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 C8 0000. ref SDS C1 0000.
040502 -
040503 - Phlabotomist drew Blood from left arm inner elbow as always.
040504 - ref SDS 0 4AXU Reviewed PRP scope today, for both feet, and skip
040505 - knees, etc. ref SDS 0 SO4N Decided not to inject callus injuries,
040506 - because no room on metatarsals between skin and bone to store PRP;
040507 - need wider shoes. ref SDS 0 IDTY Doctor Tucker palpated prospective
040508 - sites, and marked locations for injections. She sprayed sites with
040509 - numbing agent and injected lidocaine into each site. ref SDS 0 O26N
040510 - Major change from prior PRP care, injections were orders of magnitude
040511 - more painful, actually intollerable. After only 2 injections, decided
040512 - to end treatment with 22 more injections still needed. The doctor was
040513 - kind, professional and patient helping to complete treatment today, a
040514 - fortunate miracle. ref SDS 0 J47J
040515 -
040516 -
040517 -
040518 -
040519 -
040520 -
041364 -
041366 - ..
0414 -
0415 -
0416 - Progress
0417 -
041701 - Amy drove us to...
041702 -
041703 - Doctor Gloria Tucker
041704 - 250 Bel Marin Keys Boulevard #G1
041705 - Novato, CA 94945
041706 - 415 506 4907
041735 - ..
041736 - Left the house about 0800, driving to the doctor's office in Novato,
041737 - implementing plan for 15th PRP treatment, scheduled to get blood draw
041738 - by a phlebotomist at 0930, shown in letter to Doctor Tucker on 260327
041739 - 0926. ref SDS D5 ZGSU
041740 -
041741 -
041742 -
041744 - ..
0418 -
0419 -
0420 - 0910
0421 -
042101 - Arrived at Doctor Tucker's office.
042105 - ..
042106 - Paul explained the woman who will draw blood (phlebotomist) called and
042107 - said she will a few minutes late.
042108 -
042132 -
042133 -
042134 -
042135 -
042137 - ..
0422 -
0423 -
0424 - 0935
0425 -
042501 - Phlebotomist arrived and drew blood for the 1st patient, planned in
042502 - call on 260327 0926. ref SDS D5 7K6N
042503 -
042504 -
042506 - ..
0426 -
0427 -
0428 - 0945
0429 -
042901 - Blood Draw for PRP Completed with One Needle Stick
042902 -
042903 - Follow up ref SDS C8 PS4K, ref SDS C1 PS4K.
042904 -
042905 - Did not put feet on the gurney and do 10 pushups to increase blood
042906 - flow for the IV blood draw.
042908 - ..
042909 - The Phlebotomist drew blood from the left arm, again using the vein on
042910 - the inner elbow, which has been used previously, reported for the 10th
042911 - PRP treatment on 190816 1100. ref SDS B8 PS4K
042913 - ..
042914 - The nurse aligned the needle and pushed it into the vein, shown by the
042915 - film for the prior procedure...
042922 - ..
042923 - The nurse said there was good blood flow on the first stick, so nice
042924 - did not need multiple needle sticks today.
042926 - ..
042927 - The nurse aspirated 3 viles containing 20 cc of blood for total PRP
042928 - blood draw of 60 cc's.
042929 -
042930 -
042931 -
042932 -
042934 - ..
0430 -
0431 -
0432 - 1000
0433 -
043301 - Amy and I drove to Pacheco Plaza Shopping Center across the freeway
043302 - (101) on Ignacio Boulevard. Looked for place eat. Finally, went
043303 - into Nuggets store. Kathy ate here previously waiting for PRP
043304 - treatents. Ordered some kind of hamburger. Bought softdrinks. Sat
043305 - outside in sunshine. Only ate a few bites.
043307 - ..
043308 - Drove back to Doctor Tucker's office.
043309 -
043311 - ..
0434 -
0435 -
0436 - 1120
0437 -
043701 - Went into the doctor's office. Amy waited in car - she drove back to
043702 - shopping complex for exploring...
043704 - ..
043705 - Paul said Gloria is still with a patient.
043706 -
043708 - ..
0438 -
0439 -
0440 - 1142
0441 -
044101 - Patient and Gloria came out of the treatment room.
044102 -
044103 - Paul went in an cleaned the room for next patient.
044105 - ..
044106 - Called Amy and said the other patient has completed; my treatment
044107 - should start soon.
044108 -
044109 -
044110 -
044112 - ..
