042746 -
042748 - ..
042749 - 
042750 -
042752 - ..
042753 - Doctor Tucker reported finding rotator cuff tendenosis, but no tear
042754 - and so exepects good response to PRP treatment today. This aligns
042755 - with prior examination on 190403 1000, ref SDS 78 T44L, including
042756 - the doctor's Progress Notes on 190403 1000. ref SDS 78 N13O
042758 - ..
042759 - Research in the record meeting with Doctor Edwards at VAMCSF cites
042760 - benefits of ultrasound-guided PRP treatment, reported on 190327 0915.
042761 - ref SDS 70 U45I
042762 -
042763 -
042764 -
042765 -
042766 -
042767 -
042768 -
042770 - ..
0428 -
0429 -
0430 - 1440
0431 -
043101 - Blood Draw for PRP Completed with One Needle Stick
043102 -
043103 - Follow up ref SDS 78 PS4K, ref SDS 62 YY6N.
043104 -
043105 - The doctor drew blood from the left arm, again using the vein on the
043106 - inside of the elbow, which she has used previously, reported on 180824
043107 - 1515. ref SDS 48 YY6N We laughed when I explained that during blood
043108 - draw on Sunday, Maggie was disappointed she could not use this vein,
043109 - because Doctor Tucker claims dibbs, reported on 190512 1625.
043110 - ref SDS 87 EX6G
043112 - ..
043113 - Kathy assisted, holding the container for the blood draw, and clamping
043114 - the line to change vials. Doctor Tucker aligned the needle and pushed
043115 - it into the vein.
043117 - ..
043118 - Gloria said there was good blood flow. After 20 seconds or so, they
043119 - had the 60cc of blood needed for treatment.
043120 -
043122 - ..
043123 - Identify Injection Sites Numbing Agent and Lidocaine
043124 -
043125 - Follow up ref SDS 78 O26N.
043126 -
043127 - While platelets were being centrifuged using 2-spin processing, which
043128 - Doctor Tucker explained in her letter on 190419 1123, ref SDS 85 V54H
043129 - Doctor Tucker examined and palpated areas where injections would be
043130 - made, which she identified with marks.
043132 - ..
043133 - Kathy assisted today, spraying numbing agent on injection sites.
043135 - ..
043136 - Doctor Tucker injected lidocaine to further numb each PRP injection
043137 - site.
043139 - ..
043140 - Injecting lidocaine into the knees is about pain level 2 - noticable,
043141 - but easily tolerated.
043143 - ..
043144 - Injecting lidocaine into Tailor's Bunions on the fore-edge of the foot
043145 - is pain level 8+. It lasts only an instant, and so can be tolerated.
043147 - ..
043148 - Injecting lidocaine into 4-injection sites on the left shoulder which
043149 - were marked during ultrasound examination, above, ref SDS 0 JH58, was
043150 - pain level 7. Fortunately, this lasted only an instant, as well.
043151 -
043152 -
043153 -
043154 -
043156 - ..
043157 - PRP Injections
043158 -
043159 - Follow up ref SDS 78 LO4O.
043160 -
043161 - After all sites were marked and numbed with spraying agent and
043162 - lidocane, and after the centrifuging process completed, the doctor
043163 - made PRP injections.
043165 - ..
043166 - Left Shoulder Injections
043167 -
043168 - Injections......................................... 4
043169 -
043171 - ..
043172 - These injections were pain level 5, and were guided by ultrasound
043173 - examination, per above. ref SDS 0 JH58
043174 -
043175 -
043176 - 
043177 -
043179 - ..
043180 - 
043181 -
043182 -
043184 - ..
043185 - Trapezius right side
043186 -
043187 - Injections......................................... 0
043188 -
043189 - Will consult with Doctor Thuillier on 190519, and monitor.
043190 -
043192 - ..
043193 - Right Leg
043194 -
043195 - Follow up ref SDS 78 GE9L.
043196 -
043197 - Knee joint............................................ 0
043198 -
043199 -
043201 - ..
043202 - Left Leg
043203 -
043204 - Follow up ref SDS 78 TF4H, ref SDS 48 TF4H.
043205 -
043206 - Knee joint............................................ 3
043208 - ..
043209 - Reviewed patient history responding well to getting 3-PRP injections
043210 - on left knee below patella on 180824 1515. ref SDS 48 TF4H This
043211 - complemented prior lateral and medial injections 3 weeks earlier on
043212 - 180620 1530. ref SDS 43 TF4H
043214 - ..
