THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com
S U M M A R Y
DIARY: July 28, 2012 00:27 AM Saturday;
Rod Welch
Robin letter on case management resolving knee pain.
1...Summary/Objective
2...Case Management Performed without Patient Assistance
3...Medical Records No Evidence Ordered from Lawler for 2nd Opinions
4...Pain Management Degenerative Arthritis Prognosis Patient Worried
5...Patient Worried Prognosis Pain Management Degenerative Arthritis
6...Doctors Schueckler and Lawler Doctor Patient Relationship
7...Pain Right Knee Subsides Never Suffered Pain Left Knee
8...Glucosamine Chondroitin Tried 2 Weeks Without Effect False Negative
..............
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CONTACTS
SUBJECTS
Knee Pain Worse Complications Surgery 120322 Evidence MRI Radiology
1003 -
1003 - ..
1004 - Summary/Objective
1005 -
100501 - Follow up ref SDS 19 0000. ref SDS 18 0000.
100502 -
100503 -
100504 -
100505 -
100507 - ..
1006 -
1007 -
1008 - Progress
1009 -
100901 - Case Management Performed without Patient Assistance
100902 - Medical Records No Evidence Ordered from Lawler for 2nd Opinions
100903 -
100904 - Follow up ref SDS 19 MI5I, ref SDS 18 CM3V.
100905 -
100906 - Submitted letter to Robin saying...
100907 -
100908 - 1. Subject: Knee Pain Resolved - Congratulations
100909 - Date: Sat, 28 Jul 2012 02:24:24 -0700
100916 - ..
100917 - 2. Wonderful news hearing in one of 3 letters received today that
100918 - your knees don't bother you and are no longer painful. [...
100919 - referencing Robin's letter received yesterday on 120727 0912.
100920 - ref SDS 19 YC9V...].
100921 -
100922 - [On 120728 0027 Robin indicated during telephone call that
100923 - pain in her right knee has finally begun to subside, and
100924 - that she has not suffered noticable pain in her left knee,
100925 - despite recent MRI finding degenerative arthritis.
100926 - ref SDS 20 EI4H
100928 - ..
100929 - 3. Residual stiffness from surgery [...cited in Robin's letter,
100930 - ref SDS 19 YC9V...], will continue to recover with increased
100931 - exercise recommended by Doctor Vernacchia, ref SDS 19 YC8V,
100932 - especially the stationery bike with low resistance, which you
100933 - seem to indicate in your work plan. ref SDS 19 YC90 In my
100934 - experience, hiking has similar therapeutic effects, and costs
100935 - less that going to a gym.
100937 - ..
100938 - 4. I concur with Doctor Ongely diagnosing degenerative arthritis,
100939 - ...[reported in Robin's correspondence received yesterday on
100940 - 120727 0912. ref SDS 19 HP9Q...], shown in your record of MRI
100941 - reports [...presented in MRI on right knee performed 1207117,
100942 - and received in the record on 120726 0753. ref SDS 18 PB3M; and
100943 - in MRI on left knee performed 120723, and received in the
100944 - record on 120726 0753. ref SDS 18 QU3J...]. The article you
100945 - submitted by Doctor Darrow at UCLA, and published on the
100946 - Internet by Jointrehab.com, explains that removing cartilage
100947 - from the knee joint causes degenerative arthritis. [...
100948 - reported in Robin's letter received on 120727 0912. ref SDS 19
100949 - MP4F...]
100951 - ..
100952 - 5. You present competing theories on cause of former knee pain.
100953 -
100954 - 1. The last letter (subject: "look at this") attributes
100955 - prolonged knee pain in part to sciatica condition from the
100956 - spine disorders causing pain to travel into the lower legs
100957 - and knees. ...[reported on 120727 0912. ref SDS 19
100958 - UV4J...].
100960 - ..
100961 - [On 120730 1420 letter to Robin sets agenda to discuss
100962 - in meeting with surgeon, Doctor Lawler, correlation of
100963 - sciatica pain from neck and spine disorders causing
100964 - pain in legs and knees. ref SDS 22 UN7P
100966 - ..
