CONTACTS 

SUBJECTS
Yosemite Half-Dome Hike 9 Hours Reached Beginning Swishbacks to Top                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2103 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2103 -    ..
2104 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
2105 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
210501 - Follow up ref SDS 66 0000. ref SDS 60 0000. ref SDS 30 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
210502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210505 -  ..
2106 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2107 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2108 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2109 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
210901 - Letter to Doctor Rao and Doctor Tang, saying...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210902 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210903 -    1.  Subject:  Half Dome Hematoma/Contusion Injury                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
210904 -        Date:  2015-09-17 11:27                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
210912 -         ..
210913 -    2.  Yesterday, did Half Dome.  Good news - feet problems the past                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
210914 -        year or so due to dehydration and metatarsalgia were completely                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
210915 -        resolved. [...reported on 150916 0535, ref SDS 66 0001...]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
210916 -        Required no Lambs wool or other protection discussed in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
210917 -        letter to the team on 150909, shown below.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
210919 -         ..
210920 -    3.  Near Nevada Falls, had a serious fall.  Lost balance for a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
210921 -        second, and fell backwards down the mountain.  Twisted to avoid                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
210922 -        falling face first, and caught myself with both hands.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
210923 -        Probably went about 10' and came to rest against a rock, which                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
210924 -        dominants the Half Dome trail leading to Nevada Falls.  Lucky                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
210925 -        did not hit my head, or fall off a cliff. ref SDS 66 O87H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
210926 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210927 -            [...below on 150917 1028 at 2256 submitted this letter on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
210928 -            patient history of injury and symptoms, to Doctor Turner in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
210929 -            ER (Emergency Room Department) VA Medical Center San                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210930 -            Francisco, for baseline understandings to diagnose medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
210931 -            problems and provide care. ref SDS 0 PSRR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
210933 -         ..
210934 -    4.  Also lucky to have hired a guide - Lindsay - for the hike this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
210935 -        year.  She did excellent work ensuring nothing was evidently                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
210936 -        broken, before helping me to stand up.  Then tested various                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
210937 -        range of motion.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
210939 -         ..
210940 -    5.  Injured both wrists, left quadricep and lower leg.  Wrists are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
210941 -        swollen with some coloration.  Hurts to squeeze them or lift                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
210942 -        anything.  Left quad only hurts to lift the leg, so walking                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
210943 -        downhill was okay.  Going uphill was difficult.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
210945 -         ..
210946 -    6.  Initially, tried going further up the trail toward Half Dome,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
210947 -        to redeem past 12 months training.  In Little Yosemite Valley,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
210948 -        we had a few bites of lunch, then continued on.  However, every                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
210949 -        few steps there was a very severe, sharp pain across the lower                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
210950 -        left leg.  At first, since it was intermittent hoped it would                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
210951 -        go away.  Ultimately, realized that even if we made it to the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
210952 -        cables, would not be able to grip the cables to pull myself to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
210953 -        the top, so turned back.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210955 -         ..
210956 -    7.  Back at Nevada Falls, turned out there was a nurse among the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
210957 -        hikers pausing at this last station.  Jean was very helpful                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
210958 -        advising to take ibuprofen for controlling inflammation.  I had                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
210959 -        brought this along to control swelling in feet from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
210960 -        metatarsalgia, but it wasn't needed, so I took 400 mg, as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
210961 -        recommended by Jean.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
210963 -         ..
210964 -    8.  By this time the leg was further swollen.  The nurse (Jean)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
210965 -        also insisted on providing a towel and recommended going to the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
210966 -        river, wetting the towel in icy water and wrapping the leg to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
210967 -        further control inflammation.  Lyndsay was helpful with these                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
210968 -        exigent medical measures, including wrapping the towel and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
210969 -        holding it place with an ace bandage she had in her backpack.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
210971 -         ..
210972 -    9.  We then hiked 5 miles back to the Valley, and another 2 miles                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
210973 -        or so to get a sandwich at a deli in the Valley.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
210975 -         ..
210976 -   10.  Finally, got to the hotel room at Yosemite Lodge.  Kathy placed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
210977 -        ice on all of the injuries, shown in the last picture on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210978 -        150906.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
210980 -         ..
