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 38 0000. ref SDS 37 0000.
040502 -
040503 -
040504 -
040505 - [On 180820 1039 scheduled follow up with 5th PRP treatment
040506 - on 180825 1515. ref SDS 40 E27M
040507 -
040508 -
040509 -
040511 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 180105 1118 Jane called and advised of cancellation, so ordered PRP
040902 - treatment in feet and knees by Doctor Gloria Tucker. ref SDS 24 O46F
040904 - ..
040905 - On 180105 1321 letter to Doctor Thuillier in VA Orthopedics notified
040906 - have been unable to download radiologist report on MRI of both feet
040907 - performed on 171229. ref SDS 25 O46F Further explained plan on
040908 - driving to VAMCSF to get the report from VA Release of Information
040909 - (ROI). ref SDS 25 I492 Also planned to schedule meeting with Doctor
040910 - Thuillier for review results of MRI studies on feet and knees. 180105
040911 - 1321, ref SDS 25 I495
040913 - ..
040914 - On 180105 1630 Doctor Tucker performed 3rd PRP injection treatment for
040915 - feet and knees again. ref SDS 26 0001
040917 - ..
040918 - On 180108 letter to Doctor Thuillier reported PRP treatment in both
040919 - feet and both knees on 180105 1630, ref SDS 26 HP5O, and related
040920 - research indicating PRP yields measurable increase in minisucs
040921 - cartilage over 6 months. ref SDS 26 JX67
040923 - ..
040924 - On 180110 1100 meeting Doctor Thuillier. ref SDS 28 JN9H
040926 - ..
040927 - On 180423 0908 called Jane and scheduled meeting with Doctor Thuillier
040928 - on 180425 1145. ref SDS 30 OL9L
040930 - ..
040931 - On 180425 1145 meeting Doctor Thuillier review progress recover feet
040932 - and knee injuries using PRP injection treatments, ref SDS 31 V54H, and
040933 - order additional care. ref SDS 31 4J6H
040935 - ..
040936 - On 180427 0458 letter to Doctor Thuillier confirm understandings from
040937 - meeting on 180425. ref SDS 32 V54H
040939 - ..
040940 - On 180516 1015 meeting Doctor Thuillier got name of "smartwool" socks.
040941 - ref SDS 36 GW5N The doctor suggested trying Doctor Scholl's Corn
040942 - Removers using Salicylic Acid to recover from Tailor's Bunion on left
040943 - side of left foot, and from calluses on both big toes. ref SDS 36 GW7M
040944 - Doctor Thuillier indicated PRP treatments have been strong remedies
040945 - for metatrsalgia, plantar plate tear, hallux valgus, and Tailor's
040946 - Bunion. He is investigating how VA can pay for the treatments.
040947 - ref SDS 36 GG6J
040949 - ..
040950 - On 180521 1045 called Connie in Doctor Tucker's office, and she
040951 - scheduled PRP treatment on 180620 1530. ref SDS 37 V54H Connie
040952 - submitted letter confirming work plan. ref SDS 37 PQ6J She included
040953 - directions to new office location. ref SDS 37 P58O
040955 - ..
040956 - On 180522 2318 submitted letter to Doctor Tucker confirming PRP
040957 - treatment on 180620 1530, and setting scope for care. ref SDS 38 E476
040958 -
040959 -
040960 -
040961 -
040962 -
040964 - ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Arrived OA 1330. Checked in and met Paul, the doctor's husband. He
041302 - said the doctor just left and will return at 1530 for the treatment.
041304 - ..
041305 - Kathy and I went to the Pachacho Mall and walked around. Finally
041306 - bought a sandwich at Subway for lunch. Returned to the doctor's
041307 - office at 1500. Paul said the doctor still has not arrived. Went
041308 - for a walk until 1530.
041310 - ..
041311 - The 4th PRP treatment performed today, was scheduled with Connie on
041312 - 180521 1045. ref SDS 37 V54H Letter to the doctor the next day
041313 - explained priority for PRP injection treatment, reported on 180522
041314 - 2318, ref SDS 38 E476 The letter cites scope for prior treatment on
041315 - 180105 1630. ref SDS 26 VO3F
041317 - ..
041318 - Doctor Tucker requested priority for treatment today?
041320 - ..
041321 - Explained that when treatment was ordered on 180522, needed PRP
041322 - injections to cure Tailor's Bunion on left foot. ref SDS 38 E476
041324 - ..
