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: August 13, 2009 03:00 PM Thursday; Rod Welch

VA blood test for high cholesterol ordered by Doctor Sandhu.

1...Summary/Objective
2...Cholosteral High from Test 050801 Prescribe Exercise Diet Drugs
3...Cholesterol Study Patient History Decline Without Medication


..............
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CONTACTS 

SUBJECTS
Examination Planning Physical Review High Cholesterol Esophegeal Sur                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0803 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0803 -    ..
0804 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0805 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080501 - Follow up ref SDS 32 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
080502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080506 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080507 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080509 -  ..
0806 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0807 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0808 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0809 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080901 - Cholosteral High from Test 050801 Prescribe Exercise Diet Drugs                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
080902 - 
080903 - Follow up ref SDS 32 MA6I, ref SDS 20 MA6I.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
080904 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080905 - Background...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080906 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080907 -    1.  Physical examination ordered lab which                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080908 -        was performed later the same                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
080909 -        day....................................... 050629 1000, ref SDS 7 G69K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
080911 -         ..
080912 -    2.  Lab follow up ordered to test elevated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080913 -        WBC....................................... 050816 0830, ref SDS 8 G540                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
080915 -         ..
080916 -    3.  WBC still elevated doctor prescribed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080917 -        Amoxicillin Antibiotics................... 050818 1452, ref SDS 9 DG8G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
080919 -         ..
080920 -    4.  Cholesterol high reported for 3 blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
080921 -        tests a year earlier; doctor orders                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
080922 -        follow up lab............................. 060505 0830, ref SDS 20 MA6I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
080924 -         ..
080925 -    5.  Cholesterol; high in follow up blood test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
080926 -        doctor prescribes treatment with Lovastatin;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
080927 -        there is no record of receiving nor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
080928 -        taking Lovastatin......................... 060623 0840, ref SDS 26 UO6K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
080930 -         ..
080931 -    6.  Blood test for cholesterol ordered                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
080932 -        by Doctor Sandhu.......................... 090812 1030, ref SDS 32 236F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
080934 -         ..
080935 -    7.  Blood test performed...................... 090813 1500, ref SDS 0 439L,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
080936 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080938 -  ..
080939 - After fasting for 12 hours, went to VA and had blood drawn for the lab                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
080940 - ordered yesterday.  The nurse said the doctor ordered urnialysis, so                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
080941 - this was added to the lab.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
080942 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080944 -  ..
080945 - Laboratory blood test ordered on 090812.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
080946 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080961 -     ..
080962 -    Log#:                    090813 15:09                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
080963 -    <--------------------VETERANS ADMINISTRATION----------------->
080964 -    Type                 Results   Units              Normal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080965 -    Urinalysis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080966 -    Report Released Date/Time:  Aug 13, 2009 @ 1559                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
080967 -    Provider:  Sandhu Harkesh S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
080968 -    Specimine:  urine                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
080969 -    Specimine collection date:  08/13/2009 1509                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
080970 -    PH                      6.0                    5.00  -    9.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
080971 -    PROTEIN                 NEG    mg/dL           NEG   -   TRACE                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
080972 -    GLUCOSE                 NEG    mg/dL           Ref:  NEG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080973 -    KETONES                 NEG    mg/dL           Ref:  NEG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080974 -    BILIRUBIN               NEG                    Ref:  NEG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080975 -    BLOOD                 TRACE                    Ref:  NEG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080976 -    NITRITE                 NEG                    Ref:  NEG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080977 -    UROBILINOGEN            0.2    EU/dL           0.10   -   1.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
080978 -    LEUKOCYTE ESTERASE      NEG                    Ref:  NEG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080979 -    SPECIFIC GRAVITY        1.025                  1.000  -   1.030                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
080980 -    COLOR                 YELLOW                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080981 -    APPEARANCE             CLEAR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080983 -     ..
080984 -    HYAINE CASTS        Normal  (0 - 1)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
080985 -                                         CASTS/LPF     0 - 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080986 -    GRANULAR CASTS      Normal  (0 - 1.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
080987 -                                         CASTS/LPF     0 - 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080988 -    WBC/HPF             Normal  (0 - 5)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
080989 -                                         WBC/HPF       0 - 5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080990 -    RBC/HPF       H     FEW     (6 - 10)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080991 -                                         RBC/HPF       0 - 5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080992 -    CRYSTALS            Normal  (0 - 1)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
080993 -                                         CRYSTALS/LPF  0 - 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080994 -    EPITHELIAL CELLS    Normal  (0 - 1)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
080995 -                                         CELLS/HPF     0 - 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080996 -    YEAST              Moderate (2 - 5)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
080997 -                                         YEAST/HPF     0 - 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
080998 -    BACTERIA            Normal  (0 - 1)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
080999 -                                         BACT/HPF      0 - 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
081000 -    MUCOUS            Moderate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081001 -    AMORPHOUS SEDIMENT    None                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
081002 -    TRICHOMONAS       None OBS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
081004 -     ..
