CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS B4 0000. ref SDS B3 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 1311?? ????? Doctor Diana Alba in Endocrinology prescribed
040902 - continued extended endurance hiking for cardiology care in order to
040903 - minimize statin drugs that caused adverse side effects, e.g.,
040904 - periperhal neuropathy.
040906 - ..
040907 - On 140729 ???? Doctor Diana Alba made referral to Podiatry for care
040908 - to resolved feet injuries caused by cardiology care with extended
040909 - endurance hiking, and in order to continue cardiology care that
040910 - raised HDL cholesterol.
040912 - ..
040913 - On 140805 ???? Doctor Tang, Chief of Podiatry prescribed orthotic
040914 - inserts and special shoes to resolve feet injuries for continuing
040915 - cardiology care with extended endurance hiking.
040916 -
040917 -
040918 -
040919 -
040921 - ..
040922 - On 170726 1600 1st PRP treatment - Doctor Tucker performed injections
040923 - to treat plantar plate tear right foot, ref SDS 17 HE4N; she also made
040924 - PRP injections treating metatarsalgia in both feet. ref SDS 17 EG7F
040925 - PRP was injected into the left knee, ref SDS 17 4Y8K,
040927 - ..
040928 - On 170816 1400 2nd PRP injection treatment regeneration therapy;
040929 - Doctor Tucker used pain management protocol similar to 1st phase, when
040930 - no pain was experience, but on this 2nd phase there was considerable
040931 - pain, because injections were deeper and more PRP was injected to
040932 - achieve benefits of regenerating (healing) plantar plate tear, which
040933 - were not achieved with 1st phase of treatment. ref SDS 19 S543 PRP was
040934 - injected into arch to repair Halux Valgus right foot. ref SDS 19 IM7N
040936 - ..
040937 - On 170817 0836 at 1207 letter from Doctor Tucker says hallux valgus is
040938 - symptom of weakening arch; injecting PRP to ligaments of the 1st mtp
040939 - (big toe) in association with treating the arch, we are hoping to help
040940 - heal that and more importantly, keep it from worsening. ref SDS 20
040941 - 9F5H
040943 - ..
040944 - On 171229 0745 MRI right knee regenerate cartelage compare left knee.
040945 - ref SDS 33 K05I
040947 - ..
040948 - On 171229 0900 MRI both feet evaluate PRP treatments. 171229 0900,
040949 - ref SDS 34 HQ5O
040951 - ..
040952 - On 180105 1630 3rd PRP treatment - Doctor Tucker performed PRP
040953 - injections, ref SDS 38 0001, for knees and feet including Tailor's
040954 - Bunions. ref SDS 38 VO3F
040956 - ..
040957 - On 180108 letter to Doctor Thuillier reported PRP treatment in both
040958 - feet and both knees on 180105 1630, ref SDS 38 HP5O, and related
040959 - research indicating PRP yields measurable increase in minisucs
040960 - cartilage over 6 months. ref SDS 38 JX67
040962 - ..
040963 - On 180110 1100 meeting Doctor Thuillier review MRI scans both feet and
040964 - both knees on 171229. ref SDS 40 JN9H The doctor cited finding in the
040965 - report from MRI on 171229, that cartilage has not further reduced
040966 - since prior study on 170412, reported on 160805. ref SDS 33 M75N He
040967 - feels this is significant that continuing patient hiking 11 miles per
040968 - day has not further degraded miniscus cartilage in both knees.
040970 - ..
040971 - On 180425 1145 meeting Doctor Thuillier review progress recover feet
040972 - and knee injuries using PRP injection treatments, ref SDS 43 V54H, and
040973 - order additional care. ref SDS 43 4J6H
040975 - ..
040976 - On 180516 1015 meeting Doctor Thuillier got name of "smartwool" socks.
