Welch Company
San Francisco, CA


S U M M A R Y


DIARY: August 3, 2011 02:00 PM Wednesday; Rod Welch

VA Meeting Doctor Sandhu review cholesterol lab test results.

1...Summary/Objective
2...Examination Doctor Prepared Reviewed SDS Record Patient History
3...Simvastatin 40 MG and 80 MG May Cause Harmful Side Effects
4...Cholesterol Declines Reduces Risk Factor Heart Disease
5...Diabetes Risk Factor Glucose Lab Tests Declines
6...Glucose Blood Sugar Falls Below Diabetes Risk Level
7...Vitamin D Treatment Ordered
8...VA Medical Chart for Meeting Today December 23, 2010
9...Myocardial Infarction Heart Disease Risks Reduced Aspirin
10...Aspirin Avoid Heart Attack Side Effects Ulcers Bleeding


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

SUBJECTS
Examination Cholesterol 40% Improvement Heart Disease Risk Declines

2803 -
2803 -    ..
2804 - Summary/Objective
2805 -
280501 - Follow up ref SDS 62 0000. ref SDS 41 0000.
280502 -
280503 -
280504 -
280506 -  ..
2806 -
2807 -
2808 - Progess
2809 -
280901 - Examination Doctor Prepared Reviewed SDS Record Patient History
280902 -
280903 - Follow up ref SDS 62 PP8W, ref SDS 41 PP8W.
280904 -
280905 - Background reported on 100721 0800. ref SDS 41 5R5H
280907 -  ..
280908 - Janice took vitals including weight, which was 193.  This was a good
280909 - surprise, since expected to be 205+, so seem to be going in right
280910 - direction at last, with 11 mile hike this morning, reported in case
280911 - study on 101010 0744. ref SDS 46 UN9G
280912 -
280913 -            [...below on 110803 1400 Doctor Sandhu advises losing
280914 -            weight helps reduce cholesterol and increase good
280915 -            cholesterol. ref SDS 0 NQ38
280917 -  ..
280918 - Vitals were skewed by the hike, also shown earlier today on 101010
280919 - 0744. ref SDS 46 UN9G
280921 -  ..
280922 - While waiting for Doctor Sandhu to complete review of patient history
280923 - to prepare for the meeting, notice an eye examination chart on the
280924 - wall at the end of the hallway.
280926 -  ..
280927 - Jancie showed mark on the wall down the hall for testing eyesight.
280928 - She assisted in taking examination.  Passed test for 20/20 vision.
280930 -  ..
280931 - Good news on weight reduction and good eyesight was a good way to
280932 - start the meeting.
280934 -  ..
280935 - Met with Doctor Sandhu to follow up meeting on 101223 1030.
280936 - ref SDS 62 PP8W
280938 -  ..
280939 - Doctor Sandhu was concerned about the patient arriving at 1350 for
280940 - the meeting scheduled to start at 1400.
280942 -  ..
280943 - Doctor Sandhu explained needing 30 minutes for reviewing the record to
280944 - be prepared for a productive meeting, and indicated this requires the
280945 - patient to arrive at the VA and wait 30 minutes.  He noted the time
280946 - required to review patient correspondence in SDS records, cited during
280947 - the meeting on 101223 1030. ref SDS 62 KI5J
280949 -  ..
280950 - Doctor Sandhu asked if Doctor Lee has scheduled EGD and dilation every
280951 - 3 months to recover from swallowing problems?
280953 -  ..
280954 - Confirmed that GI Department has scheduled another EGD and dilation on
280955 - 110819, reported on 110607 1414. ref SDS 72 N642  At that time, on
280956 - 110607, Charlene cited Doctor Lee's medical chart showing procedures
280957 - are planned every 3 months. ref SDS 72 NG52
280959 -  ..
280960 - There was no discussion today of progress recovering from swallowing
280961 - problems, nor of recovering from coronary artery disease.
280962 -
280964 -  ..
280965 - Simvastatin 40 MG and 80 MG May Cause Harmful Side Effects
280966 -
280967 - Follow up ref SDS 62 RP4F, ref SDS 41 RP4F.
280968 -
280969 - Discussed public notice of harmful side effects from simvastatin,
280970 - particularly 80 mg dose levels, reviewed in the record last night on
280971 - 110802 1639, ref SDS 75 JX5G, including anecdotal evidence of severe
