THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


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 Lovastatis......................... 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
081076 -     ..
081077 -    LYMPHS %    L          15.4    %              20.00  -   51.00
081078 -    MONOS %                 5.4    %               2.00  -   13.00
081079 -    ..
081080 -     (NEUTS x 1000 = ANC for Kaiser)
081081 -    Neutrophils %          77.0    %              40.00  -   80.00
081083 -     ..
081084 -    EOS  %                  1.7    %               0.50  -    7.00
081085 -    BASO  %                 0.05   %               0.00  -    2.00
081087 -     ..
081088 -    Log#:                    090813 15:09
081089 -    <--------------------VETERANS ADMINISTRATION----------------->
081090 -    Type                 Results   Units              Normal
081091 -    LYMPHS #                1.6    K/cmm           1.20  -    3.40
081092 -    MONOS #                 0.6    K/cmm           0.20  -    1.20
081093 -    NEUTS #          H      8.1    K/cmm           1.50  -    7.90
081094 -
081095 -         NEUTS (also absolute neutrophils count - ANC) is calculated
081096 -         according to the formula on 060810 1330. ref SDS 27 GL4M
081097 -
081098 -             ANC = WBC x 1000 x (Neutrophils + Bands)
081099 -
081100 -                 = 10.5 x (.77 + 0) x 1000 = 8085
081102 -     ..
081103 -    EOS  #                  0.2    K/cmm           0.10  -    0.50
081104 -    BASO  #                 0.1    K/cmm           0.00  -    0.20
081106 -     ..
081107 -    Log#:                    090813 15:09
081108 -    <--------------------VETERANS ADMINISTRATION----------------->
081109 -    Type                 Results   Units              Normal
081110 -    ELECTROLYTE PANEL
081111 -    GLUCOSE                98      mg/dL          70.00  -  118.00
081112 -    SODIUM                139      mmol/L        136.00  -  144.00
081113 -    POTASSIUM               3.8    mmol/L          3.40  -    4.80
081114 -    CHLORIDE         H    108      mmol/L         98.00  -  106.00
081115 -    CO2                    30      mmol/L         23.00  -   33.00
081116 -    ANION GAP     Not Reported                     3.00  -   14.00
081118 -     ..
081119 -    UREA NITROGEN          11      mg/dL           8.00  -   26.00
081121 -     ..
081122 -    CREAT with eGFR
081123 -    CREATININE              0.86   mg/dL           0.50  -    1.10
081124 -
081125 -         Effective 7/2/08, new standardized method for creatinine in
081126 -         place.  Note reference range change.  Previous range 0.5 -
081127 -         1.2 mg/dL.
081129 -     ..
081130 -    eGFR                  >60      mL/min   ref: >60.00
081131 -
081132 -         eGFR Units = mL/min/1.73 square meters
081134 -     ..
081135 -    Log#:                    090813 15:09
081136 -    <--------------------VETERANS ADMINISTRATION----------------->
081137 -    Type                 Results   Units              Normal
081138 -    CALCIUM                 8.8    mg/dL           8.70  -   10.20
081140 -     ..
081141 -    MAGNESIUM     Not Reported     mg/dL           1.80  -    2.30
081143 -     ..
081144 -    AST                    18      IntUnits/L      8.00  -   42.00
081145 -    ALT                    16      IntUnits/L      5.00  -   55.00
081146 -    ALKALINE PHOSPHATASE  102      IntUnits/L     37.00  -  107.00
081147 -    BILIRUBIN TOTAL   H     1.7    mg/dL           0.30  -    1.20
081148 -    BILIRUBIN DIRECT        0.1    mg/dL           0.10  -    0.40
081149 -    PROTEIN                 7.1    g/dL            6.50  -    8.10
081150 -    ALBUMIN                 3.9    g/dL            3.30  -    4.80
081152 -     ..
081153 -    Log#:                    090813 15:09
081154 -    <--------------------VETERANS ADMINISTRATION----------------->
081155 -    Type                 Results   Units              Normal
081156 -    Cholesterol       H   233      mg/dL ref: <= 200.00  -  400
081157 -    Triglyceride          118      mg/dL ref: <= 150.00  -  400
081158 -    HDL Cholesterol   L    30      mg/dL ref: >=  40.00  -  400
081159 -    LDL Cholesterol   H   179      mg/dL ref: <= 160.00  -  400
081160 -
081161 -            Risk category                    LDL Goal
081162 -            CHD and CHD risk equivelents     <100 mg/dL
081163 -            Multiple (2+) risk factors       <130 mg/dL
081164 -            0 - 1 risk factor                <160 mg/dL
081165 -
081166 -                 [On 091021 0716 angiogram test for blood flow
081167 -                 restrictions was performed at VA in San Francisco;
081168 -                 discovered 4 blockages; so, heart bypass surgery was
081169 -                 prescribed. ref SDS 33 7L47
081171 -                  ..
081172 -                 [On 091022 0700 quadruple heart bypass surgery
081173 -                 performed to recover from blood flow restrictions
081174 -                 discovered in angiogram test the day before.