0442 -
0443 -
0444 - 1150
0445 -
044501 - Develope Scope of Work for 15th Regeneration PRP Injection Treatment
044502 -
044503 - Follow up ref SDS C8 SO4N, ref SDS C1 SO4N.
044504 -
044505 - Admitted to treatment room. Removed shoes and socks, ready to start
044506 - work.
044508 - ..
044509 - Gloria came into OR.
044517 - ..
044518 - The doctor looks same as last treatment on 191009.
044520 - ..
044521 - Explained knees are not being injected today, because they have held
044522 - up well after the doctor increased concentration of PRP 300%, reported
044523 - in revised progress notes that say 180cc of blood was drawn for PRP
044524 - procedure on 190925, shown in the record on 191009 1500. ref SDS C8
044525 - M46L At that time, asked, if 180 cc concentration is more effective
044526 - healing knee osteoarthritis (OA), as related in the letter on 190930
044527 - 0932, ref SDS C3 V54H, and again in the letter on 191004 1116,
044528 - ref SDS C5 5T41, why isn't 180 cc used for every PRP treatment? At
044529 - that time, Doctor Tucker advised that equipment for centrifuging 180
044530 - cc of blood is more expensive than for stantard PRP care processing 60
044531 - cc, shown in the record on 191009 1500, ref SDS C8 AQ3I
044533 - ..
044534 - Today, explained very fortunate and grateful the doctor used increased
044535 - concentration of PRP on 190925, because since then knees had done
044536 - well, despite increased hiking 20 - 30 miles per day. This may have
044537 - occurred in part because increased hiking increased HDL that maintains
044538 - and repairs cartilage.
044540 - ..
044541 - Discussed possible areas for PRP injections...
044542 -
044543 -
044544 - 1. Shoulder left side
044546 - ..
044547 - Decided not to inject left shoulder again today, because want to
044548 - concentrate on feet.
044549 -
044551 - ..
044552 - 2. Elbow right arm
044554 - ..
044555 - Decided not to inject left elbow today, because concentrate on feet.
044556 -
044557 -
044558 - 3. Left knee
044560 - ..
044561 - Decided not to inject left knee today, because concentrate on feet.
044562 -
044564 - ..
044565 - 4. Right knee
044567 - ..
044568 - Decided not to inject left knee today, because concentrate on feet.
044569 -
044570 -
044571 - 5. Tailor's Bunion right foot
044572 -
044573 - Was treated with PRP injection on 190403 1000. ref SDS 81
044574 - GE5H Some pain reported in case study on 190101, on some
044575 - hikes, e.g., on 190713. ref SDS 67 VSSS After PRP
044576 - treatment on 190816 1100, ref SDS B8 GE5H, there was no
044577 - further pain in either foot. Recently, right foot mild
044578 - pain (PL 3) in Tailor's bunion has occurred
044580 - ..
044581 - During examination Gloria determined no specific injection PRP needed
044582 - today.
044583 -
044585 - ..
044586 - 6. Tailor's Bunion left foot
044587 -
044588 - Was treated with PRP injection 190403 1000. ref SDS 81 9G4I
044589 - There was continuing pain in left foot Tailor's Bunion,
044590 - while hiking, e.g., on 190419 shown in case study on 190101
044591 - 0730. ref SDS 66 SVQX On 190427 pain level 2 - 3 almost
044592 - entire hike. ref SDS 66 UPQT
044594 - ..
044595 - Was treated again with PRP on 190515 1400. ref SDS 95 Q35G
044596 - There was continuing pain in left foot Tailor's Bunion,
044597 - while hiking, e.g., on 190522 shown in case study on 190101
044598 - 0730. ref SDS 66 XWVY
044600 - ..
044601 - On 190612 1130 the doctor injected left foot Tailor's
044602 - Bunion with PRP using ultrasound guidance. ref SDS B0 Q35G
044603 - For a month after PRP injection on 190612, there were some
044604 - hikes when minor pain ( < 3 ) occurred during part of hike.
044605 - For the past 4+ weeks there have no reports of pain in
044606 - left foot Tailor's Bunion.
044608 - ..
044609 - Recently, right foot mild pain (PL 3) in Tailor's bunion
044610 - has occurred
044612 - ..
044613 - During examination Gloria determined no specific injection PRP needed
044614 - today.
044615 -
044617 - ..
044618 - 7. Metatarsalgia both feet
044619 -
044620 - PRP will be injected between all 5 metatartsals, as
044621 - previously on 191009 1500. ref SDS C8 0108
044623 - ..
