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: July 31, 2017 03:00 PM Monday;
Rod Welch
VA Orthopedics meeting Joan for Supartz treatment on right knee.
1...Summary/Objective
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CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 35 0001, ref SDS 34 0000.
040502 -
040503 - Joan was excellent today, injecting right knee for another treatment
040504 - with Supartz that maintains pain-free function for next 6 months. She
040505 - initially reviewed the record of prior work to verify objectives and
040506 - scope, and for any issues that might have occurred which normally
040507 - would not be expected. ref SDS 0 DS94 Joan was aware that work today
040508 - is only for the right knee, after having left knee injected with PRP
040509 - by Doctor Tucker last week. ref SDS 0 F245 Actual injection process
040510 - went flawlessly - timely, professional and totally pain free.
040511 - ref SDS 0 S456 Next injection is scheduled a week from today for next
040512 - Monday on 170807. ref SDS 0 3W8N
040513 -
040514 - [On 170802 0742 submitted letter to Joan with the record on
040515 - Supartz injection for left knee; attached only 2 of 13
040516 - pictures, because Samsung s8 camera high resolution
040517 - produces large files, so only 2 passed VA email limits.
040518 - ref SDS 37 4G5J
040520 - ..
040521 - [On 170804 1622 received letter from Joan with appreciation
040522 - for the record injecting Supartz, and including pictures.
040523 - ref SDS 38 4G5J
040524 -
040525 -
040526 -
040527 -
040529 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Arrived at VA OA 1300, after hiking a few miles at Lafayette Reservoir
040902 - on the way to the City.
040904 - ..
040905 - Checked in at Module #2, and gave cellphone number for Joan to call,
040906 - if she wants to start before 1500.
040908 - ..
040909 - Next went to Pharmacy down the hall, and received Supartz treatments
040910 - for 3 injections.
040912 - ..
040913 - Went to cafeteria and worked for 90 minutes or so.
040914 -
040915 -
040916 -
040918 - ..
0410 -
0411 -
0412 - 1425
0413 -
041301 - Received call from nurse in module #2. She said Joan can do the
041302 - procedure 30 minutes ahead of schedule. Explained it will take 10
041303 - minutes to close shop in the cafeteria, and store the computer in the
041304 - car, then walk back to Module 2.
041305 -
041306 -
041307 -
041309 - ..
0414 -
0415 -
0416 - 1437
0417 -
041701 - Arrived in Module 2. A nurse said Joan took another patient ahead of
041702 - me, and I will be next in about 15 minutes.
041704 - ..
041705 - Waited in lobby reading today's paper, and other materials.
041707 - ..
041708 - Nurses came out continually and called patients. Several patients
041709 - were elderly and complained of long wait to see the doctor. One was
041710 - waiting for Joan. When the nurse came and called my name, said to
041711 - take the other patient, since he has been waiting a long time. The
041712 - patient was relieved and said thanks.
041714 - ..
041715 - There were a lot of patients in difficult circumstance, many with
041716 - walkers, and motorized wheelchairs. One was on a gurney, and so was
041717 - pushed by two attendants. Turned out he was a Wound Care patient.
041718 - Christy Burns was the provider today. She came along pushing her
041719 - mobile workstation. Christy said hello, and that she is filling in
041720 - for Lana, still on vacation.
041721 -
041723 - ..
0418 -
0419 -
0420 - 1538
0421 -
042101 - Joan came into the waiting area and called for the procedure.
042102 -
042103 - Walked into the care area, and to the procedure room at the end of
042104 - the hall, where Lana usually gives Wound Care.
042106 - ..
042107 - On the way down the hall, asked Anna if she would take pictures
042108 - today. She smiled and said sure.
042110 - ..
042111 - In the procedure room, Joan read Gina's progress notes from the last
042112 - injection on 170206 1240. ref SDS 5 RN5K
042113 -
042114 -
042115 -
042116 -
042118 - ..
042119 - Joan asked about Gina's report on patient hiking 11 - 15 miles per
042120 - day. Explained these are the usual routes. Joan asked how the right
042121 - knee injected by Gina 6 months ago has held up with this level of
042122 - stress?
042124 - ..