100967 - 2. You also note Doctor Lawler explaining that your knee pain
100968 - difficulty may be related to having failed to remove all
100969 - torn cartilage material. [... reported on 120727 0912,
100970 - ref SDS 19 PS36...]. This seems to align with the recent
100971 - MRI report on 120717. [...showing Robin still has 2 minor
100972 - tears in her knee joint cartilage after surgery on 120322,
100973 - shown in MRI on 120717, reported in the record on 120726
100974 - 0753. ref SDS 18 PB3M...]
100975 -
100976 - [...below on 120728 0027 Robin plans to resume
100977 - Glucosamine Chondroitin to evaluate pain relief from
100978 - degenerative arthritis. ref SDS 0 0288
100980 - ..
100981 - 6. Your research on prolotherapy seems to indicate Doctor Darrow
100982 - can provide treatment at UCLA. [...referenceing links in
100983 - Robin's letter received on 120727 0912. ref SDS 19 636F...].
100984 - This might save expense and avoid risks traveling to Ensenada
100985 - for treatment from Doctor Ongely, should you elect to proceed
100986 - with prolotherapy in the future.
100987 -
100988 - [...below on 120728 0027 at 0935 Robin called and requested
100989 - assistance arranging meeting with Doctor Darrow in Los
100990 - Angeles on providing prolotherapy to help recover from
100991 - degenerative arthritis in her knees. ref SDS 0 QQ8H
100993 - ..
100994 - [...below on 120728 0027 Robin plans to resume Glucosamine
100995 - Chondroitin to evaluate pain relief from degenerative
100996 - arthritis. ref SDS 0 0288
100998 - ..
100999 - [...below on 120728 0027 at 1102 received letter from Robin
101000 - confirming request to schedule meeting to investigate
101001 - treatment with prolotherapy for relieving chronic pain due
101002 - to degenerative arthritis. ref SDS 0 FG6N
101004 - ..
101005 - 7. Your case is complicated with compound causation that clouds
101006 - diagnosis and work plans. Case management guiding the medical
101007 - team requires records from Doctor Lawler, and assisting with
101008 - pending meetings to "connect the dots" which yield the power of
101009 - knowledge that controls the future. I appreciate lack of faith
101010 - in this work practice prevents getting experience to discover
101011 - SDS support improves results. "Oh ye of little faith!"
101018 - ..
101019 - 9. Again, very good news that your knees and back for the moment
101020 - are not causing you pain.
101021 -
101027 -
101028 -
101030 - ..
1011 -
1012 -
1013 - 0935
1014 -
101401 - Pain Management Degenerative Arthritis Prognosis Patient Worried
101402 - Patient Worried Prognosis Pain Management Degenerative Arthritis
101403 -
101404 - Robin called. She was crying again during the call, similar to the
101405 - call on 120718 1842, ref SDS 14 MI5I, worrying about prospects for
101406 - recovering from degenerative arthritis, and sciatica pain from neck
101407 - and spine disorders that cause pain in her legs and knees.
101409 - ..
101410 - She received the letter submitted late last night, shown above.
101411 - ref SDS 0 MI5I
101413 - ..
101414 - This morning, Robin expressed strong interest in meeting with Doctor
101415 - Darrow about getting prolotherapy. She requested assistance arranging
101416 - a meeting with the doctor at his offices in Los Angeles. This
101417 - implements planning in the the letter to Robin this morning, per
101418 - above. ref SDS 0 RL4W
101419 -
101420 - [...below on 120728 0027 Robin plans to resume Glucosamine
101421 - Chondroitin to evaluate pain relief from degenerative
101422 - arthritis. ref SDS 0 0288
101424 - ..
101425 - [...below on 120728 0027 at 1102 received letter from Robin
101426 - confirming request to schedule meeting to investigate
101427 - treatment with prolotherapy for relieving chronic pain due
101428 - to degenerative arthritis. ref SDS 0 FG6N
101430 - ..
101431 - Robin advised her understanding that Doctor Ongely in Ensenada Mexico
101432 - has a proprietary formulation of prolotherapy. She explained again
101433 - personal experience getting this treatment in her mid-20s, and to
101434 - recover from neck and spine disorders. This confirms prior
101435 - understandings from Robin's letter on
101437 - ..