043215 - Since left knee had lateral and medial injections 6 weeks ago on
043216 - 190403 1000, ref SDS 78 TF4H, decided to do 3 injections in front of
043217 - knee below patella today.
043219 - ..
043220 - 
043221 -
043223 - ..
043224 - [On 190516 1619 letter to Doctor Tucker asks to report in
043225 - Progress Notes that PRP injections today, complement prior
043226 - injections to the knee on 190403. ref SDS 93 7Q44
043227 -
043229 - ..
043230 - Anterior and Posterior Cruciate Ligaments (ACL PCL)
043231 - Hamstring Left Leg Behind Knee
043232 -
043233 -
043234 - Knee joint............................................ 3
043236 - ..
043237 - Injections will heal injury that has been painful behind the left knee
043238 - both during hikes, and 3 - 5 hours after hikes, reported in case study
043239 - on 190101 0730. ref SDS 63 PRTR
043241 - ..
043242 - The doctor initially examined the back of the knee, and then made PRP
043243 - injections...
043244 -
043245 -
043247 - 
043248 -
043250 - ..
043252 - 
043253 -
043255 - ..
043256 - Research indicates PRP injections may relieve this pain by healing
043257 - injury to posterior cruciate ligament (PCL) and/or anterior cruciate
043258 - ligament (ACL)...
043259 -
043260 - https://www.google.ca/search?as_q=ligament+pain+back+of+knee&as_epq=&as_oq=&as_eq=&as_nlo=&as_nhi=&lr=&cr=&as_qdr=all&as_sitesearch=&as_occt=any&safe=images&as_filetype=&as_rights=
043262 - ..
043263 - Main problem with left knee is degenerated miniscus from injury in
043264 - 1973, which was treated with surgery that removed cartilage.
043265 - Ordinarily it would not be expected that simple hiking with occasional
043266 - running/sprinting, as occurs in this case, would not injure PCL nor
043267 - ACL.
043268 -
043270 - ..
043271 - The doctor's assistant, John, came into the treatment room, and said
043272 - her next patient has been waiting 10 minutes.
043274 - ..
043275 - Doctor Tucker said she won't be much longer.
043276 -
043278 - ..
043279 - Right Foot
043280 -
043281 - Follow up ref SDS 78 0108, ref SDS 24 0108.
043282 -
043283 - Metatarsalgia
043284 - Between little toe and ring toe................. 0
043285 - Between ring toe and middle toe................. 0
043286 - Between middle and long toe..................... 0
043287 - Between long toe and big toe.................... 0
043289 - ..
043290 - Tailor's bunion................................. 0
043292 - ..
043293 - Pain increases as PRP is injected to level 8+, and so challenging to
043294 - tolerate.
043296 - ..
043297 - Total right foot............................... 0 0
043299 - ..
043300 - Left Foot
043301 -
043302 - Follow up ref SDS 78 YY3G.
043303 -
043304 - Metatarsalgia
043305 - Between little toe and ring toe................. 0
043306 - Between ring toe and middle toe................. 0
043307 - Between middle and long toe..................... 0
043308 - Between long toe and big toe.................... 0
043310 - ..
043311 - At this point, noticed we have already taken 80 minutes, 20 minutes
043312 - more than she had previously insisted was available for today.
043314 - ..
043315 - She said: "That's okay, because we are going good!"
043317 - ..
043318 - She then injected the Tailor's Bunion on the left foot.
043320 - ..
043321 - Tailor's Bunion................................. 1
043323 - ..
043324 - Pain increases as PRP is injected to level 8+, and so challenging to
043325 - tolerate.
043326 -
043327 - 
043328 -
043329 -
043330 - 
043331 -
043333 - ..
043334 - Total left foot................................ 1 1
043335 -
043337 - ..
043338 - Total injections...................................... 11
043339 -
043341 - ..
043342 - How long wait before doing pushups?
043344 - ..
043345 - The doctor said to buildup gradually over several weeks, rather than
043346 - starting out dong 20 or 30 pushups.
043347 -
043365 -
043369 - ..
043370 - After leaving the doctor's office took oxychodone pill to relieve
043371 - rising pain from PRP injections today.