040977 - ref SDS 48 GW5N The doctor suggested trying Doctor Scholl's Corn
040978 - Removers using Salicylic Acid to recover from Tailor's Bunion on left
040979 - side of left foot, and from calluses on both big toes. ref SDS 48 GW7M
040980 - Doctor Thuillier indicated PRP treatments have been strong remedies
040981 - for metatrsalgia, plantar plate tear, hallux valgus, and Tailor's
040982 - Bunion. He is investigating how VA can pay for the treatments.
040983 - ref SDS 48 GG6J
040985 - ..
040986 - On 180620 1530 4th PRP treatment to both feet and both knees.
040987 - ref SDS 52 VO3F
040989 - ..
040990 - On 180725 1145 meeting Doctor Thuillier about acetaminophen at
040991 - prescribed dose of 1000 mg per day taken over extended days, weeks and
040992 - months could accumulate into an "intoxination" condition that causes
040993 - liver damage and lowers HDL some 33%, ref SDS 55 155F, as reported in
040994 - the study reviewed on 180724 1645. ref SDS 54 EN4L Further considered
040995 - how long recovery might take to restore liver function after stopping
040996 - acetaminophen, particularly restoring elevated HDL levels? ref SDS 55
040997 - SV6H Dan said he has hiked Half Dome 4 times. ref SDS 55 G56K
040999 - ..
041000 - On 180824 1515 5th PRP treatment - meeting Doctor Tucker injection
041001 - treatment to protect feet and knees, enable training Half Dome.
041002 - ref SDS 57 0001
041004 - ..
041005 - On 180912 0545 hiked Half Dome in Yosemite Valley, total 28 miles that
041006 - day. ref SDS 58 0001
041008 - ..
041009 - On 181024 0752 sent letter to Doctor Thuillier, ref SDS 59 FC8M,
041010 - asking him to order Supartz injections for knees, hope to extend PRP
041011 - effectivenss to 6 months. ref SDS 59 OC44
041013 - ..
041014 - On 181025 0735 received letter from Doctor Thuillier advising that he
041015 - ordered Supartz for knees, which will be combined with PRP.
041016 - ref SDS 60 ZY9M
041018 - ..
041019 - On 181025 0735 at 0801 letter to Jane in Orthopedics Administration,
041020 - asking about coordinating schedule for Supartz injections. ref SDS 60
041021 - 7H7S
041023 - ..
041024 - On 181126 1130 1st of 3 Supartz injections - meeting with Gina at VA
041025 - Clinic in Santa Rosa performed 1st injection Supartz in both knees.
041026 - ref SDS 65 BK6H Gina is strong proponent for PRP at VA; she is
041027 - talking to Doctor Thuiller and Doctor Sara Edwards in Orthopedics at
041028 - VAMCSF, and hopes to get assignment for doing PRP injections.
041029 - ref SDS 65 375L
041031 - ..
041032 - On 181126 1127 meeting Doctor Gloria Tucker - received article on
041033 - favorable results combinging PRP with Supartz injections; and
041034 - scheduled next PRP treatment 2 days after last Supartz, which be done
041035 - on 181212. ref SDS 66 KJ5I
041037 - ..
041038 - On 181126 1547 at 1952 letter to Gina at VA Clinic in Santa Rosa, with
041039 - copy to Doctor Thuillier in Orthopedics at VAMCSF, and copy to Doctor
041040 - Tucker, and submitting to Gina and Doctor Thuiller article on study
041041 - combinging Supartz with PRP. ref SDS 65 VE46 Further report improved
041042 - hiking during 2018, with PRP treatments in feet and knees, reaching
041043 - 3,000 miles and HDL 83, an increase of nearly 300% after CABG x4
041044 - surgery 9 years ago. ref SDS 65 VE73
041046 - ..
041047 - On 181126 1547 receive results of Telomere test, ref SDS 67 ZD7J,
041048 - seeming to indicate have telomere length for average 77 year old,
041049 - reported in the record for the day of the blood draw on 181115 1037.
041050 - ref SDS 64 AY46
041052 - ..
041053 - On 181203 1030 2nd of 3 Supartz injections - meeting with Gina at VA
041054 - Clinic in Santa Rosa performed 2nd injection Supartz in both knees.
