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: June 29, 2014 07:21 PM Sunday; Rod Welch

VA letter request referral Podiatry review metatarsalgia problem.

1...Summary/Objective


..............
Click here to comment!

CONTACTS 

SUBJECTS
CBC Lab WBC VA No Results                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2003 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2003 -    ..
2004 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
2005 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
200501 - Follow up ref SDS 72 0000. ref SDS 69 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
200502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200507 -  ..
2006 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2007 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2008 - Background                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2009 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
200901 - On 131016 1632 submit letter for agenda meeting to review lab results                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200902 - scheduled 131017 1000. ref SDS 37 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
200904 -  ..
200905 - On 140131 0815 ordered another lab - cbc, electrolytes, lipid with NMR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
200906 - - from Labcor to get LDL-P. ref SDS 50 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200908 -  ..
200909 - On 140201 1159 had full lab with NMR lipid panel drawn at John Muir                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
200910 - Hospital on Treat, and by Labcorp. ref SDS 51 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
200912 -  ..
200913 - On 140203 1147 had partial lab drawn at VA in Martinez. ref SDS 52                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
200914 - KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200916 -  ..
200917 - On 140507 0857 ordered another full lab from Labcorp with NMR lipid                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
200918 - panel. ref SDS 58 OO5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
200920 -  ..
200921 - On 140508 1133 lab blood daw at Labcorp with John Muir Medical Center                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200922 - on Treat Blvd in Concord. ref SDS 59 445G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200924 -  ..
200925 - On 140514 0950 VA partial lab at Medical Center in San Francisco.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200926 - ref SDS 61 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200928 -  ..
200929 - On 140518 0920 letter to VA submits consolidated blood tests from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200930 - Labcorp on 140508 and the VA on 140514, to prepare for the meeting on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200931 - 140519. ref SDS 63 1V6M  Advise that VA has not ordered follow up lab                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
200932 - to check Electrolytes (Chem Profile) requested by Doctor Egan to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
200933 - assess previously elevated potassium (K) 5.6, that cause electrical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
200934 - problems for the heart. ref SDS 63 DV4M  Medication side effects of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
200935 - dizziness have subsided. ref SDS 63 DV50  Dry mouth and urination have                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
200936 - increased. ref SDS 63 DV56  Peripheral neuropathy related to elevated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
200937 - bilirubin has recurred. ref SDS 63 DV59                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
200939 -  ..
200940 - On 140518 0920 at 2244 received letter from Doctor Alba notifying not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200941 - to get blood draw at lab prior to meeting with medical team tomorrow                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200942 - morning. ref SDS 63 RW7O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
200944 -  ..
200945 - On 140520 0732 background and planning for getting supplemental labs                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200946 - on electrolyte (Chem Profile), and EPC. ref SDS 65 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
200948 -  ..
200949 - On 140520 0732 at 0743 letter requests VA order electrolyte (Chem                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200950 - Profile) lab order today. ref SDS 65 YW4H, and include lab for EPC.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
200951 - ref SDS 65 4U46  Doctor Sandhu notified that medical team in San                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
200952 - Francisco discusses increased urination indicates possible prostate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
200953 - issues. ref SDS 65 4U95  During meeting on 140519, decided that mild                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
200954 - symptoms peripheral neuropathy possibly due to statin treatment does                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200955 - not justify ending statin tratement, because treatments have been                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200956 - effective managing lipids. ref SDS 65 4U4F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
200958 -  ..
200959 - On 140520 0732 at 0812 letter from VA advises Doctor Alba will order                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200960 - Chem Profile lab when she arrives at the hospital. ref SDS 65 4V5H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
200962 -  ..
200963 - On 140520 0732 at 1017 VA partial lab at Medical Center in San                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
200964 - Franciso for electrolyte (Chem) panel that was omitted on lab 140514.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200965 - ref SDS 65 KK9M  Glucose, sodium, potassium declined, with potassium                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
200966 - (K 5.2) still at high end of range for Labcorp and slightly above VA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200967 - range, ref SDS 65 ZG5O; bilirubin declined dramatically. ref SDS 65                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200968 - 015M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200970 -  ..
200971 - On 140520 0732 at 1028 VA letter Doctor Alba requests clarification of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
200972 - scope for EPC lab. ref SDS 65 654J  Called to explain scope of EPC                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
200973 - lab, but encountered poor connection using cell phone. ref SDS 65 U63N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
200975 -  ..
200976 - On 140520 0732 at 1609 VA letter - Doctor Alba ordered EPC lab, she                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
200977 - advises EPC lab requires approval by lab staff of doctor's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
200978 - justification. ref SDS 65 AF5L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200980 -  ..
200981 - On 140520 0732 at 1617 letter to VA submits justification for doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200982 - to submit with order for EPC lab that saves lives, time, and money.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
