THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com
S U M M A R Y
DIARY: June 19, 2017 03:00 PM Monday;
Rod Welch
VA Orthopedics meeting Doctor Thuillier recover planttar plate wound.
1...Summary/Objective
2...Right Knee Supartz Injection Treatments Order Right and Left Knee
..............
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CONTACTS
SUBJECTS
Right Foot Long Toe Recover Severe Edema Within 2 MM Amputation Usin
3603 -
3603 - ..
3604 - Summary/Objective
3605 -
360501 - Follow up ref SDS 30 0000. ref SDS 29 0000.
360502 -
360503 -
360504 -
360505 -
360506 -
360508 - ..
3606 -
3607 - Background
3608 -
360801 - On 170417 1330 met with Doctor Thuillier in Orthopedics, where he made
360802 - referral for Outpatient Physical Therapy to wrap plantar plate tear
360803 - with plantarflexion taping system. ref SDS 16 5T7K
360805 - ..
360806 - On 17425 0830 met with Sharlene in Physical Therapy. ref SDS 19 4G5J
360807 - Submitted Rocktape. Did exercises to evaluate flexibility. Sharlene
360808 - prescribed daily calf stretching exercises to strengthen plantar
360809 - plates toward preventing further injury. ref SDS 19 GY5J Sharlene
360810 - applied Rocktape to protect the right foot plantar plate tear using
360811 - alternate wrapping method. ref SDS 19 TW5J Did not tape left foot.
360812 - ref SDS 19 PQ4L Did 2 mile hike with good results, reflecting
360813 - Rocktape applied to right foot, and earlier in the morning taking
360814 - Naproxen. ref SDS 19 SY6N Returned home and reported good results to
360815 - Sharlene. ref SDS 19 YN59 She feels Rocktape needs to be replaced
360816 - every three days, ref SDS 19 XQ79,
360818 - ..
360819 - On 170427 0830 Sharlene explained that physical therapy cannot provide
360820 - treatment to aid healing plantar plate tears, in addition to using
360821 - protective boot and plantarflexion taping; she feels jacuzzi whirl
360822 - pool type treatment will not be effective to recover from Plantar
360823 - Plate tear injuries. ref SDS 20 E48H Patient doing additional
360824 - stretching prescribed by Sharlene. Had best hike in over a year,
360825 - following taping with Rocktape by Sharlene. ref SDS 20 0E5N Sharlene
360826 - used taping scheme again, that Doctor Hewitson demonstrated on 170411.
360827 - 170427 0830, ref SDS 20 TW5J
360828 -
360829 -
360830 -
360831 -
360832 -
360833 -
360835 - ..
3609 -
3610 -
3611 - Progress
3612 -
361201 - Checked in OA 1432.
361202 -
361203 - Did a little work entering Progress Notes for EGD procedure on 161206
361204 - 1130. ref SDS 3 9N5G
361205 -
361206 -
361207 -
361208 -
361210 - ..
3613 -
3614 -
3615 - 1510
3616 -
361601 - Called into Module 2 for meeting with Doctor Thuillier.
361602 -
361603 - Meeting was scheduled by Jane on 170525 0802. ref SDS 30 4G5J Said
361604 - hellow to Jane, walking past her in the hallway. Acknowledged the
361605 - other nurses who are regulars, and so have seen me often the past 2
361606 - years.
361608 - ..
361609 - Follow up prior meeting with Dan on 170417 1330. ref SDS 16 4G5J.
361611 - ..
361612 - Agenda...
361613 -
361614 - 1. Reviewed background on 170327 the doctor demonstrated
361615 - plantarflexion care using tape to prevent pronation long toe
361616 - right foot while walking and running, that enables plantar
361617 - plate tear to heal. ref SDS 7 774N
361619 - ..
361620 - 2. Sharlene in Physical Therapy was effective applying
361621 - plantarflexion care wrapping long toe on referral from Doctor
361622 - Thuillier.
361624 - ..
361625 - 3. The toe developed edema with swelling and bleeding from
361626 - blistering using Rocktape. Since Physical Therapy does not
361627 - have wound care materials, she referred care to Wound Care.
361629 - ..
361630 - 4. Went to Wound Care, where treatment was provided to recover
361631 - from minor edema on long toe.
361633 - ..
361634 - Lana then referred care to Medical Practice for Plantarflexion
361635 - care. This did not go well, and care was referred to Podiatry.
361637 - ..
361638 - 5. Doctor Tang in Podiatry supported plantarflexion care, and
361639 - began experimenting with modifications to orthotic insert right
361640 - shoe only for complimentary treatment of plantar plate tear.
361642 - ..
361643 - 6. Plantarflexion care worked well to enable hiking without
361644 - severe pain in right foot plantar plate wound.
361646 - ..
361647 - 7. On 170605 long toe suffered severe edema from plantarflextion
361648 - care, caused by reaction to Rocktape, see picture...
361649 -
361650 -
361651 -
361652 -
361654 - ..