210981 -   11.  Most visible injury is to lower left leg as shown in attached                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
210982 -        pictures, possibly indicating hemotoma. Research indicates this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
210983 -        injury may need to be drained to prevent blood clots.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
210984 -        Therefore, decided to drive home today and report to medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
210985 -        team.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
210986 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210987 -            [...below on 150917 1028 at 2256 submitted this letter on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
210988 -            patient history of injury and symptoms, to Doctor Turner in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
210989 -            ER (Emergency Room Department) VA Medical Center San                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
210990 -            Francisco, for baseline understandings to diagnose medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
210991 -            problems and provide care. ref SDS 0 PSRR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
210993 -         ..
210994 -   12.  The last picture was taken an hour ago.  Shows 24 hours after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
210995 -        injury, to assess rate of change.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
210997 -         ..
210998 -   13.  Please let me know whether to get care at ER or another referral?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
211000 -         ..
211001 -   14.  Possibly no medical care is needed, just let me know.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
211003 -         ..
211004 -   15.  Thanks again to Doctor Tang for resolving all the feet                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
211005 -        problems, and to the entire VA for being timely, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
211006 -        comprehensive delivering outstanding care.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
211008 -         ..
211009 -   16.  By copy commending Lindsay for good work guiding the hike, with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
211010 -        notice to Yosemite Mountaineering School for providing a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211011 -        terrific guide, who fortunately was well prepared, calm and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
211012 -        knowledgeable for handling emergencies.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
211014 -         ..
211015 -   17.  Sincerely,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
211016 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211022 -         ..
211023 -   19.  Attachments:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
211024 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211025 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
211026 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211027 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
211029 -         ..
211030 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
211032 -         ..
211033 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
211035 -         ..
211036 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
211037 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211038 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211039 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211040 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211042 -  ..
2111 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2112 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2113 - 1139                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
2114 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
211401 - Called Doctor Rao...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
211402 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211403 -                                415 206 6381                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
211405 -  ..
211406 - Left message advising Doctor Rao about letter, per above.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
211407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211409 -  ..
2115 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2116 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2117 - 1142                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
2118 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
211801 - Called for Doctor Rao at VAMCSF, Medical Practice...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
211802 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211803 -                               415-750-2129                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
211805 -  ..
211806 - On hold.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
211807 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
211809 -  ..
2119 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2120 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2121 - 1151                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
2122 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
212201 - Talked to Maria.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
212202 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
212203 - She saw Doctor Rao yesterday.  Maria checked and reported that the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
212204 - doctor is offsite today, and not scheduled to return until next                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
212205 - Monday.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
212207 -  ..
212208 - Maria will page Doctor Rao and notify that a letter was sent to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
212209 - Doctor Rao reporting a fall hiking Half Dome yesterday.  Letter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
212210 - explains scope of injuries with photographs, and asks if the doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
212211 - recomends getting treatment at ER or to another referral.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
212212 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
212214 -  ..
2123 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2124 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2125 - 2049                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
2126 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
212601 - Doctor Rao called.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
212602 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
212603 - She read the letter submitted earlier today at 1127, per above.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
212604 - ref SDS 0 JN3J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
212606 -  ..
212607 - The doctor is concerned about the very large hematoma on the left leg,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
212608 - evident from the bulge in the photographs attached to the letter,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
212609 - e.g....                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
212610 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
212611 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
212613 -  ..
212614 - She will call the doctor on call this evening in the ER, and request                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
212615 - immediate examination.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
212616 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
212617 -            [...below on 150917 1028 at 2256 Doctor Turner in ER VAMCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
212618 -            was familiar with this case, based on receiving call from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
212619 -            Doctor Rao. ref SDS 0 PSRR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
212621 -             ..
212622 -            [On 150920 1917, letter commends Doctor Rao collaborating                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
212623 -            with Doctor Turner to expedite recovery from major hematoma                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
212624 -            injury caused by fall hiking Half Dome. ref SDS 67 JN3J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
212625 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
212626 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
212628 -  ..
2127 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2128 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2129 - 2105                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
2130 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
213001 - Drove to ER at VAMCSF.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
213002 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
213004 -  ..
2131 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2132 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2133 - 2210                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
2134 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
213401 - Arrived ER at VAMCSF and checked in.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
213402 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
213404 -  ..