043372 -
043373 - [On 190516 1619 letter to Doctor Tucker advised taking
043374 - oxychodone pill for pain management, but this was not
043375 - effective, so helpful that Kathy drove us home; she
043376 - suggests taking pain pill before getting next PRP
043377 - injections. ref SDS 92 7Q47
043378 -
043379 -
043380 -
043381 -
043382 -
043383 -
043384 -
043385 -
043386 -
043387 -
0434 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Progress Notes Doctor Tucker PRP Procedure on 190403
050403 -
050404 - Follow up ref SDS 78 JS8O.
050405 -
050406 - Received letter from Doctor Tucker transmitting her Progress Notes
050407 - for the procedure today.
050408 -
050409 - [On 190405 0909 submitted comments on progress notes.
050410 - ref SDS 79 OQ51
050412 - ..
050413 - [On 190412 0931 received revised progress notes.
050414 - ref SDS 81 GJ3O
050416 - ..
050417 - Stored Doctor Tucker's Progress Notes in...
050418 -
050419 - F:\05\00003\SM\CC\AGMJ\20190403-100000\PRP_G_Tucker_revised.docx
050420 -
050422 - ..
050423 - 1. Gloria Tucker MD
050424 - Diplomatic American College of Sports Medicine
050425 - 250 Bel Marin Keys Boulevard, Building G Suite 1
050426 - Novato, CA 94949
050427 - 415 506 4907
050429 - ..
050430 - Rod Welch
050432 - ..
050433 - 2. Date....................................... 2019 04 03
050435 - ..
050436 - 3. S: Return visit for multiple complaints. He notes that he is
050437 - having pain in his bilateral shoulders when he does push-ups.
050438 - He has been doing push-ups for many years 5 sets of 20, until
050439 - recently. On August 10, 2018, he resumed pushups to build
050440 - strength for ascending Half Dome cables - limited to 3 sets of
050441 - 20 reps. There were no injuries at this level. After Half
050442 - Dome on September 12, 2018, he increased to 4 sets of 20 reps.
050443 - He had to stop pushups on February 25, 2019, because right
050444 - elbow was popping (not swelled) and both shoulders pain level
050445 - 8. Shoulders felt mushy, as having no power doing a pushup.
050447 - ..
050448 - 4. In addition, he notes the sensation of jitteriness or anxiety
050449 - in his bilateral legs after hiking long distances (15+ miles).
050450 - This has only been occurring in the last few months. He
050451 - reports that he hydrates himself well after the hike. He has
050452 - no history of magnesium or iron deficiency. This does respond
050453 - to medication such as tramadol.
050455 - ..
050456 - 5. While hiking, after about 1 mile he experiences "burning
050457 - sensation" bottom right foot from above heel toward ring toe.
050458 - This can last from .25 to 1+ miles, then subsides. May recur
050459 - after a few miles, but after 7 or 8 miles does not recur for
050460 - rest of hike.
050462 - ..
050463 - 6. About 8 years ago, he suffered severe (i.e., pins and needles,
050464 - swelling, numbness - cannot feel the ground) peripheral
050465 - neuropathy (PN) mainly in right foot, but some in left foot,
050466 - and caused by statin medication (Rosuvastatin). Doctor reduced
050467 - dose and PN did not recur, until 4 or 5 months ago. Now very
050468 - mild PN occurs, as mere swelling of right foot and only
050469 - occasionally, rather than with every hike. Lasts only a mile
050470 - or so, then subsides and does not recur.
050472 - ..
050473 - 7. He would like to be treated in left foot with PRP for
050474 - recurrent metatarsalgia due to his extensive long distance
050475 - running. He has had PRP in his Bilateral feet many times with
050476 - good results. However, the only last 3-4 months. He
050477 - attempted adding Supartz before his PRP, to prolong the
050478 - effects of the PRP, without benefit.
050480 - ..
050481 - Did not get "running" changed to hiking, cited in the letter to the
050482 - team on 190405 0909. ref SDS 79 WW6O
050484 - ..
050485 - This doesn't make sense because Supartz only applied to knees, never
050486 - to feet.
050488 - ..
050489 - Progress notes continue...
050490 -
050491 - 8. On examination: Left shoulder: Range of motion is full,
050492 - however he does have a painful arc from 60 to 120 degrees on
050493 - abduction. No evidence of discomfort on internal rotation or
050494 - external rotation. Negative O'Brien test. He is distinctly
050495 - tender along his greater tuberosity, the insertion site of his
050496 - infraspinatus, and teres minor, and at his coracoid. He has a
050497 - negative lift-off test.
050499 - ..