101438 - Robin said this morning that she does not want assistance meeting
101439 - Doctor Lawler on Tuesday, 120730. She did not say why other than that
101440 - Doctor Lawler speaks summarily and so does not answer medical
101441 - questions well. Robin, however, said she plans to write down
101442 - questions for the doctor to answer during the meeting, noted
101443 - previously in her letter on 120727 0912. ref SDS 19 HC6Y
101445 - ..
101446 - Robin did not explain this morning that she will obtain medical
101447 - records from Doctor Lawler's offce for review of her patient history,
101448 - and for submission to Doctors Schueckler and Fow to prepare 2nd
101449 - opinions. Previously, Robin said she would obtain medical records,
101450 - reported on 120725 1208, ref SDS 17 CM3V, essential for effective 2nd
101451 - opinon review and for case management.
101453 - ..
101454 - Robin advised during the call today that Doctor Lawler is an imporant
101455 - customer for the radiology company where she works. Robin wants to
101456 - avoid pressuring Doctor Lawler about complications causing chronic
101457 - pain following knee surgery on 120322, reported in the record on
101458 - 120718 1842, ref SDS 14 MI5I, and in order to maintain good business
101459 - relations with the Lawler account at her company.
101461 - ..
101462 - This sounds like Paula's report on Kaiser refusing to demand that UCSF
101463 - correct medical mistakes performing radiation therapy for Millie, and
101464 - in order to maintain good business relations, reported on 091112 1229.
101465 - ref SDS 4 A593
101467 - ..
101468 - Critical question for Doctor Lawler with respect to Robin's
101469 - entitlement to recover for complications from knee surgery on 120322,
101470 - causing continuing pain is obtaining Lawler's medical records to
101471 - substantiate Robin's report that the doctor disclosed Robin's knee
101472 - pain may be due to not removing enough torn cartilage during surgery
101473 - on 120322, shown in the record on 120727 0912. ref SDS 19 PS36
101475 - ..
101476 - Another objective meeting with Lawler is to obtain referral and/or
101477 - entry into the medical chart work plan referral for treatment with
101478 - prolotherapy, cited in the letter to Robin this morning, ref SDS 0
101479 - RL4W, and discussed with Robin in the call today, per above.
101480 - ref SDS 0 QQ8H
101481 -
101482 - [On 120729 1705 Robin called and indicated plans to ask
101483 - Lawler for a referral to get prolotherapy to aid recovery
101484 - from degenerative arthritis. ref SDS 21 3Y9H
101486 - ..
101487 - Robin wants assistance for the meeting with Doctor Schueckler next
101488 - Thursday on 120802 at 1545, and also reported in her letter on 120727
101489 - 0912, ref SDS 19 VH6J, and reported previously on 120726 0753,
101490 - ref SDS 18 N755, and clarifying Robin's letter on 120725 1208.
101491 - ref SDS 17 N755
101493 - ..
101494 - This begs the question that the main assistance Doctor Schueckler
101495 - needs is Robin's medical record of care performed by Doctor Lawler,
101496 - and which at this point has not been requested, and there is now not
101497 - enough time to assemble the record and submit to Doctor Schueckler
101498 - with enough time to be prepared for a productive meeting with Robin on
101499 - 120802.
101500 -
101512 -
101514 - ..
101515 - Doctors Schueckler and Lawler Doctor Patient Relationship
101516 -
101517 - Robin advised today during this call that Doctor Lawler had knee
101518 - surgery performed by Doctor Schueckler on 120323, the day after Doctor
101519 - Lawler performed the same type of arthroscopic knee surgery on Robin's
101520 - knee on 120322. Accordingly, they are professional colleagues and
101521 - possibly personal friends. This relationship conflicts with
101522 - requirements for objective review of Doctor Lawler's work in a 2nd
101523 - opinion prepared by Doctor Schueckler, answering question on 120725
101524 - 1208. ref SDS 17 BR4J
101525 -
101526 -
101527 - <1L8M
101528 - <1L8M
101529 - Pain Right Knee Subsides Never Suffered Pain Left Knee
101530 - Glucosamine Chondroitin Tried 2 Weeks Without Effect False Negative
101531 -
101532 - Robin advised this morning that when she took prescirbed dose of
101533 - Glucosamine Chondroitin for 2 weeks, after delivery following the
101534 - order from Costco on 120516 1048. ref SDS 7 E99F
101536 - ..
