CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 27 0000. ref SDS 26 0000.
040502 -
040503 -
040504 -
040506 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 180105 1321 letter to Doctor Thuillier in VA Orthopedics notified
040902 - have been unable to download radiologist report on MRI of both feet
040903 - performed on 171229. ref SDS 23 O46F Further explained plan on
040904 - driving to VAMCSF to get the report from VA Release of Information
040905 - (ROI). ref SDS 23 I492 Also planned to schedule meeting with Doctor
040906 - Thuillier for review results of MRI studies on feet and knees. 180105
040907 - 1321, ref SDS 23 I495
040909 - ..
040910 - On 180108 letter to Doctor Thuillier reported PRP treatment in both
040911 - feet and both knees on 180105 1630, ref SDS 24 HP5O, and related
040912 - research indicating PRP yields measurable increase in minisucs
040913 - cartilage over 6 months. ref SDS 24 JX67
040915 - ..
040916 - On 180110 1100 meeting Doctor Thuillier. ref SDS 26 JN9H
040918 - ..
040919 - On 180423 0908 called Jane and scheduled meeting with Doctor Thuillier
040920 - on 180425 1145. ref SDS 27 OL9L
040921 -
040923 - ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Agenda...
041302 -
041303 - 1. Plantar plate tear right foot - seems healed treated with PRP
041304 - injections on 170726 1600, ref SDS 5 PP4N, and again on 170816
041305 - 1400. ref SDS 6 VO3F
041307 - ..
041308 - On 12 mile hike this morning, only few instances of pain level
041309 - 2 on plantar plate tear location, and lasted only few steps.
041310 - For 99.9% of hike, there was no pain in right foot plantar
041311 - plate tear, which previously was debilitating. See case study
041312 - dated, 180101 0820, ref SDS 21 GG7N
041314 - ..
041315 - Doctor Thuillier was pleased with healing of plantar plate tear
041316 - diagnosed with MRI study on 170412 0800, ref SDS 4 JG52, and shown
041317 - again in follow up MRI on 171229 0900. ref SDS 20 JG52
041319 - ..
041320 - The doctor said plantar plate injuries are very difficult to heal, so
041321 - progress in this case indicates strong response to treatment with PRP
041322 - injection therapy.
041323 -
041325 - ..
041326 - 2. Examine treatment schemes to protect blisters and calluses for
041327 - hike this morning.
041329 - ..
041330 - Any ideas for improvement?
041332 - ..
041333 - Doctor Thuillier approved use of toe caps recommended by Mark Wachter
041334 - at On-the-Run, to protect against blisters and tension tears from
041335 - hiking long distances.
041337 - ..
041338 - The doctor also approved using similar gel-like pads held with white
041339 - tape to protect Tailor's bunyon on left foot.
041341 - ..
041342 - He further approved weaving felt/wool cloth strips between toes to
041343 - transfer pressure from balls of feet to toe muscles. Wrapping the
041344 - cloth strip above the long toe applies plantarflexion to reduce
041345 - pressure on plantar plate tear, and further reduces halux valgus
041346 - pressure on big toe. All implementing the doctor's guidance on
041347 -
041349 - ..
041350 - 3. Feet "fat pad" injury (metatarsalgia) recovery, explained by
041351 - Doctor Thuillier on 180110 1100. ref SDS 26 Y45H
041353 - ..
041354 - Hoka Bondi 5 Wide shoes have "plush" cushioning, which
041355 - supplements and protects fat pads on balls of feet, reported on
041356 - 170929 1010. ref SDS 9 TZ5H
041358 - ..
041359 - Orthotic inserts supplement shoe "plush" cushioning, also
041360 - explained on 170929 1010. ref SDS 9 TZ56
041362 - ..
041363 - Double wool socks enhance feet care.
041365 - ..
041366 - Doctor Thuillier examined shoes and orthotic inserts worn today. He
041367 - feels "Hoka Bondi 5" shoes and "Satallite Elite" orthotic inserts
041368 - provided by "On-the-Run" shoe store on referral from Doctor Tang in
041369 - Podiatry at VAMCSF, have high-level cushioning that reduces rate of
041370 - degrading innate "fat pads" on balls of feet from hiking 11 - 15 miles
041371 - per day.
041373 - ..
041374 - These biomechanics compliment medical treatment with PRP injections
041375 - that stimulate collagen to maintain feet elements required for hiking
041376 - 11 - 15 miles per day.
041378 - ..
041379 - The doctor examined both feet and noted "fat pads" seem in good shape,
041380 - still soft and spongy today after hiking 900 miles since PRP treatment
041381 - on 180105. Moreover, there is no dryness, cracking nor peeling that
041382 - has occurred previously from dehydration, caused by high doses of PPI
041383 - and statin medications, which caused excessive urination.
041385 - ..