041055 - ref SDS 69 V54H
041057 - ..
041058 - On 181205 1045 meeting with Doctor Dan Thuillier at VAMCSF on
041059 - telomeres, ref SDS 70 V54H; collaborating with Doctor Sara Edwards on
041060 - adding PRP treatments at the VA. ref SDS 70 FN8M
041062 - ..
041063 - On 181210 1030 3rd of 3 Supartz injections - meeting with Gina at VA
041064 - Clinic in Santa Rosa; Gina made final injection of Supartz into both
041065 - knees to complete 3 injection series. ref SDS 71 CJ98
041067 - ..
041068 - On 181212 1600 6th PRP injection treatment - meeting Doctor Tucker
041069 - injected PRP into both feet and both knees. ref SDS 72 0001
041071 - ..
041072 - On 190327 0915 meeting at VAMCSF Doctor Sara Edwards offered to
041073 - perform PRP injection treatment for both knees and right elbow.
041074 - ref SDS 80 YM90 Expect work to be performed in about 4 weeks.
041075 - ref SDS 80 T13O
041077 - ..
041078 - On 190329 0905 letter to Jane asks for earlier date for PRP treatment
041079 - if there is a cancellation. ref SDS 85 V54H
041081 - ..
041082 - On 190329 0905 at 1127 letter from Jane saying she forwarded the
041083 - letter to Lance, who schedules PRP procedures. ref SDS 85 VN3H
041085 - ..
041086 - On 190403 1000 Doctor Tucker has not received documentation of an
041087 - order for PRP care, nor establishing payment process, so paid for 7th
041088 - PRP set of injections, by cash. ref SDS 86 V66K
041090 - ..
041091 - On 190411 130912 VA Orthopedics visit Lance to schedule PRP ordered by
041092 - Doctor Edwards on 190327. ref SDS 87 V54H
041094 - ..
041095 - On 190418 150449 VA Orthopedics letter to Lance requesting time and
041096 - location for PRP on 190425. ref SDS 88 V54H Received response from
041097 - Lance saying ASU will call on 190424 OA 1400 to advise instructions on
041098 - reporting for PRP treatment the next day. ref SDS 88 3A6N
041100 - ..
041101 - On 190423 0931 received call from Rachael in VAMCSF Orthopedics
041102 - scheduling post-procedure review of PRP on 190425, with Doctor Edwards
041103 - on 190522 0900. 190423 0931, ref SDS 90 JL4J
041105 - ..
041106 - On 190424 1515 Lance called with VAMCSF Orthopedics, and said PRP
041107 - scheduled tomorrow on 190425, was cancelled in a staff meeting the day
041108 - before on 190423, by Chiefs of Orthopedics and Surgery, ref SDS 91
041109 - V54H, who were unfamiliar with "science" of PRP, and were unfamiliar
041110 - with patient strong response to treatment with PRP the past 2 years.
041111 - ref SDS 91 E647
041113 - ..
041114 - On 190424 1515 at 1531 called Jane - she scheduled meeting with Doctor
041115 - Edwards on 190517 0845. ref SDS 91 E66G
041117 - ..
041118 - On 190425 0844 letter to Doctor Edwards confirms understanding that
041119 - PRP treatment she schedule for today, was cancelled. ref SDS 92 V54H
041120 - Radiology history with MRI studies show significant injuries to feet
041121 - and knees, which responded well to treatment with PRP injection
041122 - therapy. ref SDS 92 NQ6X
041124 - ..
041125 - On 190513 1017 letter to Doctor Tucker on scope PRP treatment
041126 - scheduled for 190517. 190513 1017, ref SDS 94 6N6L
041128 - ..
041129 - On 190514 1043 received call from Joseph in Orthopedics at VAMCSF - he
041130 - changed schedule for meeting Doctor Edwards from 190515, to 190529
041131 - 0900. ref SDS 95 JL4J Later Jane called and after discussion
041132 - confirmed meeting with Doctor Edwards on 190529 0900; she said it was
041133 - a doublebook, so there may be some wait. ref SDS 95 NY6J
041135 - ..
