CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 24 0000, ref SDS 22 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - PRP treatment by...
040902 -
040903 - Nancy E. Rolnik, MD, CAQSM
040904 - Pediatric and Adult Sports Medicine
040905 - Regenerative Medicine
040906 - Lifestyle Medicine
040907 - St. Mary?s College Team Physician
040908 -
040909 - https://remedysportsmed.com/nancy-e-rolnik-m-d-caqsm-sportsmedicine
040911 - ..
040912 - Nancy E. Rolnik, MD
040913 - Remedy Sports and Regenerative Medicine
040914 - 108 La Casa Via #106,
040915 - Walnut Creek, CA 94598
040916 - 925 464-7278
040918 - ..
040919 - Paused NSAID 7 days before treatment.
040921 - ..
040922 - Hoka shoes will be adequate to protect feet after treatment.
040924 - ..
040925 - Prior PRP treatments are listed on 200101 0701. ref SDS 13 TSYT
040927 - ..
040928 - Background on orthopedics evaluations and radiology studies, reported
040929 - on 191220 0800. ref SDS 12 743N
040931 - ..
040932 - MRI study on 200109 0610 both knees performed in VAMCSF Radiology
040933 - Department, ref SDS 14 7J84; and, on both feet. ref SDS 14 I44K
040935 - ..
040936 - PRP preparation method - 1 spin or 2-spin concentration, explained on
040937 - 180105 1630. ref SDS 2 I36H
040939 - ..
040940 - Post-treatment recovery - previously...
040941 -
040942 - Walk 1-mile around the block day after PRP injections (on
040943 - Friday), and on Saturday, do 3 miles at Lafayette, but just go
040944 - slow. After doing that for a few days, if there is still no
040945 - pain in the feet, then try 7 miles - but go slow. Just build
040946 - up gradually, reported on 170727 1747. ref SDS 1 0W5I
040948 - ..
040949 - On 180105 1630 instructions not to hike for a week after PRP.
040950 - ref SDS 2 TK9L
040952 - ..
040953 - NSAID - avoid for 2 weeks after treatment, also on 180105 1630.
040954 - ref SDS 2 055K - see as well research on, ref SDS 2 NX6F
040955 -
040957 - ..
040958 - Nancy was alone in the office today on Monday, because the day after
040959 - 4th of July occurring on Sunday, is a holiday.
040961 - ..
040962 - She provided patient identification and background forms. Used pen
040963 - to fill out the forms, and sign them.
040965 - ..
040966 - The doctor led us to a small treatent room.
040967 -
040969 - ..
040970 - Develope Scope of Work for 13th Regeneration PRP Injection Treatment
040971 -
040972 - Follow up ref SDS 11 SO4N, ref SDS 10 SO4N.
040973 -
040974 - Nancy read through the analyst's report for the MRI on the left knee,
040975 - performed at VAMCSF on 200109 0610. ref SDS 14 P48S She also read the
040976 - report for the feet, ref SDS 14 JI37
040978 - ..
040979 - She would like to get the files for the radiology imagery.
040981 - ..
040982 - Doctor Rolnik asked where pain is occurring?
040984 - ..
040985 - Reviewed objectives for PRP injections to prevent acute inflammation
040986 - that occurs shown in lab report on 210630 0815, ref SDS 21 AA48, and
040987 - so that HDL will increase above 60, as hiking mileage increases. This
040988 - correlation occurred with PRP treatments during 2017 - 2018, as set
040989 - out in the letter on 210701 1747. ref SDS 23 DP89 Doctor Thuillier in
040990 - Orthopedics at VAMCSF and UCSF Medical Center advised that
040991 - concentrated platelets injected with PRP treatments prevents
040992 - inflammation that otherwise occurs from painful feet and knee injuries
040993 - during hikes, reported on 200221 0800. ref SDS 15 WY8H
040995 - ..
040996 - HDL fell below 60 in 2019, because hiking declined in the beginning of
040997 - the year, and because acetaminaphin and gabapentin pain medications
040998 - lower HDL, shown in spreadsheet...
040999 -
041000 - F:\05\00003\SM\CC\BNKG\120216cc\130101cc\hiking_miles_3.xlsx
041002 - ..