044624 - Feet responded well with no metatarsalgia pain after PRP
044625 - treatment on 191009. Could not afford follow up
044626 - injections. There has been continuing mild burning
044627 - sensation bottom right foot, reported in the letter to the
044628 - doctor on 190513 1017. ref SDS 91 SB9M This occurred
044629 - everyday after injections on 190403, with low intensity,
044630 - e.g., on 190523, shown in case study on 190101 0730.
044631 - ref SDS 66 QL4H
044633 - ..
044634 - PRP was injected between all 5 metatartsals on 190612 1130.
044635 - ref SDS B0 0108
044637 - ..
044638 - Feet responded well to treatment on 190612, however, there
044639 - have been some hikes when metatarsalgia pain occurs in both
044640 - feet, reported in case study on 190101, e.g., on 190629,
044641 - ref SDS 66 TTTU; again on 190630, ref SDS 66 TTYR, also on
044642 - 190713, ref SDS 66 VSSS, on 190727, ref SDS 66 XSXV,
044644 - ..
044645 - PRP was injected between all 5 metatartsals and Tailor's
044646 - Bunions in both feet on 190816 1100. ref SDS B8 0108
044647 - This was very effective for several years, but pain has
044648 - gradually increased requiring increased use of pain
044649 - medications to hike.
044651 - ..
044652 - Doctor Tucker will inject PRP in feet to treat metatarsalgia.
044654 - ..
044655 - Decided not to inject PRP to treat severe calluses on edges of both
044656 - feet #1s and #5s, despite this being a primary need along with
044657 - metatarsalgia. The doctor explained there is a lot of space beneath
044658 - the skin between metatarsals for injecting PRP to treat continuing
044659 - pressure from daily hiking. However, anotomically there is not enough
044660 - space between callused skin and toe bone on the edges of #1s and #5s
044661 - for injecting enough PRP to last more than a few days.
044663 - ..
044664 - The doctor recommended getting wider shoes to reduce lateral stress
044665 - causing calluses on #1s and #5s. This aligns with Doctor Tang's
044666 - recommendations on 260206 0900. ref SDS D3 XPDM
044667 -
044668 -
044669 - 8. Inject above and off center in each foot to correct and
044670 - improve arch support.
044672 - ..
044673 - Gloria explained this theory - didn't really understand this, but that
044674 - is not unusual. Gloria is a feet expert, so readily agreed to these
044675 - injections.
044676 -
044677 -
044678 -
044680 - ..
044681 - NSAID Pain Medication, Turmeric Past 2 Days Before PRP Injections
044682 -
044683 - Follow up ref SDS C8 JT6H, ref SDS C1 JT6H.
044684 -
044685 - Protocol for PRP treatment is to avoid NSAID and Turmeric drugs 2 days
044686 - prior to getting PRP, reported in a letter received from Doctor
044687 - Tucker's office on 170721 0848. ref SDS 8 KT7K
044689 - ..
044690 - Advised that have not taken NSAID drugs the past 2 days, shown in case
044691 - study on 200101 0701. ref SDS D0 7IFE
044693 - ..
044694 - Explained that Turmeric Curcumin 2250 mg was taken, with 2 swallows
044695 - liquid the past 2 days for hiking to prevent inflammation from
044696 - blocking liver production of HDL, also, shown on 200101 0701.
044697 - ref SDS D0 7IFE These hikes totalling 31 miles may have metabolized
044698 - Turmeric sufficient to avoid effecting PRP care. There was not enough
044699 - Turmeric Curcumin to lower inflammation, since the lab after the hike
044700 - showed inflammation increased.
044701 -
044702 -
044703 -
044705 - ..
044706 - Examination and Mark Injection Sites
044707 -
044708 - Follow up ref SDS C8 O26N, ref SDS C1 O26N.
044709 -
044710 - While PRP was being created using 2-spin Harvest centrifuge
044711 - processing, explained in the doctor's letter on 190419 1123,
044712 - ref SDS 88 V54H, Doctor Tucker examined, marked and palpated areas
044713 - where injections would be made, illustrated from prior care...
044714 -
044725 - ..
044726 - Note a new centrifuge may have been used today, 7 years later for
044727 - harvesting platelet plasma.
044728 -
044729 -
044731 - ..
0448 -
0449 -
0450 - 1300
0451 -
045101 - Lidocane Injections Numb PRP Injection Sites Very Difficult Tolerate
045102 -
045103 - Follow up ref SDS C8 MN4K, ref SDS C1 MN4K.