041136 - On 190515 1400 Doctor Tucker provided 8th PRP treatment for left feet,
041137 - left knee, left shoulder. ref SDS 97 LO4O
041139 - ..
041140 - On 190517 0845 meeting Doctor Thuillier discussed referral to Doctor
041141 - Tucker through Veterans Choice for PRP treatment injured right
041142 - trapezius. ref SDS 99 SV8H Doctor will issue request for Patient
041143 - Choice to order PRP treament for knee. ref SDS 99 O45N Doctor
041144 - Thuillier will coordinate with Doctor Edwards on having Patient Choice
041145 - issue order for Doctor Tucker to perform PRP on feet, since Doctor
041146 - Tang in Podietry referred feet care to Doctor Thuillier. ref SDS 99
041147 - CH7M
041149 - ..
041150 - On 190524 1048 letter to Doctor Tucker transmit letter to Doctor
041151 - Thuillier on requirement for VA to order PRP treatment based on record
041152 - of favorable outcome reported by Doctor Simpson. ref SDS A2 V54H
041154 - ..
041155 - On 190529 1040 met with Doctor Sara Edwards in Module 2, VAMCSF.
041156 - ref SDS A3 V54H
041158 - ..
041159 - On 190610 0910 visited Jane in Orthopedics - she will notify Doctor
041160 - Edwards to make referral for meeting with Doctor Chu at VAMC Palo Alto
041161 - on clinical trial for PRP and stem cells. ref SDS B0 V54H
041163 - ..
041164 - On 190612 0910 received letter from Jane saying referral has been
041165 - entered for meeting to consult with Docto Chu at VAMC Palo Alto on
041166 - entering clinical trial for PRP and/or stem cell knee treatments.
041167 - ref SDS B2 V54H
041169 - ..
041170 - On 190621 0916 letter asks Jane in Orthopedics about status Doctor
041171 - Edwards' referral to clinical trial PRP knee treatment. ref SDS B3 V54H
041173 - ..
041174 - On 190621 0916 at 0953 call from Jane saying referral for PRP
041175 - treatment denied, recommend patient get VA support for PRP through
041176 - Veterans Choice. ref SDS B3 OH5G
041178 - ..
041179 - On 190621 0916 at 1034 letter asks Jane to schedule meeting with
041180 - Doctor Edwards. ref SDS B3 7X6I
041182 - ..
041183 - On 190621 0916 at 1500 received letter from Jane scheduling meeting
041184 - with Doctor Edwards on 190626 0945. ref SDS B3 PH4H
041186 - ..
041187 - On 190621 0916 at 1507 letter thanks Jane for assistance scheduling
041188 - meeting with Sara. ref SDS B3 MJ7K
041190 - ..
041191 - On 190626 1000 meeting with Doctor Edwards; she found xray on 190607
041192 - shows left knee looks good, indicating it has been stable after
041193 - getting PRP treatments, and despite hiking 5,000 miles. ref SDS B4
041194 - V54H
041195 -
041196 -
041197 -
041199 - ..
0412 -
0413 -
0414 - Progress
0415 -
041501 - Discussed Doctor Simpson's progress notes for examination in
041502 - Cardiology Department at VAMCSF on 181031, stating patient is "super
041503 - fit" as a result of hiking 2800 miles last year, ref SDS 61 BM86,
041504 - which raised HDL cholesterol to regress arthosclerotic plaque that had
041505 - previously required CABG x4 heart surgery on 091022. ref SDS 1 PQWU
041506 - Subsequently Coronary CT angiography (CCTA) tests on 151019,
041507 - ref SDS 4 SU62, and 3 years later on 181108, ref SDS 62 GH4U, showed
041508 - patient arteries are clear of plaque, i.e., he is cured of CVD.
041510 - ..
041511 - Doctor Kim was aware that Doctor Simpson's progress notes credit
041512 - orthopedic PRP treatments for enabling patient to raise HDL
041513 - cholesterol to achieve a significant cardiology outcome. ref SDS 61
041514 - BM9I
041516 - ..