041325 - Subsequently, Podiatry treatment at the VA has improved condition of
041326 - left foot Tailor's Bunion using Ammonium Lactate 12% lotion, reported
041327 - in a letter to Doctor Tang at VAMCSF on 180611 1052. ref SDS 39 VL4U
041328 -
041329 - [On 180820 1039 scheduled follow up with 5th PRP treatment
041330 - on 180825 1515. ref SDS 40 E27M
041331 -
041332 -
041334 - ..
041335 - Discussed scope of treatment today, presented in a letter to Doctor
041336 - Tucker on 171208 1242. ref SDS 34 CJ60
041338 - ..
041339 - Scope was reviewed again in another letter on 171227. ref SDS 38 FN52
041341 - ..
041342 - On 171227 1300, Doctor Thuillier in VA Orthotpedics ordered MRI
041343 - studies on both feet and both knees, to find changes in anatomy that
041344 - reconcile clinical improvement reducing severe osteoarthritis pain.
041345 - 171227 0915, ref SDS 37 E54H
041347 - ..
041348 - On 171229 0615 went to Radiology at VAMCSF. Jonus did MRI scans on
041349 - both knees to evaluate recovery osteoarthritis. ref SDS 39 FZ5L
041351 - ..
041352 - Doctor Tucker said earlier today, she read the MRI findings on left
041353 - knee shown in the record on 171229 0745, ref SDS 39 ZG6H, and
041354 - referenced in the copy she received of the letter sent to Doctor
041355 - Thuiller earlier today on 180105 1321. ref SDS 25~O46F
041357 - ..
041358 - The doctor said there is not a lot of reporting on MRI studies finding
041359 - regeneration of cartiage in joints. This aligns with results of MRI
041360 - on 171229 0745, ref SDS 39 PSWR, which says in part...
041361 -
041362 - Unchanged complete degenerative tearing of the medial
041363 - meniscus and partial tearing of the lateral meniscus with
041364 - extrusion of the body with intrasubstance degeneration.
041366 - ..
041367 - This finding indicates PRP did not regnerate cartilage. Why then has
041368 - there been no pain in the left knee? The right knee was treated with
041369 - Supartz on 170731 1500, ref SDS 20 0001, 5 days after PRP treatment on
041370 - 170726. It's known that hyaluronic acid in Supartz lubricates the
041371 - joint to reduce pain. This worked well in the right knee for about 4
041372 - months, then pain began to recur, so Glucosamine Chondroitin has been
041373 - taken to continue lubricating the right knee joint for pain
041374 - management. Since PRP does not inject hyaluronic acid, how has it
041375 - prevented pain in the left knee for over 5 months and counting?
041377 - ..
041378 - Doctor Tucker seemed to say PRP eliminated pain hiking 630 miles since
041379 - injections on 170726, cited in the letter to Doctor Thuillier on
041380 - 180105 1321, ref SDS 25 I48O, by regenerating (healing??) soft tissue.
041381 - The doctor mentioned specifically collagen, ligaments, muscles, and
041382 - further indicated MRI technology cannot assess these soft tissue
041383 - improvements.
041385 - ..
041386 - After the meeting, research found on the Internet...
041387 -
041388 - Arthritis-Health
041390 - ..
041391 - Platelet-Rich Plasma (PRP) Therapy for Arthritis
041392 -
041393 - By John J Wilson, MD, MS
041394 - Updated................................ 2014 01 07 | Peer Reviewed
041395 -
041396 - https://www.arthritis-health.com/treatment/injections/platelet-rich-plasma-prp-therapy-arthritis
041398 - ..
041399 - The article says in part...
041400 -
041401 - PRP injections are formulated from your own immune system's
041402 - platelets, which are extracted from a blood sample, then
041403 - concentrated to make the injection. This seems to stimulate
041404 - healing through the production of collagen and to alter pain
041405 - receptors, which reduces pain.
041407 - ..
041408 - This seems to support Doctor Tucker's theory, per above. ref SDS 0
041409 - T14I Would be helpful to have study measuring collagen before and
041410 - after PRP treatment. What signals increased collagen?
041412 - ..
041413 - Article continues...
041414 -
041415 - What Does Platelet-Rich Plasma Therapy Do?
041417 - ..
041418 - Experts are unsure exactly how PRP therapy may alleviate
041419 - symptoms for certain orthopedic conditions. Doctors who use
041420 - PRP therapy to treat osteoarthritis theorize that the
041421 - platelet-rich plasma might:
041422 -
041423 - 1. Inhibit inflammation and slow down the progression of
041424 - osteoarthritis1
041426 - ..