081005 -    Comment:  Test Performed by VA 150 Muir Road, Martinez CA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
081006 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081008 -     ..
081009 -    Log#:                    090813 15:09                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
081010 -    <--------------------VETERANS ADMINISTRATION----------------->
081011 -    Type                 Results   Units              Normal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
081012 -    Cancer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
081013 -    Report Released Date/Time:  Aug 24, 2009 @ 1216                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
081014 -    Provider:  Sandhu Harkesh S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
081015 -    Specimine:  SERUM          MAC 0813 437                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
081016 -    Specimine collection date:  08/13/2009 1509
081017 -     ..
081018 -    TSH                     2.03   uIUnits/mL      0.34  -    5.60                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081019 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081020 -          Thyroid Stimulating Hormone (TSH)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
081022 -           ..
081023 -          TSH is produced by the pituitary gland and is part of the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
081024 -          body's feedback system to maintain stable amounts of the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081025 -          thyroid hormones T4 and T3 in the blood. When concentrations                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081026 -          decrease in the blood, the pituitary is stimulated to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
081027 -          release TSH. The TSH in turn stimulates the production and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081028 -          release of T4 and T3 by the thyroid gland. When the system                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081029 -          is functioning normally, thyroid production turns on and off                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081030 -          to maintain constant blood thyroid hormone levels                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
081032 -     ..
081033 -    PSA                     1.53   ng/ml           0.00  -    4.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081034 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081035 -          Prostate cancer evaluation.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
081036 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081037 -          A prostate-specific antigen (PSA) blood test measures the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
081038 -          amount of prostate-specific antigen in the blood. PSA is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081039 -          released into a man's blood by his prostate gland. Healthy                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081040 -          men usually have low amounts of PSA in the blood. The amount                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081041 -          of PSA in the blood normally increases as a man's prostate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081042 -          enlarges with age. PSA may increase as a result of an                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
081043 -          injury, a digital rectal exam, recent (24 hours) sexual                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
081044 -          activity (ejaculation), inflammation of the prostate gland                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081045 -          (prostatitis), or prostate cancer.  When combined with a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081046 -          digital rectal exam at your doctor's office, the test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
081047 -          increases the chance of detecting prostate cancer.  A PSA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
081048 -          level within the normal ranges does not mean that prostate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081049 -          cancer is not present. Also, some men with prostate cancer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081050 -          have normal PSA levels.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
081052 -     ..
081053 -    Comment:  Test Performed by VA 150 Muir Road, Martinez CA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
081054 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081056 -     ..
081057 -    Log#:                    090813 15:09                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
081058 -    <--------------------VETERANS ADMINISTRATION----------------->
081059 -    Type                 Results   Units              Normal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
081060 -    CBC with DIFF & PLT CT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
081061 -    Report Released Date/Time:  Aug 13, 2009 @ 1538                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
081062 -    Provider:  Sandhu Harkesh S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
081063 -    Specimine:  BLOOD          HR  0813 76                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
081064 -    Specimine collection date:  08/13/2009 1509                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
081065 -    WBC COUNT              10.5    K/cmm           4.80  -   10.80                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081066 -    RBC COUNT               5.14   M/cmm           4.70  -    6.10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081067 -    HEMOGLOBIN             15.7    g/dL           14.00  -   18.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081068 -    HEMATOCRIT             45.2    %              42.00  -   52.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081069 -    MCV                    87.9    fL             80.00  -   99.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081070 -    MCH                    30.6    uug            27.00  -   34.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081071 -    MCHC                   34.8    gm/dL          32.00  -   35.20                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081072 -    RDW                    12.9    %              11.50  -   14.50                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081073 -    PLATELETS             350.0    K/cmm         130.00  -  400.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081074 -    MPV                     7.6    fL              7.00  -   10.40                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081075 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081076 -        [On 091019 1300 follow up lab at VA in San Francisco for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081077 -        angiogram test. ref SDS 33 EQP7                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
081079 -     ..
081080 -    LYMPHS %    L          15.4    %              20.00  -   51.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081081 -    MONOS %                 5.4    %               2.00  -   13.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081082 -    ..
081083 -     (NEUTS x 1000 = ANC for Kaiser)
081084 -    Neutrophils %          77.0    %              40.00  -   80.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081086 -     ..
081087 -    EOS  %                  1.7    %               0.50  -    7.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081088 -    BASO  %                 0.05   %               0.00  -    2.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081090 -     ..