041517 - Was unclear during the meeting if Doctor Kim has reviewed patient
041518 - history of radiology studies in this case...
041519 -
041520 - 1. Xray both knees.................... 151216 1130, ref SDS 5 1490
041521 -
041522 - Impression:
041523 -
041524 - 1. 4 weightbearing views of both knees show findings of
041525 - diffuse osteopenia and degenerative joint disease.
041527 - ..
041528 - 2. The left knee shows moderate medial compartmental and
041529 - medial patellofemoral joint space narrowing and moderate
041530 - tricompartmental marginal osteophytes.
041531 -
041533 - ..
041534 - 2. MRI right knee..................... 160504 0800, ref SDS 6 K654
041535 -
041536 - Impression
041537 -
041538 - 1. No acute ligamentous injury. Thickening of the MCL is
041539 - suggestive of prior injury.
041541 - ..
041542 - 2. Osteoarthritis. Most significantly affecting the
041543 - patellofemoral compartment.
041545 - ..
041546 - 3. Extruded medial meniscus. with tear within posterior
041547 - horn and body.
041549 - ..
041550 - 4. Patellofemoral osteoarthritis.
041551 -
041552 -
041553 -
041555 - ..
041556 - 3. MRI right knee..................... 160805 0800, ref SDS 9 DQ9Y
041557 -
041558 - Impression:
041559 -
041560 - 1. Interval progression of complex tear involving the posterior
041561 - horn and body of the medial meniscus.
041563 - ..
041564 - 2. New subchondral insufficiency fractures involving the medial
041565 - femoral condyle and the adjacent medial tibial plateau.
041567 - ..
041568 - 3. Grade 1 MCL sprain.
041570 - ..
041571 - Hiked Half Dome unaware of fracture right leg.
041572 -
041574 - ..
041575 - 4. MRI left knee...................... 160805 0800, ref SDS 9 PSUX
041576 -
041577 - 1. Severe tricompartmental osteoarthritis.
041578 -
041579 - 2. Extensive degenerative tearing of the medial and
041580 - lateral menisci.
041582 - ..
041583 - 3. Chronic complete tear of the anterior cruciate
041584 - ligament. PCL is intact.
041585 -
041586 -
041587 -
041589 - ..
041590 - 5. Xray right foot.................... 161221 0730, ref SDS 12 YH6I
041591 -
041592 - Impression:
041593 -
041594 - 1. 3 weightbearing views of both feet show no significant
041595 - interval change.
041597 - ..
041598 - 2. Mild to moderate bilateral hallux valgus deformities with
041599 - hypertrophic changes at the heads of the first metatarsals and
041600 - mild associated first metatarsal phalangeal joint space
041601 - narrowing.
041603 - ..
041604 - This is finding Tailor's Bunion.
041605 -
041606 -
041607 -
041608 -
041609 - 6. MRI right foot..................... 170412 0800, ref SDS 16 JG9W
041610 -
041611 - Impression:
041612 -
041613 - 1. Second MTP plantar plate and lateral collateral ligament
041614 - tears with intermediate signal within the second
041615 - interspace, which likely represents pericapsular fibrosis
041616 - versus less likely a small neuroma.
041618 - ..
041619 - 2. Degenerative changes of the first MTP with chronic tear of
041620 - the plantar plate and intersesamoidal ligament.
041622 - ..
041623 - 3. Obliquely oriented cleft and edema within the tibial
041624 - hallucal sesamoid, which likely represents a subacute to
041625 - chronic fracture versus bipartite sesamoid with stress
041626 - related changes.
041627 -
041628 -
041630 - ..
041631 - 7. MRI left foot...................... 170412 0800, ref SDS 16 JH6R
041632 -
041633 - Impression:
041634 -
041635 - 1. Degeneration of the lateral aspect of the second MTP plantar
041636 - plate without discrete tear.
041638 - ..
041639 - 2. Degenerative changes at the first MTP joint with chronic
041640 - tears of the first metatarsophalangeal joint plantar plate
041641 - and inter-sesamoidal ligaments.