041427 - MRI study may support this explanation.
041429 - ..
041430 - Article continues...
041431 -
041432 - 2. Stimulate the formation of new cartilage2
041434 - ..
041435 - MRI study seems not to support this explanation.
041437 - ..
041438 - Article continues...
041439 -
041440 - 3. Increase the production of natural lubricating fluid in the
041441 - joint, thereby easing painful joint friction3
041443 - ..
041444 - MRI study seems silent on this.
041446 - ..
041447 - Article continues...
041448 -
041449 - 4. Contain proteins that alter a patient's pain receptors and
041450 - reduce pain sensation
041452 - ..
041453 - It could be that platelet-rich plasma does all of these things,
041454 - or none.5 More large-scale, high-quality clinical studies are
041455 - needed before scientists can know.
041456 -
041458 - ..
041459 - Pubmed article sounds promising...
041460 -
041461 - NCBI
041462 - PMC
041463 - US National Library of Medicine
041464 - National Institutes of Health (NIH)
041466 - ..
041467 - Cartilage
041468 - Cartilage: 2013 Oct, 4 (4) 295-312
041470 - ..
041471 - PMCID: PCM4297162
041472 - doi: 10.1177/1947603513497553
041474 - ..
041475 - Application of Platelet-Rich Plasma to Disorders of the Knee Joint
041476 -
041477 - Omitted - authors and copyright and license information
041478 -
041479 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4297162/
041481 - ..
041482 - Abstract
041484 - ..
041485 - Importance. The promising therapeutic potential and
041486 - regenerative properties of platelet-rich plasma (PRP) have
041487 - rapidly led to its widespread clinical use in musculoskeletal
041488 - injury and disease. Although the basic scientific rationale
041489 - surrounding PRP products is compelling, the clinical
041490 - application has outpaced the research.
041492 - ..
041493 - Objective. The purpose of this article is to examine the
041494 - current concepts around the basic science of PRP application,
041495 - different preparation systems, and clinical application of PRP
041496 - in disorders in the knee.
041498 - ..
041499 - Many articles mention varying results based on "different preparation
041500 - systems, as here. In this case, where results seem favorable after
041501 - only 5 months on the left knee, and both feet, specifications on
041502 - "preparation" and "product composition" should be reported to evaluate
041503 - repetitive results.
041505 - ..
041506 - Article continues...
041507 -
041508 - Basic Scientific Rationale of Platelet-Rich Plasma Use in
041509 - Articular Cartilage Degradation and Repair
041511 - ..
041512 - On a molecular level, results have indicated a beneficial
041513 - effect of PRP on chondrocytes and mesenchymal stem cells.
041514 - Increased cell proliferation and synthesis of proteoglycans and
041515 - collagen type II has been demonstrated when cell cultures of
041516 - chondrocytes56,57 and mesenchymal stem cells58 are treated with
041517 - PRP compared with controls treated with platelet-poor plasma or
041518 - fetal bovine serum.
041520 - ..
041521 - This seems to align with Doctor Tucker's explanation that PRP
041522 - increases collagen, per above. ref SDS 0 T14I
041524 - ..
041525 - Article continues...
041526 -
041527 - Clinical Application of Platelet-Rich Plasma Use in Articular
041528 - Cartilage Degradation and Repair in the Knee
041530 - ..
041531 - Osteoarthritis
041533 - ..
041534 - In an uncontrolled prospective study, 14 patients with knee OA
041535 - were treated with PRP produced using anticoagulated blood
041536 - processed in the GPS III system.61 These authors reported
041537 - reduced pain and improved functional outcome after a series of
041538 - injections with PRP.
041540 - ..
041541 - This aligns with Welch case on left knee.
041543 - ..
041544 - Article continues...
041545 -
041546 - They also reported improvement in the ultrasonographic
041547 - measurement of femoral articular cartilage thickness in 6 out
041548 - of 13 patients at 6 months and in the satisfaction survey at
041549 - the 1-year follow-up examination, 8 of 13 patients reached
041550 - their goals at 1 year (Table 3).
041552 - ..
041553 - There is no evidence of cartilage thickness improvement in Welch,
041554 - after 5 months, at least using measurements applied by radiologists
041555 - for MRI study on 171229. Conceivably, more refined measurement
041556 - methodology might register either increase or decrease in cartilage of
041557 - left knee joint. Since PRP injected on 170726, was deminimus, i.e.,
041558 - less than protocol, per Doctor Tucker below, ref SDS 0 TR68, perhaps
041559 - another MRI in 6 months after treatment today, will show increased
041560 - miniscus. If so, this would further reconcile clinical improvement
041561 - feeling no pain in left knee hiking 630 miles between MRI on 170726,
041562 - and recent follow up MRI on 171229.
