043620 -
043622 - ..
043623 - Gloria said there was good blood flow on the first stick, so nice did
043624 - not need multiple needle sticks today. Successful blood draw from
043625 - same vein 2 weeks ago, and 4 weeks before that, was aided with running
043626 - hot water over this vein area while showering before leaving for the
043627 - doctor's office, reported above. ref SDS 0 TY9N Blood draw was
043628 - further aided by pushups testing left shoulder and right elbow, also
043629 - reported above. ref SDS 0 PS4K
043631 - ..
043632 - The doctor aspirated 3 viles containing 20 cc of blood for total PRP
043633 - blood draw of 60 cc's.
043634 -
043635 -
043637 - ..
043638 - Examination and Mark Injection Sites
043639 -
043640 - Follow up ref SDS B9 O26N, ref SDS B6 O26N.
043641 -
043642 - While PRP was being created using 2-spin Harvest centrifuge
043643 - processing, explained in the doctor's letter on 190419 1123,
043644 - ref SDS 86 V54H, Doctor Tucker examined and palpated areas where
043645 - injections would be made.
043646 -
043648 - ..
043650 - 
043651 -
043653 - ..
043654 - 
043655 -
043656 -
043657 -
043658 -
043660 - ..
0437 -
0438 -
0439 - 1300
0440 -
044001 - Numbing Agent and Lidocane Injections Numb PRP Injection Sites
044002 -
044003 - Follow up ref SDS B9 MN4K, ref SDS B6 MN4K.
044004 -
044005 - Numbing agent was sprayed on injection sites, which were then further
044006 - numbed with lidocaine injections...
044007 -
044008 -
044010 - 
044011 -
044012 -
044014 - ..
044015 - 
044016 -
044017 -
044019 - ..
044020 - 
044021 -
044022 -
044024 - ..
044025 - 
044026 -
044028 - ..
044029 - Antiseptic was applied at each injection site.
044031 - ..
044032 - Injecting lidocaine into the knees is about pain level 2 - noticable,
044033 - but easily tolerated.
044034 -
044035 -
044036 -
044038 - ..
0441 -
0442 -
0443 - 1316
0444 -
044401 - PRP Injections
044402 -
044403 - Follow up ref SDS B9 LO4O, ref SDS B6 LO4O.
044404 -
044405 - After all sites were marked and numbed with spraying agent and
044406 - lidocane, and after the centrifuging process completed, the doctor
044407 - made PRP injections...
044409 - ..
044410 - Left Shoulder Injections
044411 -
044412 - Follow up ref SDS B9 M23O, ref SDS B6 M23O.
044413 -
044414 - Injections......................................... 0
044415 -
044416 -
044417 -
044419 - ..
044420 - Right Elbow
044421 -
044422 - Follow up ref SDS B9 5M5I, ref SDS B6 5M5I.
044423 -
044424 - Injections......................................... 0
044425 -
044426 -
044428 - ..
044429 - Trapezius right side
044430 -
044431 - Follow up ref SDS B9 SB5J, ref SDS B6 SB5J.
044432 -
044433 - Injections......................................... 0
044434 -
044435 -
044436 -
044438 - ..
044439 - Right Knee
044440 -
044441 - Follow up ref SDS B9 GE9L, ref SDS B6 GE9L.
044442 -
044443 - Knee joint............................................ 0
044444 -
044445 -
044447 - ..
044448 - Left Knee
044449 -
044450 - Follow up ref SDS B9 TF4H, ref SDS B6 TF4H.
044451 -
044452 - Knee joint............................................ 8
044454 - ..
044455 - The doctor seemed to make 4 injections on left side of left knee,
044456 - including intra articular into the meniscus...
044457 -
044458 -
044460 - 
044461 -
044462 -
044464 - ..
044466 - 
044467 -
044468 -
044470 - ..
044471 - All pain level 0, except intra articular injection into lateral
044472 - meniscus was pain level 5, seemed to be deeper into the joint today.
044473 -
044474 -
044476 - ..
044477 - Seemed to be 1 injections below patella on front of knee...
044478 -
044480 - ..
044482 - 
044483 -
044484 -
044486 - ..
044487 - All pain level 0.
044488 -
044489 -
044490 -
044491 - Back of knee cruciate ligaments........................ 2
044493 - ..
044494 - Think this treated hamstring tendon strain to prevent buckling.
044495 -
044496 -
044498 - ..
044499 - All pain level 0.
044500 -
044501 -
044502 -
044504 - ..
044505 - Right Foot
044506 -
044507 - Follow up ref SDS B9 0108, ref SDS B6 0108.
044508 -
044509 - Metatarsalgia
044510 - Between little toe and ring toe................. 1
044511 - Between ring toe and middle toe................. 1
044512 - Between middle and long toe..................... 1
044513 - Between long toe and big toe.................... 1
044515 - ..
044516 - All pain level 2.
044517 -
044519 - ..
044520 - Tailor's bunion................................. 0
044522 - ..