041642 -
041643 -
041645 - ..
041646 - 8. MRI right knee..................... 171229 0745, ref SDS 33 DQ9Y
041647 -
041648 - Impression:
041649 -
041650 - 1. Redemonstration of complex tear involving the posterior
041651 - horn and body of the medial meniscus similar to prior.
041653 - ..
041654 - 2. Near resolution of the bone marrow edema and previously
041655 - noted signs of insufficiency fractures involving the
041656 - femur and tibia.
041657 -
041658 -
041660 - ..
041661 - 9. MRI left knee...................... 171229 0745, ref SDS 33 PSUX
041662 -
041663 - Impression:
041664 -
041665 - 1. Similar appearance of severe tricompartmental
041666 - osteoarthritis and chondral defects as described.
041668 - ..
041669 - 2. Extensive complete degenerative tearing of the medial
041670 - meniscus and partial tearing of the lateral menisci,
041671 - unchanged.
041673 - ..
041674 - 3. Chronic complete tear of the anterior cruciate ligament
041675 - is similar to prior.
041676 -
041677 -
041679 - ..
041680 - 10. MRI right foot..................... 171229 0900, ref SDS 34 JG9W
041681 -
041682 - Impression:
041683 -
041684 - 1. Second MTP plantar plate and lateral collateral ligament
041685 - tears with intermediate signal within the second
041686 - interspace, which likely represents pericapsular fibrosis
041687 - versus less likely a small neuroma.
041689 - ..
041690 - 2. Degenerative changes of the first MTP with chronic tear of
041691 - the plantar plate and intersesamoidal ligament.
041693 - ..
041694 - 3. Obliquely oriented cleft and edema within the tibial
041695 - hallucal sesamoid, which likely represents a subacute to
041696 - chronic fracture versus bipartite sesamoid with stress
041697 - related changes.
041698 -
041699 -
041701 - ..
041702 - 11. MRI left foot...................... 171229 0900, ref SDS 34 JH6R
041703 -
041704 - Impression:
041705 -
041706 - 1. Degeneration of the lateral aspect of the second MTP plantar
041707 - plate without discrete tear.
041709 - ..
041710 - 2. Degenerative changes at the first MTP joint with chronic
041711 - tears of the first metatarsophalangeal joint plantar plate
041712 - and inter-sesamoidal ligaments.
041713 -
041714 -
041716 - ..
041717 - Doctor Kim said he has seen medical studies that found some patients
041718 - do not experience reduced pain treating osteoarthritis with PRP
041719 - injections. He seemed to say these studies indicate to him that the
041720 - "science of PRP is not settled." He feels the patient in this case
041721 - has suffered "delusions" that 9 PRP procedures with varying numbers of
041722 - injections to feet and knees, beginning on 170726, have resolved pain
041723 - in feet and knees for varying periods of time, depending on the amount
041724 - of miles hiked.
041726 - ..
041727 - During the meeting the doctor did not explain if "delusions" he
041728 - speculates occurred to enable hiking 3,500 miles last year entailed
041729 - believing PRP injections removed "delusions" of non-existent pain; or,
041730 - that patient suffered pain from feet and knee injuries identified by
041731 - VA radiology studies, but ignored it under a delusion that PRP
041732 - repaired injuries in feet and knees.
041734 - ..
041735 - [On 190830 1118 letter to Doctor Thuillier in Orthopedics
041736 - Department at VAMCSF, reports understandings from meeting
041737 - with Doctor Kim today. ref SDS C0 V54H
041739 - ..
041740 - Asked Doctor Kim to submit the studies that found PRP did not resolve
041741 - feet and knee pain for some patients.
041743 - ..
041744 - Doctor Kim was familiar with PRP 30-cc blood draw with one-spin
041745 - procedure that produces plasma with 3 times concentration of platelets
041746 - compared to normal blood.
041748 - ..
041749 - He seemed unaware that Doctor Tucker uses 60-cc 2-spin procedure that
041750 - produces plasma with 5-7 times concentration of platelets compared to
041751 - normal blood.