361655 - 8. On 170605 began treating long toe right foot with Hydrofera
361656 - Blue Bacteriostatic dressing, available from Lana for
361657 - concurrent treatment in Wound Care for hemotoma on lower left
361658 - leg.
361660 - ..
361661 - 9. On 170608 Doctor Tang in Podiatry advised the long toe
361662 - condition on 170605, came within 2 mm of having to be
361663 - amputated, ref SDS 31 673M, and recovered after treatment with
361664 - Hydrofera Blue. ref SDS 31 744H
361666 - ..
361667 - He recommended ending plantarflexion care using Rocktape. This
361668 - required pausing hiking.
361670 - ..
361671 - Today, Doctor Thuillier cited Doctor Tang's Progress Notes on 170608.
361673 - ..
361674 - 10. Doctor Tang made further modifications to right foot orthotic
361675 - insert to relieve pressure on plantar plate tear, and issued
361676 - instructions to test results of modifications with hiking,
361677 - toward finalizing refinements to mitigate plantar plate
361678 - injuries, and then ordering new set of orthotic inserts that
361679 - implement modified design. ref SDS 31 W24L
361681 - ..
361682 - Scheduled to see Doctor Tang on 170623 0830.
361684 - ..
361685 - 11. On 170613 toe substantially recovered....
361686 -
361687 -
361689 - ..
361690 - 12. Yesterday, bought elastic-felt tape and wrapped long toe to
361691 - replace Rocktape. This can be done by patient and removed
361692 - after hiking to enable toe to rest overnight.
361694 - ..
361695 - Did trial hike 3 miles and had good results, shown by improved
361696 - condition of toe today.
361698 - ..
361699 - Doctor Thuillier examined new wrapping material. He feels this is a
361700 - good solution for injury to long toe suffered in this case.
361702 - ..
361703 - The doctor showed on the computer screen another wrapping device for
361704 - plantarflexion care, which will be less traumatic to the toe, and be
361705 - easier for the customer to put in place and remove, that conventiona
361706 - adhesive tape, which was demonstrated in the meeting on 170327 1430.
361707 - ref SDS 7 774N
361709 - ..
361710 - He wrote the name of the device...
361712 - ..
361713 - Later could not make out handwriting.
361715 - ..
361716 - During the meeting, he submitted a letter
361717 -
361719 - ..
361720 - 13. Plantar plate wound - consider cutting relief in top layer of
361721 - orthotic insert and either leaving open or filling with soft
361722 - material to prevent pressure on planter plate and reduce
361723 - promation of long toe.
361725 - ..
361726 - Doctor Thuillier said this scheme might be helpful for enabling
361727 - plantar plate to heal. He commended patient initiative, and is
361728 - pleased Doctor Tang is experimenting in Podiatry to fashion an
361729 - orthotic insert that prevents further injury to right foot plantar
361730 - plate.
361731 -
361732 -
3618 -
SUBJECTS
Default Null Subject Account for Blank Record
3703 -
370401 - ..
370402 - Right Knee Supartz Injection Treatments Order Right and Left Knee
370403 -
370404 - Follow up ref SDS 7 HG8M, ref SDS 5 0234.
370405 -
370406 - 14. Supartz order 6 month line treatment with another 3 injections
370407 - for right knee, and also 3 injections for left knee.
370409 - ..
370410 - Doctor Thuillier will order another Supartz treatment for both left
370411 - and right legs.
370413 - ..
370414 - Thanked the doctor for a great meeting.
370415 -
370416 - [On 170628 0840 visited Jane in Orthotpeics; she found
370417 - Doctor Thuillier's order for Supartz injection treatments
370418 - in both knees, and so scheduled the work on 170731.
370419 - ref SDS 33 4G5J
370421 - ..
370422 - The doctor indicated the meeting went extremely well, working from an
370423 - agenda with links to relevant patient history for checking context.
370424 -
370426 - ..
370427 - On leaving the clinic examination area, said good bye to the nurses,
370428 - who have provided good assistance and care on prior visits.
370430 - ..
370431 - Doctor Alexis Dang was standing on the corner. He said hello
370432 - and asked how the meeting went?
370434 - ..
370435 - Explained everything on the agenda was reviewed. Doctor Thuillier
370436 - found good progress applying plantarflexion care to recover from
370437 - plantar plate tear, and he offered new ideas to advance recovery.
370438 - Doctor Thuillier further ordered another series of 3-injections with
370439 - Supartz for right knee, and he ordered the same care for left knee,
370440 - planned previously on 170327 1430. ref SDS 7 HG8M
370442 - ..
370443 - Doctor Dang was pleased that Supartz treatments he ordered on 161212
370444 - 1632, ref SDS 4 5U93, has worked pretty well on the right knee, so
370445 - that this justifies another phase treating both knees with Supartz.
370446 -
370447 -
370448 -
370449 -
370450 -
370451 -
370452 -
370453 -
370454 -
3705 -