041003 - Later in 2019 and 2020, atrial fibrillation lowered HDL.
041005 - ..
041006 - Doctor Pellegrini performed 3 cardiac ablations to resolve AF and AFL,
041007 - ending on 201210 0700. ref SDS 18 4H5J
041009 - ..
041010 - Hiking then increased by order of magnitude from 11 - 15 miles per
041011 - day, to 18 - 27 miles per day. However, HDL remained in 50s. Prior
041012 - 12 PRP treatments to feet and knees together with glucosamine
041013 - chondroitin prevented pain during hikes, supplemented with Tramadol,
041014 - oxycodone, and naproxen.
041016 - ..
041017 - New injuries to edges of feet, not previously treated with PRP, caused
041018 - breakthrough pain. Recent lab showed elevated inflammation after
041019 - hiking 13 miles on 210630 0815. ref SDS 21 AA4F This indicates hiking
041020 - may be causing acute inflammation which prevents HDL from rising while
041021 - hiking, cited by Doctor Thuillier at VAMCSF and UCSF on 200221 0800.
041022 - ref SDS 15 WY8H
041024 - ..
041025 - Doctor Rolnik palpated injury sites in the feet and left knee.
041027 - ..
041028 - Based examination today, and the letter on 210701 1747, ref SDS 23
041029 - DP98, set following sites for PRP injections...
041030 -
041031 - 1. Between 5 metatarsals top of both feet to maintain fat pads.
041032 -
041033 - Fat pads have held up remarkably well the past 2 years since
041034 - prior 10 PRP injections, ending on 190816 1100, ref SDS 8 0108
041035 - These injections prevented pain and suppressed inflammation so
041036 - that HDL 83, was achieved from hiking extended distance,
041037 - reported in lab on 181112 1720. ref SDS 4 5C7M In recent
041038 - weeks, have begun to experience pain level 1 - 2 near end of
041039 - hikes. Since PRP is available and doesn't take very much to
041040 - inject metatarsals, decided to inject these locations today.
041042 - ..
041043 - Nancy palpated and marked injection sites. She examined the
041044 - Stable Elite orthotic inserts and noted wear and tear that may
041045 - be contributing to pain and inflammation in feet.
041046 -
041047 - [On 210707 0952 letter notifies Mark at On-The-Run that
041048 - examination found Stable Elite orthotic inserts are over
041049 - worn, so need new inserts. ref SDS 25 W441
041051 - ..
041052 - On 200919 1123 purchased 2-pair Stable Elite orthotic inserts
041053 - from On-The Run. ref SDS 17 VT4I Hiking mileage was 21,889.
041054 - Today, mileage is 25,841, shown in case study...
041055 -
041056 - F:\05\00003\SM\CC\BNKG\120216cc\130101cc\hiking_miles_3.xlsx
041058 - ..
041059 - Miles hiked with 2 sets of inserts = 3952, say 4,000 miles.
041061 - ..
041062 - On 200221 1003 report says orthotic inserts typically last
041063 - about 1,000 miles, ref SDS 16 RV4H; so, the 2 pair acquired on
041064 - 200919 should last for 2,000 miles. They now exceed twice
041065 - design life cycle due to budget restraints, when VA ended
041066 - pension payments in January.
041067 -
041069 - ..
041070 - 2. Tailor's Bunions both feet.
041071 -
041072 - These locations were injected with PRP previously on 180620
041073 - 1530, ref SDS 3 GE5H, which prevented pain and suppressed
041074 - inflammation yielding favorable results, as with metatarsals,
041075 - per above. ref SDS 0 NT42
041077 - ..
041078 - These locations could be treated by surgically cutting back the
041079 - bones now protruding that cause painful calluses to form. Pain
041080 - and inflammation occur from repetitive strees as shoe sides
041081 - press on the widened foot profile. The VA has avoided this
041082 - procedure, because there is a risk of complications that could
041083 - impede hiking, reported on 191220 0800. ref SDS 12 VA5F
041084 -
041086 - ..
041087 - 3. Little toe - callus near tip outside edge right foot.
