CONTACTS
SUBJECTS
Knee Injury ER Examination Xray Favorable Right Recurrance Hiking Se
2203 -
2203 - ..
2204 - Summary/Objective
2205 -
220501 - Follow up ref SDS 29 0000. ref SDS 28 0000.
220502 -
220503 -
220504 -
220505 - [On 160101 0700 reporting hiking on 170125, 48 hours after
220506 - 1st treatment; seemed to prevent pain right knee on 6 mile
220507 - hike; hours after hike right knee swelled and stiff.
220508 - ref SDS 11 z17O
220509 -
220510 -
220511 -
220513 - ..
2206 -
2207 -
2208 - Background
2209 -
220901 - Right knee history of injuries listed in the record on 160720 0505.
220902 - ref SDS 20 HV5G
220904 - ..
220905 - On 160504 0800 MRI on right knee. ref SDS 13 DE5L
220907 - ..
220908 - On 160720, meeting Orthopedics considered anthroscopic surgery to
220909 - remove debris in the knee causing pain while hiking. Doctor concerned
220910 - extended endurance training has worn away meniscus to a point that
220911 - anthroscopic surgery will remove so much material there will not be
220912 - enough to provide any cushion. In that case, the better alternative
220913 - will be knee replacement. ref SDS 21 VQ51
220915 - ..
220916 - On 160805 MRI found severe injuries to both right knee, ref SDS 24
220917 - DQ5J, and to the left knee. ref SDS 24 PSWR However, only right knee
220918 - suffers pain during hiking, event though left knee suffered much more
220919 - severe injury, and required surgery to remove cartelage.
220921 - ..
220922 - On 160810 1512 examination in Orthopedics review MRI on 160805,
220923 - compared with MRI on right knee performed on 160504. Clinical tests
220924 - found range of motion normal, and pain level 0 moving in all
220925 - directions. ref SDS 25 K05I This finding was helpful for increasing
220926 - training to hike Half Dome in Yosemite, scheduled on 160914.
220927 - ref SDS 25 MS4H The doctor consulted attending physician. She
220928 - indicated current regimen hiking 11 - 15 miles per day along with
220929 - icing before and after, is stimulating faster than normal recovery,
220930 - while taking Glucosamine Chondroitin, and Naproxen 400 mg to control
220931 - inflammation. ref SDS 25 YT9O As a result, at that time on 160805,
220932 - there was no need to implement prior planning for arthroscopic surgery
220933 - to remove torn meniscus, nor repair other injuries to the knee,
220934 - discussed with Doctor Trevor Grace on 160720 1550. ref SDS 21 VQ4M
220935 - The doctor said to notify the Orthopedic Department of any further
220936 - injuries or worsening symptoms to evaluate for medical measures.
220937 - ref SDS 25 J35N
220939 - ..
220940 - Following meeting on 160810, and beginning on 160814, increased
220941 - training for Half Dome. Hiked 208 miles, reported in case study
220942 - spreadsheet...
220943 -
220944 - F:\05\00003\SM\CC\BNKG\120216cc\130101cc\hiking_miles_3.xlsx
220945 -
220946 - ...which is cited in case study on exercise, diet, medication and
220947 - vitals, shown on 160101 0700. ref SDS 10 4X7F
220949 - ..
220950 - On 160914, hiked to top of Half Dome, 22 miles up and back. 160914
220951 - 0530, ref SDS 26 0001; suffered no evident right knee nor other
220952 - symptoms after nor following this hike.
220954 - ..
220955 - After Half Dome, continued extended endurance exercise, but with
220956 - gradual increase in right knee symptoms, e.g., reported in case study
220957 - on dates...
220958 -
220959 - Right Knee
220960 - Date Miles Naproxen Pain
220961 -
220962 - 160922.....11....400 mg....no..... 160101 0700, ref SDS 10 SWPS
220963 - 160923.....11....400 mg....no..... 160101 0700, ref SDS 10 G48N
220964 - 160924.....13....400 mg....no..... 160101 0700, ref SDS 10 8Q4I
220965 - 160925.....15....400 mg....no..... 160101 0700, ref SDS 10 ZI9O
220966 - 160926.....10....400 mg....no..... 160101 0700, ref SDS 10 JX5J
220967 - 160927.....11....400 mg....no..... 160101 0700, ref SDS 10 EE4F
220968 - 160928.....15....400 mg....no..... 160101 0700, ref SDS 10 6L6G
220969 - 160929.....15....400 mg....no..... 160101 0700, ref SDS 10 O55G
220970 - 160930.....15....400 mg....no..... 160101 0700, ref SDS 10 PC6G
220971 - 161001.....14....400 mg....no..... 160101 0700, ref SDS 10 3N5F
220972 - 161002.....15....400 mg....no..... 160101 0700, ref SDS 10 TX6G
220973 - 161003.....14....400 mg....no..... 160101 0700, ref SDS 10 ZR5G
220974 -
220976 - ..
220977 - On 161212 1632 meeting with Doctor Alexis Dang reviewed MRI scan image
220978 - showing fracture across top of tibia and fibula chondril, with bone
220979 - marrow edema, ref SDS 28 KW6J At that time on 161212, the doctor
220980 - ordered treatment with synvisc. ref SDS 28 W579
220982 - ..