101537 - She stopped taking this remedy because knee pain continued, which
101538 - seemed to indicate lack of response to treatment.
101540 - ..
101541 - Robin will try Glucosamine Chondroitin again, based on current theory
101542 - that knee and leg pain may be due to sciaticia, reported in her letter
101543 - on 120727 0912, ref SDS 19 UV4J, and cited in the letter to her above.
101544 - ref SDS 0 RL4J
101546 - ..
101547 - Robin advised again this morning that pain in right knee has subsided
101548 - lately, and that she has not experienced pain in her left knee. This
101549 - aligns with her recent letter on 120727 0912. ref SDS 19 YC9V
101550 -
101551 - [On 120729 1705 Robin called again and expressed worry
101552 - about future knee disorders causing severe pain, and desire
101553 - to take proactive remedial care with prooltherapy and
101554 - Glucosamine Chondroitin with exercise to reduce
101555 - degenerative artiritis diagnosed in recent MRI tests, and
101556 - despite not suffering pain in left knee, and pain in right
101557 - knee having recently subsided. ref SDS 21 Q74Q
101559 - ..
101560 - She feels now that pain management requires remedy for both neck and
101561 - spine disorders causing pain from sciaticia, and also pain caused by
101562 - degenerative arthritis in her knees, shown by recent MRI reports,
101563 - cited in the record on 120727 0912. ref SDS 19 QY4J
101565 - ..
101566 - Glucosamine Chondroitin is a good, immediate first remedy for
101567 - degenerative arthritis and possibly spinal disorders, and followed by
101568 - inquiry into treatment with prolotherapy, discussed with Robin today,
101569 - per above. ref SDS 0 QQ8H
101570 -
101571 - [...above on 120728 0027 at 0935 Robin called and requested
101572 - assistance arranging meeting with Doctor Darrow in Los
101573 - Angeles on providing prolotherapy to help recover from
101574 - degenerative arthritis in her knees. ref SDS 0 QQ8H
101576 - ..
101577 - [...below on 120728 0027 at 1102 received letter from Robin
101578 - confirming request to schedule meeting to investigate
101579 - treatment with prolotherapy for relieving chronic pain due
101580 - to degenerative arthritis. ref SDS 0 FG6N
101581 -
101582 -
101583 -
101584 -
101586 - ..
1016 -
1017 -
1018 - 1102
1019 -
101901 - Received letter from Robin saying...
101902 -
101903 - 1. Subject: Prolotherapy
101904 - Date: Sat, 28 Jul 2012 10:27:02 -0700 (PDT)
101911 - ..
101912 - Please watch the video on the website showing prolotherapy
101913 - injections of the knee. I seriously want to see Dr Darrow,
101914 - go for a consultation with the prospect of getting these
101915 - injections. The woman in the video is approx my age and was
101916 - diagnosed with arthritis in both of her knees...
101918 - ..
101919 - Robin confirms in her letter a request during her call earlier this
101920 - morning for help arranging to meet Doctor Darrow for considering
101921 - treatment with prolotherapy to recover from degenerative arthritis,
101922 - per above. ref SDS 0 QQ8H
101924 - ..
101925 - Robin's letter on 120728 0027 at 1102 continues...
101926 -
101927 - 2. Marc Darrow, M.D - Prolotherapy
101928 -
101929 - http://www.getprolo.com/darrow_california_prolotherapy.htm
101931 - ..
101932 - Marc Darrow, M.D.
101933 - Darrow Wellness Institute
101934 - 11645 Wilshire Blvd.,Suite 120.
101935 - Los Angeles, CA 90025.
101936 - CALL: (310) 231-7000
101937 -
101938 - http://www.jointrehab.com.
101940 - ..
101941 - 3. See you Thursday :)
101942 -
101943 - *********************************
101945 - ..
101946 - Received 2 other letters which intend to transmit additional
101947 - electronic media, but which failed to actually attach or otherwise
101948 - convey anything.
101949 -
101950 -
101951 -
101952 -
101953 -
101954 -
101955 -
101956 -
101957 -
101958 -
1020 -