041753 - ..
041754 - Asked Doctor Kim for his prescription to treat repetitive stress
041755 - injuries to feet and knees that result from hiking at therapeutic
041756 - levels required for cardiovascular care, cited by Doctor Simpson in
041757 - progress notes on 181031 1000? ref SDS 61 BM9I
041759 - ..
041760 - The doctor indicated the Orthopedics Department has no surgical
041761 - treatments for feet and knee injures from hiking. Patients are
041762 - prescribed pain medication for hiking at high levels of 20 miles per
041763 - week. He mentioned ibuprofen and acetaminophen to relieve pain and
041764 - inflammation in feet and knees.
041766 - ..
041767 - Reviewed the record in this case shows hiking even at 30 miles per
041768 - week for six (6) years, achieved only HDL 30, which was significantly
041769 - adverse for coronary health. On 091022, coronary arteries were over
041770 - 90% occluded, and required 4 bypass grafts. ref SDS 1 PQWU After CABG
041771 - x4, the patient had to increase hiking to 70 - 100+ miles per week in
041772 - order to achieve therapeutic levels of HDL 60+ (actually HDL 83 on
041773 - 181112 1720. ref SDS 63 5C7M). This meaningfully regressed
041774 - atherosclerotic plaque in blood vessels, reported in coronary CT
041775 - angiography (CCTA) test on 151019 0930. ref SDS 4 SU62 Follow up CCTA
041776 - found same results 3 years later on 181108 0930. ref SDS 62 GH4U
041778 - ..
041779 - Ibuprofen and acetaminophen were effective 15 years ago, hiking at 20
041780 - miles per week. Acetaminophen lowers HDL 30%, and so had to be ended.
041781 - Ibuprofen was not effective treating pain and inflammation hiking 70 -
041782 - 100+ miles per week. VA has prescribed hydrocodone, oxycodone and
041783 - naproxen to sustain daily hiking at therapeutic levels. Hydrocodone
041784 - provided by the VA is actually a combination of hydrocodone and
041785 - acetaminophen. Since acetaminophen lowers HDL, it is
041786 - counterproductive to raising HDL.
041788 - ..
041789 - Oxycodone and naproxen are effective, but should not be relied upon to
041790 - numb pain being caused by continual breakdown of feet and knee tissue
041791 - from repetitive stress. Besides having no curative effects, and thus
041792 - allowing feet and knee injuries to worsen everyday, these drugs have
041793 - severe side effects taken daily over long periods of time. Naproxen
041794 - is not recommended for cardiology deficits, and oxycodone is an opiod
041795 - with adverse addictive qualities.
041797 - ..
041798 - For the past 2+ years, PRP injections have treated pain, inflammation,
041799 - and seem to reduce the severity of degraded internal tissue. This
041800 - might not be scientific evidence, but shows strong response to
041801 - treatment, with no side effects.
041803 - ..
041804 - Doctor Kim asked about weight? Explained weight the past few months
041805 - has been in the range of 180 after hiking 11 - 20+ miles each day.
041806 - Have been down to 175, and up to 190.
041808 - ..
041809 - Doctor Kim said losing weight would reduce osteoarthritis pain in
041810 - the left knee.
041812 - ..
041813 - Hiking is a primary line of care for weight loss. Thus, PRP aids
041814 - weight management.
041815 -
041816 - [On 190816 1100 pictures taken during PRP treatment show
041817 - patient extremely overweight, especially for hiking Half
041818 - Dome. ref SDS B9 KF94
041820 - ..
041821 - Doctor Kim said he knows Connie Chu in the Orthopedics Department at
041822 - Stanford Medical Center, and who runs the clinical trial for PRP at VA
041823 - in Palo Alto. He seemed to say they were students together at
041824 - Stanford Medical School. Doctor Kim will call Doctor Chu about
041825 - including this patient in the PRP study, and to get the reason for not
041826 - including the patient. Previously, Doctor Chu advised that VAMCSF
041827 - Orthopedics should order PRP for patient through Veterans Choice
041828 - program, reported by Jane on 190621 0916. ref SDS B3 OH5G
041830 - ..