041563 -
041564 -
041566 - ..
041567 - Develope Scope of Work for Regeneration PRP Injection Treatments
041568 -
041569 - Follow up ref SDS 24 PPVQ.
041570 -
041571 - Doctor Tucker asked about pain medication. How long since taking
041572 - NSAID drugs? She said these should have been stopped for at least
041573 - the past 7 days.
041575 - ..
041576 - Cited letter to the medical team (including Doctor Tucker) on 171103,
041577 - reported all pain medication was stopped 4 weeks earlier ref SDS 33
041578 - S273 Ending pain medication actually began on 171018, shown in diary
041579 - listing daily exercise, diet, vitals and medication in case study
041580 - beginning on 160101 0700. ref SDS 9 PM5F
041582 - ..
041583 - Based on understanding for rational basis that PRP in left knee
041584 - reduced pain through improving multiple joint deficits, made
041585 - following decisions...
041586 -
041587 - Because the meeting today, was scheduled ad hoc from a call
041588 - this morning, reported on 180105 1118, ref SDS 26 GO9L, it was
041589 - not possible to have a driver.
041591 - ..
041592 - Driver is needed when injections require strong medication to
041593 - manage pain, which then impairs ability to drive, based on
041594 - prior care, reported on 170816 1400, ref SDS 24 J97M On that
041595 - occasion, the body suffered severe side effects from
041596 - post-procedure pain medication. ref SDS 24 RN5H
041598 - ..
041599 - Without driver, should not do deep injections to left and right
041600 - feet plantar plate tears, nor to arches, which both caused
041601 - severe pain and so required pain medication for prior PRP
041602 - injections on 170816 1400. ref SDS 24 1H6M
041604 - ..
041605 - Doctor Tucker agreed to defer injections into the arch today,
041606 - but noted efficacy to relieve hallus valgus in both feet.
041608 - ..
041609 - We noted simple procedure of placing felt pad spreaders between
041610 - toes has been successful preventing feet pain and increased
041611 - blisters caused by hallus valgus injuries, as recommended by
041612 - Doctor Thuillier during the meeting at the VA on 171227 0915.
041613 - ref SDS 37 3B3H This reduces urgency for injecting hallus
041614 - valgus today, so that PRP can be injected in left knee.
041616 - ..
041617 - Will consider PRP injecting hallus valgus during subsequent
041618 - treatments, when a driver is available and/or conscious
041619 - sedation can be performed.
041621 - ..
041622 - Primary PRP injection objective is right knee, presented in the
041623 - letter on 171208 1242, ref SDS 34 YM3I, and to achieve pain
041624 - relief comparable to total relief experienced with left knee
041625 - during hiking, reported in the letter to the medical team on
041626 - 171103 1141, ref SDS 33 S293, further presented in the letter
041627 - to Doctor Tucker on 171208 1242. ref SDS 34 CK36 This was
041628 - confirmed in recent letter on 171227 1328. ref SDS 38 FN52
041630 - ..
041631 - Next inject both feet metatarsals only, and not inject bottom
041632 - of feet to specifically treat plantar plate. These seem
041633 - largely healed. Injecting metatartsals today, may also
041634 - additonally treat plantar plate area without direct injections.
041636 - ..
041637 - Tailor's bunion inject PRP on both feet.
041639 - ..
041640 - Remaining PRP plasma, if any, can be injected into left knee.
041642 - ..
041643 - Doctor Tucker said she was surprised the left knee responded so well
041644 - to PRP injection on 170726, which used less than standard protocol for
041645 - knee injections. She explained this occurred, because at that time,
041646 - the left knee was injected last with only what remained after
041647 - injecting both feet metatarsals and plantar plate tear on bottom of
041648 - right foot.
041650 - ..
041651 - Longevity of recovery was discussed.
041653 - ..
041654 - Doctor Tucker seemed to say the single injections into both feet and
041655 - left knee could last 1 - 5 years.
041657 - ..
041658 - Discussed research indicating some patients get injections every 6
041659 - months or at least annually.
041661 - ..
041662 - The doctor seemed to say that properly applied PRP injection
041663 - treatments should last at least multiple years.
041665 - ..
041666 - Since the left knee did not receive a full amount of PRP injection,
041667 - supplementing the first injection today, is good insurance for longer
041668 - results.
