CONTACTS
SUBJECTS
Yosemite Half-Dome Hike 9 Hours Reached Beginning Swishbacks to Top
2103 -
2103 - ..
2104 - Summary/Objective
2105 -
210501 - Follow up ref SDS 13 0000. ref SDS 11 0000.
210502 -
210503 -
210504 -
210505 -
210506 -
210508 - ..
2106 -
2107 -
2108 - Progress
2109 -
210901 - Met with Doctor Brian Lau in Orthopedics following up prior meeting
210902 - with Kevin Lau last month on 151104 1315. ref SDS 13 JN3J
210904 - ..
210905 - Right wrist has improved significantly. Pain pressing the right wrist
210906 - that occurred on 151005, has completely resolved. Now the only pain
210907 - is on the right side of the wrist and only when the wrist is twisted
210908 - counter clockwise. This pain only occurs when wrist is twisted to 90
210909 - degrees and pain level is about 2 - 3. Previously pain level 6
210910 - occurred twising the wrist counter clockwise to only 45 degrees.
210912 - ..
210913 - Another major improvement is drivig. Previoulsy, when grasping the
210914 - streering wheel near the top with the right hand, holding for over 30
210915 - seconds, and then letting go, there was severe pain level 7. Now
210916 - there is pain level 0 - 2.
210918 - ..
210919 - Doctor Lau was pleased with this record of recovery.
210921 - ..
210922 - Doctor Lau showed the radiology CT study done earlier this morning on
210923 - 151216 1130. ref SDS 14 XH9M
210925 - ..
210926 - He pointed to the location where a fracture occurred in the right
210927 - wrist across the radius wrist bone and near the end, and noted today
210928 - the xray shows this fracture has fully healed.
210930 - ..
210931 - Doctor Lau then showed the xray studies on the knees. He cited the
210932 - radiology report saying under "Impression...
210933 -
210934 - 4 weightbearing views of both knees show findings of
210935 - diffuse osteopenia and degenerative joint disease.
210937 - ..
210938 - The left knee shows moderate medial compartmental and
210939 - medial patellofemoral joint space narrowing and moderate
210940 - tricompartmental marginal osteophytes. ref SDS 14 C540
210942 - ..
210943 - Doctor Lau said that he feels the xray study shows that both knees
210944 - look basically normal with no evident trauma.
210946 - ..
210947 - He showed on the computer screen the cartilage gap across the knee
210948 - joint of both knees appears similar and normal.
210950 - ..
210951 - This seems like a miracle...
210952 -
210953 - [...below on 151216 1315 Doctor Lau's Progress Notes say
210954 - "Left knee: mild degenerative changes". ref SDS 0 U658
210955 -
210956 - [On 151223 1013 went to Kaiser - requested xray study
210957 - performed on 990910 that showed severe degenrative
210958 - arthritis. ref SDS 15 XJ6L
210960 - ..
210961 - [On 160105 1114 ROI request Progress Notes Orthopedics
210962 - meetings at Kaiser on 990910, and on 000124, to assess
210963 - improvement in condition of left knee degenerative
210964 - arthritis over past 16 years. ref SDS 17 OD6X
210966 - ..
210967 - We reviewed patient history...
210968 -
210969 - On 881010 xray showed cartilage gap across the left knee was
210970 - normal on the outside and narrow with bone to bone contact on
210971 - inside. ref SDS 1 6295
210973 - ..
210974 - On 990910 xray at Kaiser Orthopedics Department shows moderate
210975 - narrowing between upper and lower leg at knee joint has
210976 - worsened. ref SDS 2 SY78
210978 - ..
210979 - On 000124 Doctor Vincent Yamamoto in Orthopedics Department at
210980 - Kaiser in Walnut Creek diagnosed left knee degenerative
210981 - arthritis will continue to worsen, and require knee replacement
210982 - in 5 years. ref SDS 3 HU5O
210984 - ..
210985 - Doctor Lau seemed to say results of xray study today, reported in
210986 - another record, ref SDS 14 BO5O, shows left knee cartelage appears
210987 - normal with mild narrowing on the inside. The doctor indicated there
210988 - is no reason to believe knee replacement will ever be needed in this
210989 - case. This represents significant recovery from degenerative
210990 - arthritis diagnosed 15 years ago at Kaiser.