081091 -    Log#:                    090813 15:09                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
081092 -    <--------------------VETERANS ADMINISTRATION----------------->
081093 -    Type                 Results   Units              Normal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
081094 -    NEUTS #          H      8.1    K/cmm           1.50  -    7.90                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081095 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081096 -         NEUTS (also absolute neutrophils count - ANC) is calculated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081097 -         according to the formula on 060810 1330. ref SDS 27 GL4M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
081098 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081099 -             ANC = WBC x 1000 x (Neutrophils + Bands)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
081100 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081101 -                 = 10.5 x (.77 + 0) x 1000 = 8085                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
081102 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081104 -     ..
081105 -    Log#:                    090813 15:09                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
081106 -    <--------------------VETERANS ADMINISTRATION----------------->
081107 -    Type                 Results   Units              Normal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
081108 -    ELECTROLYTE PANEL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
081109 -    GLUCOSE                98      mg/dL          70.00  -  118.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081110 -    SODIUM                139      mmol/L        136.00  -  144.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081111 -    POTASSIUM               3.8    mmol/L          3.40  -    4.80                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081112 -    CHLORIDE         H    108      mmol/L         98.00  -  106.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081113 -    CO2                    30      mmol/L         23.00  -   33.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081114 -    ANION GAP     Not Reported                     3.00  -   14.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081116 -     ..
081117 -    UREA NITROGEN          11      mg/dL           8.00  -   26.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081119 -     ..
081120 -    CREAT with eGFR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
081121 -    CREATININE              0.86   mg/dL           0.50  -    1.10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081122 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081123 -         Effective 7/2/08, new standardized method for creatinine in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081124 -         place.  Note reference range change.  Previous range 0.5 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
081125 -         1.2 mg/dL.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
081127 -     ..
081128 -    eGFR                  >60      mL/min   ref: >60.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
081129 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081130 -         eGFR Units = mL/min/1.73 square meters                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
081132 -     ..
081133 -    Log#:                    090813 15:09                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
081134 -    <--------------------VETERANS ADMINISTRATION----------------->
081135 -    Type                 Results   Units              Normal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
081136 -    CALCIUM                 8.8    mg/dL           8.70  -   10.20                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081138 -     ..
081139 -    MAGNESIUM     Not Reported     mg/dL           1.80  -    2.30                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081141 -     ..
081142 -    AST                    18      IntUnits/L      8.00  -   42.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081143 -    ALT                    16      IntUnits/L      5.00  -   55.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081144 -    ALKALINE PHOSPHATASE  102      IntUnits/L     37.00  -  107.00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081145 -    BILIRUBIN TOTAL   H     1.7    mg/dL           0.30  -    1.20                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081146 -    BILIRUBIN DIRECT        0.1    mg/dL           0.10  -    0.40                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081147 -    PROTEIN                 7.1    g/dL            6.50  -    8.10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081148 -    ALBUMIN                 3.9    g/dL            3.30  -    4.80                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081150 -     ..
081151 -    Log#:                    090813 15:09                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
081152 -    <--------------------VETERANS ADMINISTRATION----------------->
081153 -    Type                 Results   Units              Normal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
081154 -    Cholesterol       H   233      mg/dL ref: <= 200.00  -  400
081155 -    Triglyceride          118      mg/dL ref: <= 150.00  -  400
081156 -    HDL Cholesterol   L    30      mg/dL ref: >=  40.00  -  400                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081157 -    LDL Cholesterol   H   179      mg/dL ref: <= 160.00  -  400
081158 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081159 -            Risk category                    LDL Goal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
081160 -            CHD and CHD risk equivelents     <100 mg/dL
081161 -            Multiple (2+) risk factors       <130 mg/dL
081162 -            0 - 1 risk factor                <160 mg/dL
081163 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081164 -                 [On 091021 0716 angiogram test for blood flow                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081165 -                 restrictions was performed at VA in San Francisco;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
081166 -                 discovered 4 blockages; so, heart bypass surgery was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
081167 -                 prescribed. ref SDS 34 7L47                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081169 -                  ..
081170 -                 [On 091022 0700 quadruple heart bypass surgery                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
081171 -                 performed to recover from blood flow restrictions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081172 -                 discovered in angiogram test the day before.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
081173 -                 ref SDS 35 01F9                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081175 -                  ..
081176 -                 [On 091104 0718 VA San Francisco ordered Simvastatin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
081177 -                 20 MG taken every day to control cholesterol,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
081178 -                 ref SDS 36 IA4H; and this duplicates prescription by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
081179 -                 Doctor Sandhu for Simvastatin 40 MG to take one-half                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
081180 -                 pill every day to control cholesterol. ref SDS 36 IA5W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
081182 -             ..