041831 - Doctor Kim further said that UCSF Medical Center is running another
041832 - clinical trial for PRP. He will call them about including the
041833 - patient in the study.
041835 - ..
041836 - Doctor Kim examined left shoulder by placing his hands on each
041837 - patient elbow and asking patient to push elbows away from the body.
041838 - He concluded injury is minor and can be treated with physical
041839 - therapy. He will order PT.
041840 -
041841 - [On 190814 0949 received call from Connie in Physical
041842 - Therapy; she scheduled meeting with Carrol on 190916 1100.
041843 - ref SDS B8 IS6I
041845 - ..
041846 - [On 190903 0845 Connie called and changed the meeting with
041847 - Physical Therapy to 190927 1000 with Britanny. ref SDS C1
041848 - 455O
041849 -
041850 -
0419 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Progress Notes Release of Information ROI CD Contents Received on 190316
050403 -
050404 - Follow up ref SDS B6 Q05K.
050405 -
050406 - Download medical records from VA website at...
050407 -
050408 - https://www.myhealth.va.gov/mhv-portal-web/track-health
050409 -
050416 - ..
050417 - Stored Progess Notes for procedure on 190416 at location...
050418 -
050419 - F:\05\00003\SM\CC\AGMJ\20190812-133000\mhv_WELCH_20190818_1856.txt
050420 -
050421 - 1. Date/Time: 12 Aug 2019 @ 1434
050422 - Note Title: ORTHO ATTENDING CLINIC NOTE (SURG)
050423 - Location: San Francisco CA VAMC
050424 - Signed By: KIM,HUBERT T
050425 - Co-signed By: KIM,HUBERT T
050426 - Date/Time Signed: 12 Aug 2019 @ 1441
050428 - ..
050429 - 2. LOCAL TITLE: ORTHO ATTENDING CLINIC NOTE (SURG)
050430 - STANDARD TITLE: ORTHOPEDIC SURGERY ATTENDING NOTE
050431 - DATE OF NOTE: AUG 12, 2019@14:34 ENTRY DATE: AUG 12, 2019@14:34:05
050432 - AUTHOR: KIM,HUBERT T EXP COSIGNER:
050433 - URGENCY: STATUS: COMPLETED
050435 - ..
050436 - 3. Patient presents with many questions regarding PRP and stem
050437 - cell injections for his knees. Explained in depth the current
050438 - status of these treatments and that I cannot advocate for their
050439 - use clinically based on current data which does not support
050440 - efficacy for knee arthritis.
050442 - ..
050443 - Will do some inquiring about clinical trials that might be
050444 - appropriate.
050446 - ..
050447 - Patient also exhibits symptoms c/w left shoulder rotator cuff
050448 - impingement vs. small tear, so will order course of PT--patient
050449 - will f/u with Dr. Edwards.
050450 -
050451 - 40 minute visit mostly spent for counseling.
050453 - ..
050454 - 4. Clinical Reminder Activity
050455 - MED REC NON PRIMARY CARE:
050456 - MEDICATION RECONCILIATION:
050458 - ..
050459 - Current medications reviewed with patient/caregiver and
050460 - reconciliation of medications related to today's visit
050461 - completed, including non-VA medications and discrepancies, if
050462 - identified, were addressed. Medication changes and the
050463 - importance of medication management were reviewed with the
050464 - patient/caregiver today based on individual needs.
050465 - Patient/caregiver acknowledged understanding of instructions as
050466 - stated.
050468 - ..
050469 - An updated list of reconciled medications has been provided to
050470 - the patient/caregiver.
050471 -
050472 - 5. /es/ HUBERT T KIM, MD 25051
050473 - Attending Ortho UC# 25051
050474 - Signed: 08/12/2019 14:41
050475 -
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050480 -
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050482 -
050483 -
050484 -
050485 -
050486 -
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050488 -
050489 -
050490 -
0505 -