2135 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2136 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2137 - 2256                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
2138 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
213801 - Meeting with Jesse Turner, MD.  He was familiar with the case, citing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
213802 - call from Doctor Rao earlier today, planned in the call with Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
213803 - Rao today at 2049. ref SDS 0 TP3H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
213804 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
213805 -            [On 150920 1917, letter commends Doctor Rao collaborating                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
213806 -            with Doctor Turner to expedite recovery from major hematoma                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
213807 -            injury caused by fall hiking Half Dome. ref SDS 67 JN3J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
213809 -  ..
213810 - Doctor Turner initially read the record of injury and rising symptoms                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
213811 - from fall suffered climbing Half Dome trail yesterday on 150916 0535.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
213812 - ref SDS 66 O87H, and as set out in the letter to Doctor Rao earlier                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
213813 - today, shown above. ref SDS 0 JN3J  This letter was provided to Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
213814 - Turner by handing him the Samsung S5 cell phone, with the letter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
213815 - already displayed on the screen.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
213817 -  ..
213818 - The doctor examined all wounds, including both wrists, presented in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
213819 - the letter to Doctor Rao, per above, ref SDS 0 JV59, citing injury                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
213820 - during hike to Half Dome on 150916 0535. ref SDS 66 O89O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
213822 -  ..
213823 - He used clincial tactical methods touching the bottom of the left foot                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
213824 - to determine no nerve damage has occurred so far.  The doctor observed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
213825 - range of motion moving the foot and toes is normal.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
213827 -  ..
213828 - The doctor performed similar clinical examination on both hands to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
213829 - evaluate painful wrists.  Doctor Turner advised there is no evidence                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
213830 - of nerve damage in the left foot nor either hand.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
213831 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
213832 -            [On 151005 0852 left and right wrists improve, but after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
213833 -            discharge from hospital on 150925, following debridement                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
213834 -            surgery on 150923, to recover from hematoma lower left leg,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
213835 -            right wrist pain symptoms increase; examination in ER at VA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
213836 -            Medical Center in San Francisco, ref SDS 69 0QTP; CT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
213837 -            radiology study found small fracture in right wrist.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
213838 -            ref SDS 69 PR8Y                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
213840 -  ..
213841 - Doctor Turner related having previously suffered injury similar to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
213842 - large hematoma on lower left leg seen during examination today.  He                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
213843 - feels his personal experience shows continued exercise with hiking is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
213844 - the best treatment to ensure full and fast recovery by maintaining                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
213845 - blood flow to the injury.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
213846 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
213847 -            [On 150923 0847 letter to Doctor Rao, Primary Care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
213848 -            Physician, reports moderate hiking prescribed by Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
213849 -            Turner. ref SDS 68 XR69                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
213851 -  ..
213852 - Asked about draining the wound to prevent blood clots, cited as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
213853 - standard of care by some authorities.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
213855 -  ..
213856 - Doctor Turner seemed to say the wound does not look serious enough to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
213857 - require draining, and that maintaining blood flow with hiking will                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
213858 - prevent risks of blood clots breaking off and causing cardiovascular                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
213859 - maladies.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
213861 -  ..
213862 - Doctor Turner related that in his case, there was some residual hard                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
213863 - tissue that took a year to go away.  It was not clear during the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
213864 - meeting whether this was the entire swelled area of the bruise, or a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
213865 - smaller part.  He called this hard tissue a "knot."                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
213867 -  ..
213868 - Reviewed patient history hiking 11 miles per day.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
213870 -  ..
213871 - Discussed at length benefits of daily hiking to recover from injuries                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
213872 - reported in the letter earlier today, per above, ref SDS 0 JV5S, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
213873 - which Doctor Turner read during the meeting, also above. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
213874 - PSRR Doctor Turner assured that continuing patient history of hiking                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
213875 - is the best course of care at this time.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
213877 -  ..
213878 - Doctor Turner prescribed ibuprofen as needed to control pain.  He was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
213879 - pleased that by the time of the examination this evening, pain has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
213880 - subsided substantially.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
213882 -  ..
213883 - Forgot to ask how recovery will progress, and what changes in patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
213884 - status should be further reviewed by the medical team.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
213885 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
213886 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
213887 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
213888 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
213889 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
213891 -  ..
2139 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2140 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2141 - 2318                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
2142 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
214201 - Drove home from VA Medical Center.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
214202 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
214204 -  ..
2143 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2144 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2145 - 0013                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
2146 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
214601 - Arrived home.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
214602 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
214603 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
214604 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
214605 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
214606 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
214607 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
214608 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
214609 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2147 -