200983 - ref SDS 65 JP8O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200985 -  ..
200986 - On 140522 1052 letter to Doctor Egan at Martinez submits results of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
200987 - labs on Electrolyte Chem Profile showing Potassium, which Doctor Egan                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200988 - requested. ref SDS 66 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
200990 -  ..
200991 - On 140529 0942 letter to Doctor Alba at VA Medical Center in San                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
200992 - Francisco adise placed order with Release of Information Department to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
200993 - submit Progress Notes for meeting on 140519, so no need for Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
200994 - Alba so submit. ref SDS 67 X45G  Recommend correcting errors in prior                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
200995 - notes so they are carried forward in Progress Notes for meeting on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
200996 - 140519. ref SDS 67 QF6T  Recommend Progress Notes cite patient support                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
200997 - to improve lipid labs past 6 months, ref SDS 67 QF67, referencing the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
200998 - lab report on 140514 0950, ref SDS 61 W25L, which also presents                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200999 - extended exercise, weight loss, and diet changes. ref SDS 61 I17G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
201000 - Asked about progress getting approval for EPC lab. ref SDS 67 QG3U                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
201001 - Request VA order coronary CT angiography with calcium score to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
201002 - evaluate regression of athersclerosis, as a result of good labs from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201003 - medication and extended exercise the past 6 months. ref SDS 67 QG38                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
201005 -  ..
201006 - On 140610 0930 letter asks again about publishing Progress Notes for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201007 - meeting at the VA on 140519. ref SDS 68 X45G  Reminds to order EPC and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
201008 - coronary CTA tests. ref SDS 68 LJ61  Customer offers to order EPC and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
201009 - coronayr CTA tests in order to save time for the VA. ref SDS 68 LJ6L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
201010 - Report peripheral neuropathy and urination symptoms have again                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
201011 - subsided. ref SDS 68 LJ6Y                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201013 -  ..
201014 - On 140610 0930 at 1115 letter from Doctor Alba advising that Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
201015 - Notes for meeting on 140519, were completed last week. ref SDS 68 W84I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
201017 -  ..
201018 - On 140610 0930 at 1114 letter asks Doctor Alba about progress ordering                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
201019 - EPC lab and coronary CTA with calcium score, ref SDS 68 KH3O, repeating                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
201020 - request in the letter earlier this morning, ref SDS 68 LJ61, but not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
201021 - discussed in Doctor Alba's letter received at 1115. ref SDS 68 W84I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
201023 -  ..
201024 - On 140612 1048 VA letter notifies refuse order coronary CTA to test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
201025 - for level of atherosclerosis because history of CABG surgery on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201026 - 091022, shows coronary artery disease, which VA relies upon to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
201027 - speculate plaques remain in arteries, therefore, CT angiography, is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
201028 - not going to add any value to your current diagnoses or treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
201029 - ref SDS 70 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
201031 -  ..
201032 - On 140626 1652 letter notify VA commend Doctor Alba correcting errors                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
201033 - in Progress Notes in prior meeting so they are not replicated in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
201034 - Progress Notes for meeting on 140519. ref SDS 72 X45G  Commend VA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
201035 - timely prescription refill on Ezetibime and Atorvastatin. ref SDS 72                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
201036 - MY9Y  Offer to defer lab on EPC to assess prospects for regression of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
201037 - atherosclerosis, since EPC should be favorable based on increased                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
201038 - exercise that has increased WBC 50%. ref SDS 72 MY45  Review VA refusal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
201039 - to order coronary CTA aligns with prior experience at Kaiser ordering                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
201040 - CT testing to evaluate pulmonary embolism. ref SDS 72 MY51  VA grounds                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
201041 - for refusing CTA testing that results will not aid care for patients                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201042 - with CABG surgery, conflicts with the record showing CTA is commonly                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201043 - performed to assess recovery from atherosclerosis who have undergone                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201044 - CABG surgery. ref SDS 72 MZ33  Request recommendations for 2nd opinions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
201045 - on CTA testing. ref SDS 72 MZ82                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
201047 -  ..
201048 - On 140629 1921 report side effects of prescribed care metatasalgia                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
201049 - causing sore feet. ref SDS 0 UZ64  Efforts to resolve without medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
201050 - care have not been effective. ref SDS 0 U13R  Request referral to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
201051 - Podiatry for consultation. ref SDS 0 U14H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
201052 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201053 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201055 -  ..
2011 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2012 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2013 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2014 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
201401 - Letter to Doctor Alba at VA saying...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
201402 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201403 -    1.  Subject:  Podiatry Referral Resolve Metatarsalgia                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
