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
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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 -
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