050500 - 9. Left foot: He has good fat pads in the region of his
050501 - metatarsals on the left. He is tender between his metatarsal
050502 - heads 1 and 2, 2 and 3, 3 and 4, and 4 and 5. He is also
050503 - tender at his tailor's bunion.
050505 - ..
050506 - 10. Plan: Case discussed at length. Left shoulder: Rotator cuff
050507 - tendinosis, no tear. Next I think he would respond well to
050508 - PRP. I would back off his exercise regimen for 1 month and
050509 - then steadily begin again.
050511 - ..
050512 - Finding no rotator cuff tear, aligns with understandings during the
050513 - meeting, per above. ref SDS 78 FG8N
050515 - ..
050516 - Progress notes continue...
050517 -
050518 - 11. Knee pain: Needs frequent treatments with PRP and failed PRP
050519 - plus hyaluronidase. I would suggest adding ozone 2 weeks after
050520 - his PRP treatment x3. Symptoms consistent with restless leg
050521 - syndrome, I would suggest checking levels of magnesium,
050522 - potassium, sodium, iron, TIBC, and ferritin. Afterwards I
050523 - would treat with magnesium malate. I also would like him to be
050524 - hydrated during his hike not just after and well-hydrated
050525 - before. Lastly I will treat his left foot at the MTPs today
050526 - with PRP.
050528 - ..
050529 - What does "...PRP treatment x3" mean"?
050531 - ..
050532 - Add ozone to PRP knee injections 2 weeks later aligns with
050533 - understandings during the meeting, per above, ref SDS 78 UW8L, - will
050534 - discuss with Doctor Edwards at VA, in relation to getting additional
050535 - PRP.
050537 - ..
050538 - Ozone therapy reported as alternative medical care, reviewed above.
050539 - ref SDS 78 EW4N
050540 -
050541 - [On 190414 2007 letter asks Doctor Tucker to call and
050542 - clarify proposed ozone treatment. ref SDS 82 HX55
050544 - ..
050545 - Progress notes continue...
050546 -
050547 - 12. In light of his history of responding to PRP, but it lasting
050548 - only 3 months. And his hiking 3,500 miles per year - nearly
050549 - 300 miles per month with 11 - 20+ mile daily hikes, I believe
050550 - he will continue to need PRP every 3 months as long as he
050551 - continues this hiking regimen.
050553 - ..
050554 - This review reflects request a few days later in a letter to the
050555 - doctor on 190405 0909. ref SDS 79 WW9I
050556 -
050557 - [On 190414 2007 letter asks Doctor Tucker to consider
050558 - amending progress notes with context on benefits of
050559 - getting PRP treatments every 3 months that regress
050560 - atherosclerosis plaques to improve cardiovascular
050561 - health. ref SDS 83 HK3X
050563 - ..
050564 - [On 190414 2145 letter to Doctor Tucker presents treating
050565 - achalasia once per month with EGD dilation, presents
050566 - similar approach for PRP treatments every 3 - 6 months.
050567 - ref SDS 84 FA6H
050569 - ..
050570 - Progress notes continue...
050571 -
050572 - Gloria Tucker MD
050573 -
050575 - ..
050576 - Rod Welch
050577 - April 3, 2019
050579 - ..
050580 - 13. Procedure: I aspirated 60 cc of blood from his left brachium,
050581 - and spun this down to 3 cc of PRP. I activated this with
050582 - calcium chloride and buffered this with sodium bicarbonate. I
050583 - then injected his metatarsal heads 1 through 5 in his left
050584 - foot as well as his left tailor's bunion. He tolerated the
050585 - procedure well.
050587 - ..
050588 - Gloria Tucker MD
050590 - ..
050591 - Does spinning 60 cc down to 3 cc of PRP represent a 2-spin high (5-9
050592 - times baseline) concentration of PRP, which is a change from using
050593 - 1-spin low (3 times baseline) concentration of platelets for prior
050594 - procedures that yielded 6 and 7 cc of PRP?
050596 - ..
050597 - What contrifuge equipment was used today?
050598 -
050599 - [On 190412 0931 letter to Doctor Tucker requests amend
050600 - Progress Notes to report centrifuge equipment - whether
050601 - 1-spin or 2-spin high-platelet-concentration process.
050602 - ref SDS 80 SL30
050604 - ..
050605 - Actually, 3 cc of PRP is only for the feet.
050606 -
050607 -
050608 -
050609 -
050610 -
050611 -
050612 -
050613 -
050614 -
050615 -
0507 -