201404 -        Date:  2014-06-29 19:44                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
201412 -         ..
201413 -    2.  Kathy mentioned that July 1, interns complete their residency                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201414 -        and cycle to permanent assignments.  Just want to say thanks                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
201415 -        again for good work on my case, and wish you the best in your                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201416 -        career going forward.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
201418 -         ..
201419 -    3.  As discussed in the meeting on 140519, good labs and vitals                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
201420 -        achieved the past 6 months have come at a price of side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
201421 -        effects, including very sore feet hiking 11 miles per day -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
201422 -        70-90+ miles per week.  This past week could only do 10 miles,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
201423 -        shown in case study on 120101 (see line 106801. ref SDS 17 ZW4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
201425 -         ..
201426 -    4.  The study below on "Monthly Mileage" shows progressive                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
201427 -        Metatarsalgia, since April. ref SDS 17 PS3F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
201429 -         ..
201430 -    5.  Have tried for 6 months or so to resolve metatarsalgia by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
201431 -        purchasing special shoes, and further commissioning resoling to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
201432 -        increase cushioning, cited in a letter to Resole America last                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201433 -        week on 140626. ref SDS 71 IE4H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
201435 -         ..
201436 -    6.  This has not been effective trying several different designs                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
201437 -        for custom soles.  Research today indicates a podiatry solution                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
201438 -        may be required using orthotics, explained on 140627.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
201439 -        ref SDS 73 Q73I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
201441 -         ..
201442 -    7.  Wondering if the VA Podiatry Department can support integrated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
201443 -        care to resolve metatarsalgia so that good results resolving                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
201444 -        atherosclerosis based on cholesterol labs the past 6 months can                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
201445 -        continue, shown in the record of lipid history on 140514 0950.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
201446 -        ref SDS 61 W25L as noted in your Progress Notes on 140519.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
201447 -        140519 0800, ref SDS 64 OV90  The Progress Notes report                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201448 -        "vigorous exercise hiking..." ref SDS 64 OU5Q  During the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
201449 -        meeting we discussed ideas to reduce painful side effects,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
201450 -        based on prospective findings from coronary CTA showing less                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
201451 -        effort is justified, discussed again in the letter on 140520                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
201452 -        0732. ref SDS 65 VQ51                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
201454 -         ..
201455 -    8.  Accordingly, would appreciate consideration of referral to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
201456 -        Podiatry for evaluation of orthotics that enable current line                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201457 -        of care to continue.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
201459 -  ..
201460 - Progress Notes prescribe continue exercise on 140213 0830. ref SDS 55                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
201461 - E34O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201462 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201463 -            [On 140703 1938 VA Medical Center in San Francisco                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
201464 -            recommends notifying Primary Care at VA Clinic in Martinez                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
201465 -            for referral on Podiatry consultation. ref SDS 74 H240                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
201467 -             ..
201468 -            [On 140703 1938 at 2023 letter notifies VA have not been                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
201469 -            able to hike since 140624, due to metatarsalgia side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201470 -            effects.  Present record attempting to resolve medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
201471 -            maladies that prevent prescribed care in Progress Notes on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
201472 -            140213, ref SDS 55 E34O; plan to request Primary Care make                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
201473 -            referral to Podiatry during meeting next month. ref SDS 74                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
201474 -            6X57                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201476 -  ..
201477 - Letter to VA continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
201478 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201479 -    9.  As well, if you have already moved on, and can no longer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201480 -        influence this case, I am delighted to say again it was a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
201481 -        pleasure working with you.  Doubtless your new patients will be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
201482 -        very fortunate to have your excellent care.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
201484 -         ..
201485 -   10.  Good luck and best regards,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
201486 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201490 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201491 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201492 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201493 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201494 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201495 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201496 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201497 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201498 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201499 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201500 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201501 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2016 -