044523 - Total right foot............................... 0 0
044524 -
044525 -
044527 - ..
044528 - Left Foot
044529 -
044530 - Follow up ref SDS B9 YY3G, ref SDS B6 YY3G.
044531 -
044532 - Metatarsalgia
044533 - Between little toe and ring toe................. 1
044534 - Between ring toe and middle toe................. 1
044535 - Between middle and long toe..................... 1
044536 - Between long toe and big toe.................... 1
044537 -
044539 - ..
044540 - All pain level 0.
044541 -
044542 -
044544 - ..
044545 - Tailor's Bunion................................. 0
044546 -
044548 - ..
044549 - Total left foot................................ 8 8
044550 -
044552 - ..
044553 - Total PRP injections.................................. 9
044554 -
044555 -
044556 -
044576 - ..
044577 - Did not schedule another PRP treatment. Hope treatment today,
044578 - combined with prior 3 treatments beginning on 190403, will last until
044579 - after January 2020.
044580 -
044581 -
044583 - ..
044584 - Pain Management with Oxycodone and Tramadol
044585 -
044586 - Follow up ref SDS B9 NA4G, ref SDS B6 NA4G.
044587 -
044588 - Doctor Trucker referred to VA for oxycodone to manage pain from 24 PRP
044589 - injections today.
044591 - ..
044592 - Doctor Trucker referred to VA for Tramadol to manage restless legs
044593 - syndrome from hiking long miles.
044594 -
044595 -
044596 -
044597 -
044598 -
044599 -
044600 -
044601 -
044602 -
0447 -
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 B9 JS8O, ref SDS B6 JS8O.
050405 -
050406 - Received letter from Doctor Tucker transmitting her Progress Notes
050407 - for the procedure today.
050409 - ..
050410 - Stored Doctor Tucker's Progress Notes in...
050411 -
050412 - F:\05\00003\SM\CC\AGMJ\20191009-150000\rod_oct_2019.docx
050414 - ..
050415 - 1. Gloria Tucker MD
050416 - Diplomatic American College of Sports Medicine
050417 - 250 Bel Marin Keys Boulevard, Building G Suite 1
050418 - Novato, CA 94949
050419 - 415 506 4907
050420 - NPI:1265516231
050422 - ..
050423 - Rod Welch
050425 - ..
050426 - 2. Date....................................... October 9, 2019
050427 -
050428 - S: Per patient request, we are repeating his PRP injection to
050429 - his left knee at 2 weeks rather than 6. He notes that his knee
050430 - swelled after the last injection. We used a very concentrated
050431 - solution. He reports that in the last 3 days his knee is much
050432 - better, although he does have tenderness at the posterior
050433 - lateral and posterior medial knees and the sensation of
050434 - pressure in his anterior knee after hiking an extensive number
050435 - of miles. He says he has a sensation of some weakness but it
050436 - is very mild and continues to improve after his injection 2
050437 - weeks ago.
050439 - ..
050440 - Again, he is requesting narcotic pain medication. Reports in
050441 - the past that he uses very little at the time of the injection
050442 - and uses it intermittently for his pain in order that he can
050443 - continue hiking. I declined, since he already had one more
050444 - tablet to take after this injection. Again he requested more
050445 - pain medication, wanting both tramadol and oxycodone. Again, I
050446 - declined. I told him we do not treat chronic pain in this
050447 - clinic and we give narcotics only around the procedure. His
050448 - narcotics for his chronic pain needs to come from his primary
050449 - care provider. He told me he will be seeing his primary care
050450 - provider tomorrow.
050452 - ..
050453 - 3. Examination: effusion in his left knee, nontender except for
050454 - his posterior medial knee.
050456 - ..
050457 - 4. Impression: decline of his knee joint on the left due to high
050458 - impact activity, and underlying arthritis. He is aware of my
050459 - recommendation to decrease his high impact activity or at the
050460 - very least, cross train with swimming or biking.
050462 - ..
050463 - 5. Plan: He would like to attempt PRP to his left knee and the
050464 - metatarsals of his bilateral feet.
050466 - ..
050467 - Gloria Tucker, MD
050469 - ..
050470 - 6. Procedure: I aspirated 60 cc of blood from his left
050471 - antecubital fossa. We spun this down to PRP and then buffered
050472 - this with sodium bicarbonate and activated this with calcium
050473 - chloride. After numbing with 1% lidocaine, I treated his
050474 - distal patellar pole, medial retinaculum, tibial tubercle,
050475 - medial joint line, lateral joint line, proximal fibula, PCL,
050476 - and intra-articularly. I also treated his posterior medial
050477 - meniscus.
050479 - ..
050480 - In his bilateral feet: I treated the metatarsals of 1,2,3 and
050481 - 4 and went intra-articularly into his fifth metatarsal after
050482 - ultrasound visualization.
050484 - ..
050485 - He tolerated the procedure well
050487 - ..
050488 - Gloria Tucker, MD
050489 -
050490 -
050491 -
050492 -
050493 -
050494 -
050495 -
050496 -
0505 -