045104 -
045105 - Numbing agent was sprayed on injection sites, which were then further
045106 - numbed with lidocaine injections, similar to prior treatents, 7 years
045107 - ago...
045108 -
045109 -
045129 - ..
045130 - Antiseptic was applied at each injection site.
045132 - ..
045133 - Lidocaine injections into the feet and knees is about pain level 2 -
045134 - noticable, but easily tolerated, reported during PRP treatment on
045135 - 191009 1500, ref SDS C8 XV6O, and set out in letter to Doctor Tucker
045136 - reporting Supartz injections at VA were preceded by injecting
045137 - Lidocaine...
045138 -
045139 - "Don't feel a thing."
045140 -
045141 - ...shown in the record on 170724 1507. ref SDS 9 OP6P
045143 - ..
045144 - Today, lidocaine injections were PL 10+ and PRP injections PL 8 - very
045145 - difficult to tolerate. After 2 injections, asked for something to
045146 - squeeze in the hands for off loading pain expression, while keeping
045147 - foot steady, avoid striking the doctor or causing the needle to injure
045148 - the foot.
045150 - ..
045151 - After next injection, under bleak prospect of 20 more, I asked to end
045152 - treatment, saying pain was intollerable, and the doctor could keep the
045153 - full $2,000 pre-paid.
045155 - ..
045156 - Doctor Tucker was kind and understanding. She paused the work,
045157 - reminded of how long it has taken to reach the point of getting here -
045158 - doing mission critical care. She expressed disbelief her patient
045159 - could be impacted to such degree, based on experience of this patient
045160 - easily tolerating lidocaine and PRP for 12 prior treatments, and of
045161 - course doing the same for thousands of her other patients. This
045162 - record indicates pain from lidocaine injections should be de minimis.
045163 - Since it is not, something is amiss.
045165 - ..
045166 - The doctor suggested taking oxycodone to get through injections that
045167 - have always been easily tolerated. There is no record of having done
045168 - this during 12 prior PRP treatments. Brought oxycodone to take after
045169 - all injections are completed, and in order to drive home, because pain
045170 - gradually increases, and commute traffic can extend the time to get
045171 - home, before there is opportunity to take more pain relief drugs.
045173 - ..
045174 - Took 2 oxycodone. The doctor brought a cup of water. She said to
045175 - chew the pills to cause pain relief to build faster.
045177 - ..
045178 - Pain level remained elevated for continuing injecting lidocaine,
045179 - intended to avoid pain injecting PRP. This dropped some for PRP
045180 - injections.
045182 - ..
045183 - The mystery is why injecting lidocaine causes intollerable pain today,
045184 - when prior treatments reported this was pain level 2, very tolerable,
045185 - i.e., didn't feel a thing, per above. ref SDS 0 J47J
045186 -
045187 -
045188 -
045189 -
045190 -
045192 - ..
0452 -
0453 -
0454 - 1316
0455 -
045501 - PRP Injections
045502 -
045503 - Follow up ref SDS C8 LO4O, ref SDS C1 LO4O.
045504 -
045505 - After all sites were marked and numbed with spraying agent and
045506 - lidocane, and after the centrifuging process completed, the doctor
045507 - made PRP injections...
045509 - ..
045510 - Left Shoulder Injections
045511 -
045512 - Follow up ref SDS C8 M23O, ref SDS C1 M23O.
045513 -
045514 - Injections......................................... 0
045515 -
045516 -
045517 -
045519 - ..
045520 - Right Elbow
045521 -
045522 - Follow up ref SDS C8 5M5I, ref SDS C1 5M5I.
045523 -
045524 - Injections......................................... 0
045525 -
045526 -
045528 - ..
045529 - Trapezius right side
045530 -
045531 - Follow up ref SDS C8 SB5J, ref SDS C1 SB5J.
045532 -
045533 - Injections......................................... 0
045534 -
045535 -
045536 -
045538 - ..
045539 - Right Knee
045540 -
045541 - Follow up ref SDS C8 GE9L, ref SDS C1 GE9L.
045542 -
045543 - Knee joint............................................ 0
045544 -
045545 -
045547 - ..
045548 - Left Knee
045549 -
045550 - Follow up ref SDS C8 TF4H, ref SDS C1 TF4H.
045551 -
045552 - Knee joint............................................ 0
045554 - ..