210991 -
210992 - [...below on 151216 1315 Doctor Lau Progress Notes report -
210993 - Bilateral knees: reassured patient that clinically and
210994 - radiographically no signficant disease that would require
210995 - any intervention particularly because he is not
210996 - symptomatic. ref SDS 0 U669
210998 - ..
210999 - [On 151223 1013 went to Kaiser - requested xray study
211000 - performed on 990910 that showed severe degenrative
211001 - arthritis. ref SDS 15 XJ6L
211003 - ..
211004 - [On 151229 1239 met with Erica, Director of Imaging
211005 - Services for Diablo service Area, ref SDS 16 LK45; she
211006 - submitted copy of xray study on the left knee, performed on
211007 - 990910, at the Kaiser Radiology Department in Walnut Creek;
211008 - the report said simply "There is moderate narrowing of the
211009 - knee joint space on the left both medial and laterially.
211010 - Spurring of the articular surfaces is seen. Patellofemoral
211011 - joint space also shows narrowing." ref SDS 16 03A4
211013 - ..
211014 - [On 160105 1114 ROI request Progress Notes Orthopedics
211015 - meetings at Kaiser on 990910, and on 000124, to assess
211016 - improvement in condition of left knee degenerative
211017 - arthritis over past 16 years. ref SDS 17 OD6X
211019 - ..
211020 - Doctor Lau asked about remedies applied since prior xray studies in
211021 - October 1988, and September 1999?
211023 - ..
211024 - Reported using liquid Glucosamine Chondroitin since 2003, and hiking
211025 - about 3 miles per day 4 - 5 days per week = 100 miles per month. Over
211026 - the last 4 years increased hiking to 11 miles per day, 7 days per
211027 - week, sometimes 300+ miles per month, while continuing liquid
211028 - Glucosamine Chondroitin.
211029 -
211030 -
211031 -
211032 -
2111 -
SUBJECTS
Default Null Subject Account for Blank Record
2203 -
220401 - ..
220402 - Medical Chart Progress Notes for Orthopedics Meeting 151216
220403 - Progress Notes Orthopedics Meeting 151216 Doctor Lau
220404 - Doctor Lau Progress Notes Orthopedics Meeting 151216
220405 -
220406 - Progress Notes are one entry of several files stored on CD received
220407 - from VA on 151218, and includes Orthopedics meeting on 151216
220408 - 0115; Doctor Lau entered his Progress Notes at 1412...
220409 -
220410 - F:\05\00003\SM\CC\AGMJ\20151216-141236\w0144_welch_12 15 15.pdf
220412 - ..
220413 - LOCAL TITLE: ORTHO CLINIC (SURG)
220414 - STANDARD TITLE: ORTHOPEDIC SURGERY OUTPATIENT NOTE
220415 - DATE OF NOTE: DEC 16, 2015@14:12 ENTRY DATE: DEC 16, 2015@14:12:36
220416 - AUTHOR: LAU,BRIAN EXP COSIGNER:
220417 - URGENCY: STATUS: COMPLETED
220419 - ..
220420 - I have discussed the patient with my Attending Physician,
220421 - Dr Alan Dang, who agrees with my assessment and plan.
220423 - ..
220424 - Clinical Reminder Activity
220425 - MED REC NON PRIMARY CARE:
220426 - Current medications reviewed with patient/caregiver and reconciliation
220427 - of medications related to today's visit completed, including non-VA
220428 - medications and discrepancies, if identified, were addressed.
220429 - Medication changes and the importance of medication management were
220430 - reviewed with the patient/caregiver today based on individual needs.
220431 - Patient/caregiver acknowledged understanding of instructions as
220432 - stated. An updated list of reconciled medications has been provided
220433 - to the patient/caregiver.
220435 - ..
220436 - ID/CC: 70 with right distal radius fracture after fall 9/16/2015 and
220437 - history of bilateral knee pain
220439 - ..