041088 -
041089 - Calluses on both little toes are new sources of pain and
041090 - inflammation, which have not been previously injected.
041091 - Calluses on outer edges of little toes together with calluses
041092 - on the corresponding outer edges of the big toes, widen the
041093 - foot profile that exceeds the width of even "wide" Hoka Bondi 6
041094 - shoes, causing pain and inflammation from repetitive stress
041095 - that occurs while hiking at therapeutic levels over extended
041096 - miles.
041098 - ..
041099 - The right foot little toe and Tailor's Bunion and the big toe
041100 - callus have been less painful in recent weeks, where pain does
041101 - not occur until mile 15 or so. May indicate treatment with
041102 - ammonium lactate has partially healed these callus locations.
041103 - The left foot little toe and big toe calluses seem the biggest
041104 - contributors to pain and inflammation during hikes at this
041105 - time.
041107 - ..
041108 - Decided to inject outer edge of right foot little toe, because
041109 - of liklihood that continued repetitive stress may cause
041110 - increased pain and inflammation to occur. Maintenance
041111 - injections today, when PRP is available, will provide a window
041112 - of time to hike wihout pain and inflammation in order to test
041113 - increasing HDL by reducing inflammation.
041115 - ..
041116 - Injection will be painful and so difficult to tolerate because
041117 - not much room between skin and the bone to accomodate injection
041118 - of PRP. Since these little locations seem to be major
041119 - contributors to inflammation, an effective test of theory that
041120 - inflammation is inhibiting HDL, requires these injections
041121 - today. Additionally, it is expected that even if HDL starts to
041122 - rise after PRP treatment, as it has in the past, these little
041123 - injuries will recur more quickly.
041125 - ..
041126 - The doctor took time to select a favorable injection site with
041127 - soft skin adjacent to callus, and using an angular injection
041128 - tilt to get PRP as near as possible under the callus.
041130 - ..
041131 - Doctor Rolnik commented that both little toes could be aided by
041132 - a prosthetic to increase natural profile laying flat. This was
041133 - previously noticed by Doctor Tang in Podiatry at VAMCSF.
041134 - Various prosthetics have been tried the past year, which have
041135 - not prevented pain and inflammation, reported on 210601 0900.
041136 - ref SDS 20 RG44
041138 - ..
041139 - Previously, PRP has provided a window of time when pain and
041140 - inflammation during hikes was prevented, and so enabled HDL to
041141 - rise. Today, we are testing if this prior favorable outcome
041142 - and be repeated.
041143 -
041145 - ..
041146 - 4. Big Toe outer edge right foot.
041147 -
041148 - Callus on this toe seems large, perhaps more than on the left
041149 - foot; however, the past few weeks there has been noticeably
041150 - less pain from this location than on the right foot.
041152 - ..
041153 - As with Tailor's Bunions, Orthopedics and Podiatry report these
041154 - locations can be treated by surgically cutting back the bones
041155 - now protruding that cause painful calluses to form. Pain and
041156 - inflammation occur from repetitive strees, as shoe sides press
041157 - on the widened foot profile. The VA has avoided this
041158 - procedure, because there is a risk of complications that could
041159 - impede hiking, reported on 191220 0800. ref SDS 12 VA5F
041161 - ..
041162 - Seems like a surgical procedure could be done to remove the
041163 - callus wihtout necessarily cutting back the underlying bone
041164 - growth that presents unacceptable risks, per above.
041166 - ..
041167 - Decided to inject for same reason as for the little toe, per
041168 - above. ref SDS 0 4K51
041170 - ..
041171 - The doctor again palpated to select a favorable injection site
041172 - with soft skin adjacent to callus, and using an angular
041173 - injection to get PRP as near as possible to under the callus.
041174 -
041176 - ..
041177 - 5. Little toe - callus left foot.
041178 -
041179 - Toe shows significant blood blister and deformation of toenail,
041180 - together with callus. This location seems biggest contributor
041181 - to pain and inflammation, typically starting at pain level 1,
041182 - and increasing gradually to level 3 even 4 on some hikes, e.g.,
041183 - 2 days ago on 210703, shown in case study on 210101 0643.