220983 - On 161221 0814 visited Betty in Orthopedics on 2nd floor building 203.
220984 - She referred to Joe next door. Joe scheduled 1st of 3 weekly
220985 - injection treatments with Synvisc to be performed in Module #2 with
220986 - synvisc is on 170123 1530, and advised patient must first go to
220987 - Pharmacy on ground floor and get prescription for synvisc. Bring this
220988 - to the meeting for use in performing injection. ref SDS 29 JJ9G
220989 -
220990 -
220991 -
220992 -
220994 - ..
2210 -
2211 -
2212 - Progress
2213 -
221301 - Arrived at VA about 1310. Checked in with Megan at Module #2 for
221302 - Orthopedic treatment with Synvisc at 1530. Gave Megan cellphone
221303 - number. She will tell the Orthopedics provider to call if treatment
221304 - can be given earlier than scheduled for 1530 today.
221306 - ..
221307 - At about 1315 visited Module #1 clinic, and scheduled meeting with
221308 - Doctor Simpson in Cardiology for 170412 1000.
221310 - ..
221311 - At about 1320 visited Doctor Hewitson in Podiatry and Biomechanics for
221312 - adjusting orthotic inserts, treating metatarsalgia.
221314 - ..
221315 - About 1420 went to Cafeteria for lunch.
221317 - ..
221318 - About 1500, noticed there was a call on the cellphone that came in
221319 - about 1410. It was from Eugeni Franco, saying to pick up Synvisc
221320 - treatment at the Pharmacy and that she could perform injections at
221321 - 1420.
221323 - ..
221324 - Went to Pharmacy and got the prescription. However it was for Supartz
221325 - rather than Synvisc, as discussed with Doctor Dang on 161212 1632.
221326 - ref SDS 28 W579 Had to wait about 10 minutes while the nurse prepared
221327 - the prescription. She was very kind to expedite the order on notice
221328 - that meeting with Orthopedics for doing the injection was scheduled at
221329 - 1530. The nurse at the Pharmacy counter said the VA has switched to
221330 - Supartz for superior knee care compared to Synvisc. Box for Supartz
221331 - says...
221332 -
221333 - Inject 25 mg (2.5 ML)
221334 - Inter-articular every week on the same day.
221335 - RX 6409712
221337 - ..
221338 - Hyalurnate NA 10MG/ML INJ 2.5ML Syringe
221340 - ..
221341 - Refill left: 0
221343 - ..
221344 - Quantity 3 syringe
221345 -
221346 -
221347 -
221348 -
221350 - ..
2214 -
2215 -
2216 - 1520
2217 -
221701 - Eugenia (Geana) Franco called us into Module #2 clinic examination
221702 - room.
221704 - ..
221705 - She carefully and thoroughly explained Supartz injection procedure
221706 - will use.
221708 - ..
221709 - Explained paitient history of self-treatment with Glucosamine
221710 - Chondroitin for past 15 years, prescribed by Doctor Boulris at Kaiser.
221711 - This has been effective enabling normal activities hiking 11 - 15
221712 - miles per day and hiking Half Dome last year on 160914. However,
221713 - right knee was injured several times last year. Glucosamine
221714 - Chondroitin has not worked well on right knee as it has on left knee.
221716 - ..
221717 - As a result, on 161212, Doctor Alexis Dang ordered treatment with
221718 - Synvisc. ref SDS 28 W579 Today, the Pharmacy changed this to Supartz,
221719 - per above. ref SDS 0 LL5N
221721 - ..
221722 - Eugenia seemed to say that for many patients this 3 week treatment
221723 - will be effective for about 12 months.
221725 - ..
221726 - She further advised that walking is good therapy for getting best
221727 - results with Supartz injections.
221729 - ..
221730 - Actual procedure was fast and easy. Eugenia made the injection, and
221731 - the there was no pain...
221732 -
221733 - 1. Provider presses thumb to feel for location for making
221734 - injection...
221737 -
221739 - ..
221740 - 2. Location for injection site is marked...
221744 - ..
221745 - 3. Needle inserted with lidocane to anesthetize location.
221748 -
221750 - ..
221751 - 4. With needle still inserted, nurse switches source tube and
221752 - injects Supartz into the knee. There is no pain nor
221753 - discomfort of any kind.
221757 - ..
221758 - 5. Practitioner removes syringe and bends knee several times
221759 - forcing Supartz to flow into openings in the miniscus...
221762 -
221764 - ..
221765 - Thanked Eugenia for excellent work.
221766 -
221767 - [On 160101 0700 reporting hiking on 170125, 48 hours after
221768 - 1st treatment with Supratz; seemed to prevent pain right
221769 - knee on 6 mile hike; hours after hike right knee swelled
221770 - and stiff. ref SDS 11 X17O
221772 - ..
221773 - She said to take the remaining 2 boxes of Supartz containing
221774 - treatment for remaining 2 applications next week on 170130 at 1530,
221775 - and the last on 170206 1530 for the final treatment.
221776 -
221777 -
221778 -
221779 -
221780 -
221781 -
221782 -
221783 -
221784 -
221785 -
221786 -
2218 -