220440 - HPI: 70yo RHD man p/w R wrist pain following fall on 9/16. He reports
220441 - that his wrist pain is much improved and does not really feel any
220442 - restrictions. He does not require medications.
220444 - ..
220445 - In regards to his right knee, he reports a history MCL tear in 2/2015
220446 - and wanted to know if anything needed to be done. He does not feel
220447 - any instability. No catching or locking.
220449 - ..
220450 - For his left knee, he wanted to know if there was any significant
220451 - arthritis in knee. Pain is very managable and does not limit his
220452 - daily activities.
220454 - ..
220455 - Physical Exam:
220457 - ..
220458 - General: NAD
220460 - ..
220461 - RUE
220462 - No visible deformity
220463 - Full wrist ROM 40/40 flex/extension 45/45 sup/pro and equal to
220464 - contralateral side, +AIN/PIN/U/M, + m/r/u sensation
220466 - ..
220467 - Bilateral knees: ROM 0-130
220468 - stable to varus and valgus stress and stable lachman, no joint line
220469 - tenderness R knee with medial scar- well healed from prior CABG
220471 - ..
220472 - L knee with lateral scar- well healed from prior "cartilage surgery"
220474 - ..
220475 - Imaging/Diagnostic Studies
220476 - Plain films 12/16/2015: demonstrate interval healing of minimally displaced
220477 - extra-articular distal radius fracture
220479 - ..
220480 - Right knee: minimal degenerative changes, evidence of
220481 - pellgrini-steidi lesion c/w prior MCL injury
220483 - ..
220484 - Left knee: mild degenerative changes
220486 - ..
220487 - Aligns with understandings from meeting today, per above. ref SDS 0
220488 - DR3L
220489 -
220490 - [On 151223 1013 went to Kaiser - requested xray study
220491 - performed on 990910 that showed severe degenrative
220492 - arthritis. ref SDS 15 XJ6L
220494 - ..
220495 - A/P
220496 - 70M w/ right minimally displaced DRF that is clinically and
220497 - radiographically healed; prior R knee MCL injury and L knee "cartilage
220498 - surgery" performed at Kaiser. Currently, no significant pain in any
220499 - of the joints and no restrictions in his daily activities.
220500 -
220501 - - R wrist, no restrictions
220503 - ..
220504 - - Bilateral knees: reassured patient that clinically and
220505 - radiographically no signficant disease that would require any
220506 - intervention particularly because he is not symptomatic.
220508 - ..
220509 - Doctor Lau references xray study performed earlier today, reported in
220510 - another record on 151216 1130, ref SDS 14 BO5O; and, discussed during
220511 - the meeting, per above. ref SDS 0 F44H
220512 -
220513 - [On 151223 1013 went to Kaiser - requested xray study
220514 - performed on 990910 that showed severe degenrative
220515 - arthritis. ref SDS 15 XJ6L
220517 - ..
220518 - [On 151229 1239 met with Erica, Director of Imaging
220519 - Services for Diablo service Area, ref SDS 16 LK45; she
220520 - submitted copy of xray study on the left knee, performed on
220521 - 990910, at the Kaiser Radiology Department in Walnut Creek;
220522 - the report said simply "There is moderate narrowing of the
220523 - knee joint space on the left both medial and laterially.
220524 - Spurring of the articular surfaces is seen. Patellofemoral
220525 - joint space also shows narrowing." ref SDS 16 03A4
220527 - ..
220528 - [On 160105 1114 ROI request Progress Notes Orthopedics
220529 - meetings at Kaiser on 990910, and on 000124, to assess
220530 - improvement in condition of left knee degenerative
220531 - arthritis over past 16 years. ref SDS 17 OD6X
220532 -
220533 - - He has no restrictions and will follow up as needed
220534 -
220535 - /es/ BRIAN LAU
220536 - PGY3, Orthopaedic Surgery
220537 - Signed: 12/16/2015 14:23
220539 - ..
220540 - Receipt Acknowledged By:
220541 - 12/17/2015 10:14 /es/ ALAN B.C. DANG, MD
220542 - Orthopaedic Surgery Attending
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