Follow up ref SDS 24 YY3G.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041737 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041738 -        Metatarsalgia                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041739 -        Between little toe and ring toe................. 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041740 -        Between ring toe and middle toe................. 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041741 -        Between middle and long toe..................... 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041742 -        Between long toe and big toe.................... 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041744 -         ..
041745 -        Tailor's Bunion................................. 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041747 -         ..
041748 -        Total right foot...............................  5      5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041750 -         ..
041751 -        Total injections...................................... 12                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041752 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041754 -  ..
041755 - Blood Draw for PRP Completed with One Needle Stick                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041756 - 
041757 - Follow up ref SDS 24 YY6N, ref SDS 17 FG7F.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041758 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041759 - Doctor Tucker drew blood for PRP platelet extraction.  She used outer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041760 - side of left arm inner elbow, which was successful for prior treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041761 - on 170816 1400, ref SDS 24 YY6N, and previously on 170726 1600.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041762 - ref SDS 17 TZ8N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041764 -  ..
041765 - This took only 1 stick today.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041766 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041768 -  ..
041769 - PRP Injections Mostly Pain Free                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041770 - 
041771 - Follow up ref SDS 24 K65M, ref SDS 17 GU6N.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041772 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041773 - Doctor Tucker initially, marked all locations for PRP injections.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041774 - She sprayed numbing agent on each location.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041776 -  ..
041777 - The doctor made markings around the knee caps to consider possible                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041778 - multiple injection points.  However, she ultimately made only 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041779 - injection, and advised this is a standard protocol location for knees.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041781 -  ..
041782 - Doctor Tucker injected each location with lidocain to further numb                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041783 - needle penetrations.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041785 -  ..
041786 - Right knee - after waiting mintutes for lidocain to take effect, PRP                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041787 - was injected into the right knee joint, using standard protocol                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041788 - amount, discussed above. ref SDS 0 059O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041790 -  ..
041791 - This was completely pain free.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041793 -  ..
041794 - Right foot - PRP was next injected into 4 locations on top of right                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041795 - foot metatarsals.  The outer 2 injections were pain free.  The middle                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041796 - injections caused severe pain.  The doctor noted this reflected these                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041797 - middle toes have been worn down by hiking, running and sprinting.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041799 -  ..
041800 - Tailor's bunion right foot was injected with small amount.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041802 -  ..
041803 - Left foot - same scenario as right foot, with considerable pain                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041804 - injecting middle metatarsals.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041806 -  ..
041807 - Pain was only at moments of needle penetration, similar but less                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041808 - severe than prior procedure on 170816 1400. ref SDS 24 1A3I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041810 -  ..
041811 - Tailor's bunion left foot was injected with small amount.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041812 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041813 -            [On 180315 shown in case study on 160101 0700 tailor's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041814 -            bunion on left foot now requires dressing to relieve shoe                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041815 -            pressure during hikes.  Tailor's bunion right foot does not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041816 -            require dressing. ref SDS 10 4B6L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041818 -  ..
041819 - Left knee - remainting PRP was injected into left knee.  This was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041820 - completely pain free.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041821 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041822 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041824 -  ..
041825 - Follow Up Treatments Might be Needed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041826 - Discharge Instructions and Payment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041827 - 
041828 - Follow up ref SDS 24 WV5I, ref SDS 17 S93J.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041829 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041830 - Doctor Tucker cleaned forefeet which had leaked blood slightly.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041832 -  ..
041833 - On standing up from the treatment table, there was mild pain at level                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041834 - 1 - 2 in the feet where injections were made.  This was much less                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041835 - severe than after deep injections to plantar plate and arches done on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041836 - 170816 1400. ref SDS 24 J97T  As a result, pain medication was not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041837 - needed today.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041839 -  ..
041840 - Doctor Tucker said not to hike for a week, then follow prior protocol.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041841 - On 170727 1747 Doctor Tucker called and said walking 1 mile 2 days                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041842 - after feet injections stimulates PRP healing (regeneration) processes,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041843 - and then slow for about 3 miles helps distribute PRP in the feet.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041844 - ref SDS 18 0W6V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041846 -  ..
041847 - After treatment today, research found...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041848 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041849 -        The Stemcell Orthopedic Institute of Texas                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041850 -        Call 210 293 3136                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041852 -         ..