041386 - Doctor Thuillier mentioned an enhanced type of wool sock may further
041387 - improve feet care.
041389 - ..
041390 - Need the name of these socks.
041391 -
041393 - ..
041394 - 4. Burning sensation in balls of both feet, mostly right foot,
041395 - reflect continually degrading fat pads from extended endurance
041396 - exercise hiking 11 - 15 miles per day.
041397 -
041398 - F:\05\00003\SM\CC\BNKG\120216cc\130101cc\hiking_miles_3.xlsx
041400 - ..
041401 - This injury arises after hiking a few miles, and then subsides
041402 - about mile 5, before starting a 1-mile uphill climb on Crystal
041403 - Ranch Road.
041405 - ..
041406 - Acetaminophen combined with small dose of ibuprofen, since
041407 - normal dose of NSAID reduces effect of PRP, provides pain
041408 - management for 15 mile hikes, started a week or so ago on
041409 - 180421.
041411 - ..
041412 - Need more collagen production -- PRP injection treatment to
041413 - reduce reliance on medication.
041415 - ..
041416 - Doctor Thuillier indicated reduced reliance on medication for pain
041417 - relief, particularly hydrocodone is preferred line of care.
041418 -
041420 - ..
041421 - 5. MRI exam on 171229 - any indications that guide where PRP
041422 - injections would be most beneficial?
041424 - ..
041425 - Right knee Pain in going uphill.
041427 - ..
041428 - Left knee pain in going downhill - going uphill theraputic.
041429 -
041431 - ..
041432 - Doctor Thuillier looked briefly at MRI study on 171229. In the
041433 - limited time available he did not see anything that would guide PRP
041434 - injections toward evident injured tissue. He was pressed for time,
041435 - because of a surgery scheduled in 30 minutes, so he may be able to
041436 - look more closely on Friday.
041438 - ..
041439 - Have hiked 1,000 miles since the MRI on 171229, including 10% running
041440 - and sprinting, there may be new injuries that require another MRI
041441 - study to locate.
041442 -
041443 -
041444 - 6. Benefits walking 11 - 15 miles per day.
041445 -
041446 - Prior to CABG x4 on 091022, patient hiked about 2 miles per
041447 - day, i.e., 3 - 6 miles per day, 4 - 6 days a week. This only
041448 - achieved HDL 30, well below target of HDL 60+ needed to prevent
041449 - CAD. HDL 30 required heart surgery at age 64. Hiking at these
041450 - levels caused neither feet nor knee injuries.
041452 - ..
041453 - Besides coronary deficits, patient also suffered declining
041454 - eyesight, e.g., unable to read standard 12-point font common to
041455 - newspapers and magazines like Time, Newsweek, etc. Patient
041456 - further had severe pain sitting on hard surfaces like a park
041457 - bench. Rising from sitting position caused spinal pain.
041459 - ..
041460 - Apart from sitting, patient further had occasional hip and
041461 - back pain from standing.
041463 - ..
041464 - After CABG x4 on 091022, patient increased hiking to 6 - 11
041465 - miles per day, still 4 - 6 days per week. HDL remained below
041466 - 50, well below 60. On 131125, research found that hiking can
041467 - raise HDL, so increased hiking to 11 miles per day, 7 days a
041468 - week. Within 2 months, on 140201, VA lab reported HDL 61.
041470 - ..
041471 - Since then hiking has varied due to feet and knee injuries, but
041472 - has held HDL 55 - 73, now hiking 11 - 15 miles per day for
041473 - several weeks in a row, then days off due to injuries.
041475 - ..
041476 - With increased circulation, shown by CCTA on 151019, and
041477 - numerous brain MRIs in 2016, vision has improved remarkably,
041478 - hip and back pain have resolved, and loss of muscle mass from
041479 - sarcopenia has not occurred, further suggesting telomeres have
041480 - been maintained or extended with extended endurance exercise.
041481 - Equally, blood pressure and heart rate declined.
041483 - ..
041484 - Doctor Thuillier noted significant medical benefits of composite care
041485 - in this case.
041487 - ..
041488 - It should be interesting to discover the full range of medical
041489 - benefits that derive from extended endurance exercise, here hiking,
041490 - made possible with PRP care.
041491 -
041493 - ..
041494 - 7. VA order continuing PRP injections to maintain hiking line of
041495 - care.
041497 - ..
041498 - Doctor Thuillier will order PRP injection treatment, and recommend
041499 - payment by VA for essential care not available at the VA.
041501 - ..
041502 - We need to develop protocols and work history on amount and locations
041503 - of injections correlated with response to treatment following care.
041505 - ..
041506 - Pain management through local and general anesthetic, e.g., conscious
041507 - sedation.
041509 - ..
041510 - The doctor said he will write the order on Friday, 180427, and will
041511 - submit copy to the patient.
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