045555 - The doctor did not make the usual 4 injections on left side of left
045556 - knee, including intra articular into the meniscus, as done for prior
045557 - PRP care...
045558 -
045571 - ..
045572 - Previously, all prior PRP injections to left knee have been pain level
045573 - 0, except intra articular injection into lateral meniscus was pain
045574 - level 5, seemed to be deeper into the joint on 191009.
045576 - ..
045577 - On 191009 there was an injection below patella on front of knee...
045578 -
045586 - ..
045587 - All pain level 0.
045588 -
045590 - ..
045591 - Back of knee cruciate ligaments........................ 0
045593 - ..
045594 - Think this treated hamstring tendon strain to prevent buckling,
045595 - discussed on 191009 1500. ref SDS C8 NV9I
045597 - ..
045598 - All pain level 0.
045599 -
045601 - ..
045602 - On 191028 1000 after PRP treatment today, left knee buckled several
045603 - times during hiking 15 miles, reported in case study on 190101 0730,
045604 - ref SDS 66 RXQS
045606 - ..
045607 - On 191029 1020 after PRP treatment today, left knee buckled several
045608 - times during hiking 15 miles, reported in case study on 190101 0730,
045609 - ref SDS 66 SPQW
045611 - ..
045612 - On 191209 1020 after PRP treatment today, left knee buckled several
045613 - times during hiking 15 miles, reported in case study on 190101 0730,
045614 - ref SDS 66 YRSU
045616 - ..
045617 - On 240101 0712 left knee buckled again, 4 years after PRP treatment
045618 - today. ref SDS D2 RTPP
045620 - ..
045621 - Knees have not buckled in past 3 months, so no PRP treatment needed
045622 - today.
045623 -
045624 -
045626 - ..
045627 - Right Foot
045628 -
045629 - Follow up ref SDS C8 0108, ref SDS C1 0108.
045630 -
045631 - Metatarsalgia
045632 - Between little toe and ring toe................. 1
045633 - Between ring toe and middle toe................. 1
045634 - Between middle and long toe..................... 1
045635 - Between long toe and big toe.................... 1
045636 -
045638 - ..
045639 - Doctor Tucker requested assistance; her husband who manages the
045640 - office, came into the OR. The doctor asked him to manually spread #1
045641 - and #2, possibly others both feet to prepare for inserting a needle to
045642 - inject PRP. This seems like a change or enhancement from prior
045643 - procedures.
045644 -
045646 - ..
045647 - Tailor's bunion................................. 0
045648 -
045650 - ..
045651 - Arch support.................................... 2
045652 -
045654 - ..
045655 - Total right foot............................... 6 6
045656 -
045658 - ..
045659 - All pain level 8.
045660 -
045661 -
045663 - ..
045664 - Left Foot
045665 -
045666 - Follow up ref SDS C8 YY3G, ref SDS C1 YY3G.
045667 -
045668 - Metatarsalgia
045669 - Between little toe and ring toe................. 1
045670 - Between ring toe and middle toe................. 1
045671 - Between middle and long toe..................... 1
045672 - Between long toe and big toe.................... 1
045673 -
045675 - ..
045676 - Tailor's Bunion................................. 0
045677 -
045679 - ..
045680 - Arch support.................................... 2
045681 -
045683 - ..
045684 - Total left foot................................ 6 6
045685 -
045687 - ..
045688 - Total PRP injections.................................. 12
045689 -
045691 - ..
045692 - All pain level 8.
045693 -
045711 - ..
045712 - Discussed scheduling next PRP treatment. Will assess results and
045713 - coordinate follow up care.
045714 -
045715 -
045717 - ..
045718 - Pain Management with Oxycodone and Tramadol
045719 -
045720 - Follow up ref SDS C8 NA4G, ref SDS C1 NA4G.
045721 -
045722 - Need to solve pain issue; possibly fentanyl and/or versed, that have
045723 - worked well for nearly 80 EGD dilation procedures the past 15 years.
045724 -
045725 -
045726 -
045727 -
045728 -
045729 -
045730 -
045731 -
045732 -
045733 -
0458 -
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 C8 JS8O, ref SDS C1 JS8O.
050405 -
050406 - Pending...
050407 -
050408 -
050409 -
050498 -
050499 -
050500 -
050501 -
050502 -
050503 -
050504 -
050505 -
050506 -
050507 -
050508 -
050509 -
050510 -
050511 -
050512 -
050513 -
050514 -
050515 -
050516 -
050517 -
050518 -
0506 -
Distribution. . . . See "CONTACTS"