041184 - ref SDS 19 TWQW Unclear why right foot little toe shows some
041185 - healing, and left little toes has worsened. Injury to left leg
041186 - has caused right leg to get stronger and do more of the work
041187 - hiking. Nominally, this places increased pressure on right
041188 - foot, so why is left foot worse?
041190 - ..
041191 - Decided to inject for same reason as for right foot little toe,
041192 - per above. ref SDS 0 4K51
041194 - ..
041195 - The doctor again palpated to select a favorable injection site
041196 - with soft skin adjacent to callus, and using an angular
041197 - injection to get PRP as near as possible to under the callus.
041198 -
041200 - ..
041201 - 6. Big Toe outer edge left foot.
041202 -
041203 - Callus on this toe seems smaller than on the left, and because
041204 - a few weeks ago used a knife to cut down the callus. While
041205 - this was a clumsy effort (botched self surgery), it did result
041206 - in narrowing the cross foot profile, which reduced pressure on
041207 - the side of the toe. This reduced pain for a week or so, until
041208 - the callus began to grow back, with the result of noticeably
041209 - increased pain from this location, making this likely second
041210 - biggest contributor to pain and inflammation.
041212 - ..
041213 - Decided to inject for same reason as for the little toe, per
041214 - above. ref SDS 0 4K51
041216 - ..
041217 - The doctor again palpated to select a favorable injection site
041218 - with soft skin adjacent to callus, and using an angular
041219 - injection to get PRP as near as possible to under the callus.
041221 - ..
041222 - 7. Left knee
041223 -
041224 - Reviewed patient history of industrial accident OA 1973,
041225 - falling 40' into pump station. Cartilage was surgically
041226 - removed, causing osteoarthritis to gradually rise over the
041227 - years from running and tennis, explained in Doctor Tucker
041228 - Progress Notes for PRP treatment on 190816 1100. ref SDS 8 YO7K
041230 - ..
041231 - Doctor Rolnik examined the knee with ultra sound radiology.
041232 - She palpated for pain locations around the entire knee to
041233 - select injection sites for primary intra articular PRP
041234 - treatment.
041235 -
041237 - ..
041238 - NSAID Pain Medication Paused 7 Days Before PRP Injections
041239 -
041240 - Follow up ref SDS 11 JT6H. ref SDS 10 JT6H.
041241 -
041242 - Protocol for PRP treatment is to avoid NSAID drugs at least 7 days
041243 - prior to getting PRP.
041245 - ..
041246 - Advised Doctor Rolnik have not taken NSAID drugs since taking naproxen
041247 - on 210628, shown in case study on 210101 0643. ref SDS 19 O55I
041248 -
041249 -
041251 - ..
041252 - Blood Draw for PRP Completed with One Needle Stick
041253 -
041254 - Follow up ref SDS 11 PS4K, ref SDS 10 PS4K.
041255 -
041256 - Discussed doing pushups to increase blood flow for the IV blood draw,
041257 - but decided not necessary today, given recent history of extended
041258 - endurance hiking.
041260 - ..
041261 - Doctor Rolnik drew blood from the left arm, again using the vein on
041262 - the inner elbow, which has been used previously, reported for the 12th
041263 - PRP treatment on 191009 1500. ref SDS 11 PS4K
041265 - ..
041266 - The doctor aligned the needle and pushed it into the vein, shown in
041267 - the film for the prior procedure on 190816...
041268 -
041269 - C:\sd\wl\pic\health\190816_PRP_procedure\20190816_122430.mp4
041271 - ..
041272 - The doctor aspirated 60 cc of blood to yield 6 ccs of PRP plasma using
041273 - ____________ model centrifuge with _________ concentration.
041274 -
041275 -
041276 -
041277 -
041279 - ..
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0415 - 0716
0416 -
041601 - Nancy charged $1,800.
041602 -
041603 - Invoice......................... 1508339375
041604 -
041605 -
041606 -
041608 - ..
041609 - Posted expense ledger...
041610 -
041613 -
041615 - ..
041616 - Payment history....
041617 -
041618 - 210705.................. $ 1,800.......... ref SDS 0 RD4G
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