041670 - ..
041671 - Finally, most patients don't hike 2,500 miles per year, with running
041672 - and sprinting included.
041674 - ..
041675 - The doctor seemed to indicate that running and sprinting in particular
041676 - reduce longevity of PRP care. She recommended agains it. This
041677 - conflicts with reporting that many professional atheltes are extending
041678 - their careers by getting PRP injections, cited in the letter to Doctor
041679 - Tucker on 171212 1657. ref SDS 35 RX52 These athletes run and sprint,
041680 - endemic to tennis, baseball, et al.
041682 - ..
041683 - As a result, multiple PRP injections to feet and knees are required to
041684 - achieve longevity normally expected for patients who receive only
041685 - single injections. Hopefully, injections today, will last 2 - 5
041686 - years.
041687 -
041689 - ..
041690 - PRP Treatment Layout Injection Sites
041691 -
041692 - Follow up ref SDS 24 VO3F, ref SDS 17 PP4N.
041693 -
041694 - In procedure room laying on treatment table, Doctor Tucker again
041695 - marked locations on both feet and both knees to be injected.
041697 - ..
041698 - Right Leg Injections
041699 -
041700 - Knee joint........................................... 1
041701 -
041703 - ..
041704 - Left Leg
041705 -
041706 - Knee joint........................................... 1
041707 -
041709 - ..
041710 - Right Foot
041711 -
041712 - Follow up ref SDS 24 0108.
041713 -
041714 - Metatarsalgia
041715 - Between little toe and ring toe................. 1
041716 - Between ring toe and middle toe................. 1
041717 - Between middle and long toe..................... 1
041718 - Between long toe and big toe.................... 1
041720 - ..
041721 - Tailor's bunion................................. 1
041723 - ..
041724 - Total right foot............................... 5 5
041726 - ..
041727 - Left Foot
041728 -
041729 - Follow up ref SDS 24 YY3G.
041730 -
041731 - Metatarsalgia
041732 - Between little toe and ring toe................. 1
041733 - Between ring toe and middle toe................. 1
041734 - Between middle and long toe..................... 1
041735 - Between long toe and big toe.................... 1
041737 - ..
041738 - Tailor's Bunion................................. 1
041740 - ..
041741 - Total right foot............................... 5 5
041743 - ..
041744 - Total injections...................................... 12
041745 -
041747 - ..
041748 - Blood Draw for PRP Completed with One Needle Stick
041749 -
041750 - Follow up ref SDS 24 YY6N, ref SDS 17 FG7F.
041751 -
041752 - Doctor Tucker drew blood for PRP platelet extraction. She used outer
041753 - side of left arm inner elbow, which was successful for prior treatment
041754 - on 170816 1400, ref SDS 24 YY6N, and previously on 170726 1600.
041755 - ref SDS 17 TZ8N
041757 - ..
041758 - This took only 1 stick today.
041759 -
041761 - ..
041762 - PRP Injections Mostly Pain Free
041763 -
041764 - Follow up ref SDS 24 K65M, ref SDS 17 GU6N.
041765 -
041766 - Doctor Tucker initially, marked all locations for PRP injections.
041767 - She sprayed numbing agent on each location.
041769 - ..
041770 - The doctor made markings around the knee caps to consider possible
041771 - multiple injection points. However, she ultimately made only 1
041772 - injection, and advised this is a standard protocol location for knees.
041774 - ..
041775 - Doctor Tucker injected each location with lidocain to further numb
041776 - needle penetrations.
041778 - ..
041779 - Right knee - after waiting mintutes for lidocain to take effect, PRP
041780 - was injected into the right knee joint, using standard protocol
041781 - amount, discussed above. ref SDS 0 059O
041783 - ..
041784 - This was completely pain free.
041786 - ..
041787 - Right foot - PRP was next injected into 4 locations on top of right
041788 - foot metatarsals. The outer 2 injections were pain free. The middle
041789 - injections caused severe pain. The doctor noted this reflected these
041790 - middle toes have been worn down by hiking, running and sprinting.
041792 - ..
041793 - Tailor's bunion right foot was injected with small amount.
041795 - ..
041796 - Left foot - same scenario as right foot, with considerable pain
041797 - injecting middle metatarsals.
041799 - ..
041800 - Pain was only at moments of needle penetration, similar but less
041801 - severe than prior procedure on 170816 1400. ref SDS 24 1A3I
041803 - ..
041804 - Tailor's bunion left foot was injected with small amount.