081175 -                 ref SDS 34 01F9
081177 -                  ..
081178 -                 [On 091104 0718 VA San Francisco ordered Simvastatin
081179 -                 20 MG taken every day to control cholesterol,
081180 -                 ref SDS 35 IA4H; and this duplicates prescription by
081181 -                 Doctor Sandhu for Simvastatin 40 MG to take one-half
081182 -                 pill every day to control cholesterol. ref SDS 35 IA5W
081184 -             ..
081185 -            HDL chol greater than/equalto 60 mg/dL counts as
081186 -            "negative' risk factor; its presence removes 1 risk factor
081187 -            from the total count.
081189 -             ..
081190 -            Ref:  Adult treatment panel III (ATP III) JAMA 5/16/01 Vol
081191 -            285 #19.
081193 -     ..
081194 -    Comment:  Test performed by VA, 150 Muir Road, Martinez CA
081196 -     ..
081197 -    Performing Lab Sites
081198 -    [400]  Martinez OPC/CREC
081199 -           150 Muir Road
081200 -           Martinez, CA  94553
081201 -
081202 -
081204 -  ..
081205 - Cholesterol Study Patient History Decline Without Medication
081206 -
081207 - This record shows progress toward health targets using exercise and
081208 - diet adjustment, and without taking medication...
081210 -         ..
081211 -        Lab     Cholesterol Triglycerides  HDL   LDL     Reported
081212 -        Targets     <200      <150         >40  <160     090813, 1500, ref SDS 0 4N5H
081213 -        090813....   233...... 118......... 30.. 179.... 090813, 1500, ref SDS 0 4N5H
081214 -        060605...... 238....... 68......... 32.. 192.... 060623, 0840, ref SDS 26 UO6K
081216 -  ..
081217 - Graphs display limited data, view details for more information.
081218 -
081219 -          [On 091021 0716 angiogram test for blood flow restrictions
081220 -          was performed at VA in San Francisco; discovered 4 blockages;
081221 -          so, heart bypass surgery was prescribed. ref SDS 33 7L47
081222 -
081223 -          [On 091022 0700 quadruple heart bypass surgery performed to
081224 -          recover from blood flow restrictions discovered in angiogram
081225 -          test the day before. ref SDS 34 01F9
081227 -  ..
081228 - Date Range:  All results selected items from 050628 - 090813.
081230 -                     ..
081231 -                    Cholesterol plasma  Ref High = 200 mg/dL
081233 -   ..
081234 -  278 mg/dL
081235 -           277 (050629 1000, ref SDS 7 G69K)
081236 -  276       \
081237 -             \
081238 -  274         |
081239 -              |
081240 -  272         |
081241 -              |
081242 -  270          \
081243 -                |
081244 -  268           |
081245 -                |
081246 -  266           |
081247 -                \
081248 -  264            |
081249 -                 |
081250 -  262            |
081251 -                 |
081252 -  260            |
081253 -                257 (050906 1204, ref SDS 10 DG8G)
081254 -  258            \
081255 -                  \
081256 -  256              \
081257 -                    \
081258 -  254                |
081259 -                     |
081260 -  252                |
081261 -                     |
081262 -  250                |
081263 -                     |
081264 -  248                 \
081265 -                       |
081266 -  246                  |
081267 -                       |
081268 -  244                   \
081269 -                         |
081270 -  242                    |
081271 -                          \
081272 -  240                     |
081273 -                          |
081274 -  238                    238 (060605 reported on 060623 0840, ref SDS 26 UO6K)
081275 -                          \
081276 -  236                      -----------
081277 -                                      \
081278 -  234                                  -----------------------\
081279 -                                                              233 (090813, ref SDS 0 4N5H)
081280 -  232
081281 -  .......
081282 -   ..
081283 -  200
081284 -       <---2005---><---2006---><---2007---><---2008---><---2009--->
081285 -       1  3  6  9  1  3  6  9  1  3  6  9  1  3  6  9  1  3  6  9
081286 -
081287 -
081288 -          [On 091021 0716 angiogram test for blood flow restrictions
081289 -          was performed at VA in San Francisco; discovered 4 blockages;
081290 -          so, heart bypass surgery was prescribed. ref SDS 33 7L47
081292 -           ..
081293 -          [On 091022 0700 quadruple heart bypass surgery performed to
081294 -          recover from blood flow restrictions discovered in angiogram
081295 -          test the day before. ref SDS 34 01F9
081297 -           ..
081298 -          [On 091104 0718 VA San Francisco ordered Simvastatin 20 MG
081299 -          taken every day to control cholesterol, ref SDS 35 IA4H; and
081300 -          this duplicates prescription by Doctor Sandhu for Simvastatin
081301 -          40 MG to take one-half pill every day to control cholesterol.
081302 -          ref SDS 35 IA5W
081303 -
081304 -
081305 -
081306 -
081307 -
081308 -
081309 -
081310 -
081311 -
0814 -