042125 - Explained Supartz has worked well, until the past few weeks, and so
042126 - requested another phase of injection treatment. On 170619, Doctor
042127 - Thuillier ordered this treatment. At that time, the doctor ordered
042128 - injections for both knee. ref SDS 33 U76F
042130 - ..
042131 - Joan was aware that scope of work was changed from both knees to only
042132 - the right knee, because the left knee was treated experimentally with
042133 - platelet rich plasma (PRP) by Doctor Tucker last Wednesday on 170726
042134 - 1600. ref SDS 36 0001
042135 -
042136 - https://www.google.ca/imgres?imgurl=https://embed.widencdn.net/img/veritas/8niw4d0qto/600px/knee-injection.jpg%3Fquality%3D80%26u%3Dat8tiu%26use%3Dthpzr&imgrefurl=https://www.arthritis-health.com/treatment/injections/efficacy-platelet-rich-plasma-injections&h=338&w=600&tbnid=dDg1VNCMwG1QjM:&tbnh=160&tbnw=284&usg=__6FL_HsZM1_28AuiTzIYy91j1W0M=&vet=10ahUKEwjG_-OcjbnVAhXIv1QKHYqICMYQ9QEIODAA..i&docid=4Mde7CuwlVcBzM&sa=X&ve d=0a
042137 -
042138 - https://www.spinemd.com/treatments/platelet-rich-plasma
042139 -
042141 - ..
042142 - Joan was generally aware of PRP, and that the VA does not support
042143 - this line of care at this time.
042145 - ..
042146 - Signed consent statement.
042148 - ..
042149 - Joan setup the injection table...
042150 -
042151 -
042152 -
042153 -
042154 -
042155 -
042157 - ..
042158 - She then called for Anna to take pictures. She asked if Gina took
042159 - pictures previously. Explained we took pictures for the 1st of the
042160 - 3-injections, on 170123 1530. ref SDS 4 VG6M
042162 - ..
042163 - Joan requested copies of piectures taken today, to send to her
042164 - parents, so they can see her work. She said they have no idea what
042165 - she does.
042166 -
042167 - [...below on 170731 1500 at 1031 received Joan's letter
042168 - requesting pictures. ref SDS 0 9Q8N
042170 - ..
042171 - [On 170802 0742 submitted letter to Joan with the record on
042172 - Supartz injection for left knee; attached only 2 of 13
042173 - pictures, because Samsung s8 camera high resolution
042174 - produces large files, so only 2 passed VA email limits.
042175 - ref SDS 37 4G5J
042177 - ..
042178 - Joan prepared materials for numbing injection area...
042179 -
042180 -
042181 -
042182 -
042184 - ..
042185 - Joan palpated the knee to determine precise location for making the
042186 - injection...
042187 -
042188 -
042189 -
042190 -
042192 - ..
042193 - She used the syrenge for marking where to make the injection...
042194 -
042195 -
042196 -
042198 - ..
042199 - Next, she applied numbing agent...
042200 -
042201 -
042202 -
042204 - ..
042205 - After initial site numbing of the skin, Joan injected lidocane to numb
042206 - the area inside knee where Supartz will be injected...
042207 -
042208 -
042209 -
042211 - ..
042212 - Finally, Joan injected Supartz...
042213 -
042214 -
042215 -
042216 -
042217 -
042218 -
042220 - ..
042221 - She removed the needle, and applied bandaid to protect wound...
042222 -
042223 -
042224 -
042225 -
042226 -
042227 -
042228 -
042230 - ..
042231 - Thanked Joan for great work. Did not feel anything from the
042232 - injections - everything pain free.
042234 - ..
042235 - Joan said to take the remaining 2 boxes of Supartz for the next
042236 - injections over the next 2 weeks, on Monday.
042237 -
042238 -
042240 - ..
0423 -
0424 -
0425 - 1841
0426 -
042601 - After the procedure, Joan sent a letter to facilitate submitting
042602 - pictures taken today, to her, per above. ref SDS 0 486J
042604 - ..
042605 - Received Joan's letter saying...
042606 -
042607 - 1. Subject: Hello
042608 - Date: 2017-07-31 16:10
042612 - ..
042613 - 2. Hi Rod,
042615 - ..
042616 - 3. Great working w/ you and I look forward to the pics.
042618 - ..
042619 - 4. Take care,
042621 - ..
042622 - 5. Joan
042623 -
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042625 -
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0427 -