041805 -
041806 - [On 180315 shown in case study on 160101 0700 tailor's
041807 - bunion on left foot now requires dressing to relieve shoe
041808 - pressure during hikes. Tailor's bunion right foot does not
041809 - require dressing. ref SDS 10 4B6L
041811 - ..
041812 - Left knee - remainting PRP was injected into left knee. This was
041813 - completely pain free.
041814 -
041815 -
041817 - ..
041818 - Follow Up Treatments Might be Needed
041819 - Discharge Instructions and Payment
041820 -
041821 - Follow up ref SDS 24 WV5I, ref SDS 17 S93J.
041822 -
041823 - Doctor Tucker cleaned forefeet which had leaked blood slightly.
041825 - ..
041826 - On standing up from the treatment table, there was mild pain at level
041827 - 1 - 2 in the feet where injections were made. This was much less
041828 - severe than after deep injections to plantar plate and arches done on
041829 - 170816 1400. ref SDS 24 J97T As a result, pain medication was not
041830 - needed today.
041832 - ..
041833 - Doctor Tucker said not to hike for a week, then follow prior protocol.
041834 - On 170727 1747 Doctor Tucker called and said walking 1 mile 2 days
041835 - after feet injections stimulates PRP healing (regeneration) processes,
041836 - and then slow for about 3 miles helps distribute PRP in the feet.
041837 - ref SDS 18 0W6V
041839 - ..
041840 - After treatment today, research found...
041841 -
041842 - The Stemcell Orthopedic Institute of Texas
041843 - Call 210 293 3136
041845 - ..
041846 - PRP POST INJECTION GUIDELINES AND EXERCISES
041847 -
041848 -
041849 - https://stemcellorthopedicinstituteoftexas.com/platelet-rich-plasma-therapy-prp/after-prp-therapy/
041850 -
041851 - 1. Medication Guidelines
041852 -
041853 - For a minimum of two weeks post-injection, it is important
041854 - for the efficacy of the treatment that all
041855 - anti-inflammatory medications (NSAIDS) are discontinued.
041856 - You can take Tylenol (Acetaminophen) and Celebrex, but we
041857 - ask that you avoid other NSAIDS such as aspirin, Naproxen
041858 - (Aleve) and Ibuprofen (Advil, Motrin) because they will
041859 - inhibit platelet function. Other prescription medication
041860 - should be reviewed with your procedure physician.
041862 - ..
041863 - Apply moist heat to treated area for the first 24 hours.
041865 - ..
041866 - 2. Activity Guidelines
041867 -
041868 - FIRST WEEK&Treated areas should remain immobile. For the
041869 - first two weeks, we encourage you to resume normal day-to
041870 - day activities&BUT NO exercise of the treated extremity.
041872 - ..
041873 - SECOND WEEK& light exercises and progressively build back
041874 - to normal exercise after 4 weeks. Controlled and moderate
041875 - movement is important for the proper stimulation of tissue
041876 - to rebuild in a linear and physiologic fashion. However,
041877 - we strongly advise that you avoid heavy lifting or high
041878 - exercise levels because these activities will compromise
041879 - the progress we are trying to make
041881 - ..
041882 - AFTER TWO WEEKS&you are cleared by your physician to resume
041883 - exercising the area. However, we ask that you gradually
041884 - increase the intensity of your workouts so as not to
041885 - re-injure the tissue. Use pain in the area of injection as
041886 - a guide to how far you push yourself. This is not like
041887 - physical therapy after surgery. We do not want you to push
041888 - through the pain. Instead, ease off the intensity if the
041889 - pain persists.
041891 - ..
041892 - The question is whether damaged tissue heals, i.e., regenerates, e.g.,
041893 - miniscus cartilage, ligaments. How long does this take? 1 week,
041894 - month, 6 months, a year. Once healed, how long will "healed" miniscus
041895 - cartilage, metatarsal cartilage last hiking 11 - 15 miles per day?
041897 - ..
041898 - Article continues...
041899 -
041900 - If you feel any of the following symptoms immediately
041901 - contact our office: prolonged redness, swelling, fevers,
041902 - chills, muscle weakness as well as numbness and/or
041903 - tingling.
041904 -
041906 - ..
041907 - The doctor also cautioned against using NSAID pain medications for 2
041908 - weeks after injections, since NSAID drugs block/reduce blood flow
041909 - needed for PRP healing process.
041911 - ..
041912 - Thanked Doctor Tucker for great work.
041913 -
041914 -
041916 - ..
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"