041853 -        PRP  POST INJECTION GUIDELINES AND EXERCISES                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041854 -        
041855 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041856 -              https://stemcellorthopedicinstituteoftexas.com/platelet-rich-plasma-therapy-prp/after-prp-therapy/                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041857 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041858 -        1.  Medication Guidelines                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041859 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041860 -            For a minimum of two weeks post-injection, it is important                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041861 -            for the efficacy of the treatment that all                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041862 -            anti-inflammatory medications (NSAIDS) are discontinued.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041863 -            You can take Tylenol (Acetaminophen) and Celebrex, but we                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041864 -            ask that you avoid other NSAIDS such as aspirin, Naproxen                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041865 -            (Aleve) and Ibuprofen (Advil, Motrin) because they will                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041866 -            inhibit platelet function.  Other prescription medication                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041867 -            should be reviewed with your procedure physician.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041869 -             ..
041870 -            Apply moist heat to treated area for the first 24 hours.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041872 -             ..
041873 -        2.  Activity Guidelines                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041874 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041875 -            FIRST WEEK&Treated areas should remain immobile.  For the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041876 -            first two weeks, we encourage you to resume normal day-to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041877 -            day activities&BUT NO exercise of the treated extremity.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041879 -             ..
041880 -            SECOND WEEK& light exercises and progressively build back                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041881 -            to normal exercise after 4 weeks.  Controlled and moderate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041882 -            movement is important for the proper stimulation of tissue                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041883 -            to rebuild in a linear and physiologic fashion.  However,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041884 -            we strongly advise that you avoid heavy lifting or high                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041885 -            exercise levels because these activities will compromise                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041886 -            the progress we are trying to make                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041888 -             ..
041889 -            AFTER TWO WEEKS&you are cleared by your physician to resume                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041890 -            exercising the area.  However, we ask that you gradually                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041891 -            increase the intensity of your workouts so as not to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041892 -            re-injure the tissue.  Use pain in the area of injection as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041893 -            a guide to how far you push yourself.  This is not like                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041894 -            physical therapy after surgery.  We do not want you to push                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041895 -            through the pain.  Instead, ease off the intensity if the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041896 -            pain persists.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041898 -  ..
041899 - The question is whether damaged tissue heals, i.e., regenerates, e.g.,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041900 - miniscus cartilage, ligaments.  How long does this take?  1 week,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041901 - month, 6 months, a year.  Once healed, how long will "healed" miniscus                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041902 - cartilage, metatarsal cartilage last hiking 11 - 15 miles per day?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041904 -  ..
041905 - Article continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041906 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041907 -            If you feel any of the following symptoms immediately                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041908 -            contact our office: prolonged redness, swelling, fevers,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041909 -            chills, muscle weakness as well as numbness and/or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041910 -            tingling.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041911 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041913 -  ..
041914 - The doctor also cautioned against using NSAID pain medications for 2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041915 - weeks after injections, since NSAID drugs block/reduce blood flow                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041916 - needed for PRP healing process.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041918 -  ..
041919 - Thanked Doctor Tucker for great work.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041920 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041921 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041923 -  ..
0420 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0421 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0422 - 1842                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0423 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
042301 - Jane had already left, so Doctor Tucker prepared the bill...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
042302 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042303 -                             $900                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
042304 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042312 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042313 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042315 -  ..
0424 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0425 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0426 - 1613                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0427 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
042701 - Driving from Novato to Concord                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042702 - 
042703 - Follow up ref SDS 24 VJ3G.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
042704 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042705 - After leaving the doctor's office traffic was okay on 101 for the 5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
042706 - miles to highway 37 off ramp.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
042708 -  ..
042709 - Traffic moved well for 2 or 3 miles on highway 37 with 2 lanes in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
042710 - both directions.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
042712 -  ..
042713 - Fortunately, traffic speed remained normal all the way to Vallejo.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
042715 -  ..
042716 - Made it to Vallejo and transitioned onto US 80 toward San Francisco.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042717 - There was moderate rain, and in the dark took wrong turn off, so                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
042718 - missed highway 780 to Benecia- Martinez bridge.  Was fortunate to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
042719 - quickly find an onramp for highway 80 West to Sacramento.  Took this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042720 - to 680, and then to Benecia-Martinez bridge and home.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
042721 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042723 -  ..
0428 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0429 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0430 - 2010                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0431 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043101 - Arrived home, and transferred the record from c23 to c22.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
043102 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043103 - Began writing up the record meeting with Doctor Tucker.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
043104 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043105 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043106 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043107 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043108 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043109 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043110 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043111 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043112 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043113 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043114 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043115 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0432 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
Distribution. . . . See "CONTACTS"