081183 -            HDL chol greater than/equalto 60 mg/dL counts as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
081184 -            "negative' risk factor; its presence removes 1 risk factor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081185 -            from the total count.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
081187 -             ..
081188 -            Ref:  Adult treatment panel III (ATP III) JAMA 5/16/01 Vol                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081189 -            285 #19.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081191 -     ..
081192 -    Comment:  Test performed by VA, 150 Muir Road, Martinez CA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
081194 -     ..
081195 -    Performing Lab Sites                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
081196 -    [400]  Martinez OPC/CREC                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081197 -           150 Muir Road                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
081198 -           Martinez, CA  94553                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
081199 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081200 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081202 -  ..
081203 - Cholesterol Study Patient History Decline Without Medication                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
081204 - 
081205 - This record shows progress toward health targets using exercise and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081206 - diet adjustment, and without taking medication...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081208 -         ..
081209 -        Lab     Cholesterol Triglycerides  HDL   LDL     Reported                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
081210 -        Targets     <200      <150         >40  <160     090813, 1500, ref SDS 0 4N5H
081211 -        090813....   233...... 118......... 30.. 179.... 090813, 1500, ref SDS 0 4N5H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
081212 -        060605...... 238....... 68......... 32.. 192.... 060623, 0840, ref SDS 26 UO6K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
081214 -  ..
081215 - Graphs display limited data, view details for more information.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081216 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081217 -          [On 091021 0716 angiogram test for blood flow restrictions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
081218 -          was performed at VA in San Francisco; discovered 4 blockages;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
081219 -          so, heart bypass surgery was prescribed. ref SDS 34 7L47                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
081220 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081221 -          [On 091022 0700 quadruple heart bypass surgery performed to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
081222 -          recover from blood flow restrictions discovered in angiogram                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081223 -          test the day before. ref SDS 35 01F9                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081225 -  ..
081226 - Date Range:  All results selected items from 050628 - 090813.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
081228 -                     ..
081229 -                    Cholesterol plasma  Ref High = 200 mg/dL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
081231 -   ..
081232 -  278 mg/dL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
081233 -           277 (050629 1000, ref SDS 7 G69K)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081234 -  276       \                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
081235 -             \                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
081236 -  274         |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
081237 -              |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
081238 -  272         |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
081239 -              |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
081240 -  270          \                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081241 -                |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
081242 -  268           |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
081243 -                |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
081244 -  266           |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
081245 -                \                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
081246 -  264            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081247 -                 |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081248 -  262            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081249 -                 |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081250 -  260            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081251 -                257 (050906 1204, ref SDS 10 DG8G)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
081252 -  258            \                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
081253 -                  \                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
081254 -  256              \                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081255 -                    \                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
081256 -  254                |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081257 -                     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081258 -  252                |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081259 -                     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081260 -  250                |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081261 -                     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081262 -  248                 \                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
081263 -                       |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
081264 -  246                  |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
081265 -                       |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
081266 -  244                   \                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
081267 -                         |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
081268 -  242                    |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
081269 -                          \                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
081270 -  240                     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
081271 -                          |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
081272 -  238                    238 (060605 reported on 060623 0840, ref SDS 26 UO6K)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081273 -                          \                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
081274 -  236                      -----------                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081275 -                                      \                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
081276 -  234                                  -----------------------\                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
081277 -                                                              233 (090813, ref SDS 0 4N5H)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
081278 -  232                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
081279 -  .......
081280 -   ..
081281 -  200                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
081282 -       <---2005---><---2006---><---2007---><---2008---><---2009--->
081283 -       1  3  6  9  1  3  6  9  1  3  6  9  1  3  6  9  1  3  6  9                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
081284 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081285 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081286 -          [On 091021 0716 angiogram test for blood flow restrictions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
081287 -          was performed at VA in San Francisco; discovered 4 blockages;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
081288 -          so, heart bypass surgery was prescribed. ref SDS 34 7L47                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
081290 -           ..
081291 -          [On 091022 0700 quadruple heart bypass surgery performed to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
081292 -          recover from blood flow restrictions discovered in angiogram                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
081293 -          test the day before. ref SDS 35 01F9                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
081295 -           ..
081296 -          [On 091104 0718 VA San Francisco ordered Simvastatin 20 MG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
081297 -          taken every day to control cholesterol, ref SDS 36 IA4H; and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
081298 -          this duplicates prescription by Doctor Sandhu for Simvastatin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
081299 -          40 MG to take one-half pill every day to control cholesterol.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
081300 -          ref SDS 36 IA5W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
081301 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081302 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081303 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081304 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081305 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081306 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081307 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081308 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
081309 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0814 -