280972 - pain, and death from taking simvastatin, reported on 110802 1639,
280973 - ref SDS 75 FU6H
280975 -  ..
280976 - Cited severe pain in left shoulder beginning on 101126, reported in
280977 - case study on 101010 0744. ref SDS 46 6E5I, and about a year after
280978 - starting simvastatin on 091220 0527. ref SDS 30 OX5X also, and 6
280979 - months after increasing the dose from 20 to 40 mg, prescribed on
280980 - 100721 0800. ref SDS 41 RP4F, as further reported on 110802 1639.
280981 - ref SDS 75 V26L
280983 -  ..
280984 - Doctor Sandhu reported personal experience with simvastatin.  He
280985 - suffered severe muscle pain, particularly in his lower body.  As a
280986 - result, he cannot take simvastatin for his personal health care.
280987 -
280988 -            [On 110817 1030 meeting with Doctor Egan discussed symptoms
280989 -            and risks of worsening myopathy from continuing and/or
280990 -            increasing simvastatin dose to 80 mg, ref SDS 76 QF61,
280991 -            Doctor Egan switched treatment to rosuvastatin 10 mg.
280992 -            ref SDS 76 DG36
280994 -  ..
280995 - Doctor Sandu related having painful left shoulder.  He explained
280996 - having found research today recommending yoga exercises to recover by
280997 - strengthening adjacent muscles.  The doctor seemed to cite from
280998 - printed material that this method has brought relief to hundreds of
280999 - patients.  He did not submit the article nor a source.
281001 -  ..
281002 - It was not clear in discussion today whether yoga exercising was done
281003 - in conjunction with taking simvastatin to relieve adverse side
281004 - effects, or was effective after ending simvastatin to recover from
281005 - side effects.
281006 -
281007 -
281009 -  ..
281010 - Cholesterol Declines Reduces Risk Factor Heart Disease
281011 -
281012 - Follow up ref SDS 62 415H, ref SDS 56 E19L.
281013 -
281014 - Doctor Sandhu discussed results of blood test on 110727, which was
281015 - ordered on 101223, 101223 1030, ref SDS 62 9P83, to prepare for the
281016 - meeting today assessing effect on lowering cholesterol from doubling
281017 - medication to Simvastatin 40 mg, ordered a year ago on 100721 0800.
281018 - ref SDS 41 RP4F ref SDS 49 6X8Q
281020 -  ..
281021 - Objectives for managing cholesterol is to reduce risks of coronary
281022 - artery disease, include heart attack.
281024 -  ..
281025 - Doctor Sandhu was pleased with results of treadmill streass test
281026 - performed on 110406, and showing
281027 -
281029 -  ..
281030 - Cholesterol increased slightly in the lab on 110727, ref SDS 73 E19L,
281031 - showing..
281032 -
281033 -            Lab Results
281034 -            LIPID PANEL............................ 2011 07 27 1258
281035 -            PLASMA               Results     Units          Range
281036 -            CHOL                   163       mg/dL       Ref: <=200
281037 -            TRIGLYC                 81       mg/dL       Ref: <=150
281038 -            HDL                     45       mg/dL       Ref: >=40
281039 -            LDL                    102       mg/dL       Ref: <=160
281041 -               ..
281042 -              [On 110114 1309 received results for lab on 101207, and
281043 -              VA medical chart for meeting with Doctor Lee on 101207,
281044 -              and also meeting with Doctor Sandhu on 101223.
281045 -              ref SDS 65 GT5K
281047 -  ..
281048 - Doctor Sandhu was disappointed to see slight increase in cholesterol
281049 - that signals challenges reducing risk of coronary events, following
281050 - significant improvement reported on 101223 1030. ref SDS 62 QV7K
281052 -  ..
281053 - There is no explanation in the record for cholesterol to suddenly stop
281054 - declining while continuing prescription to increase medication with
281055 - Simvastatin from 20 to 40 mg per day on 100721 0800. ref SDS 41 RP4F
281057 -         ..
281058 -        Collection DT       Spec      CHOL  TRIGL    HDL     LDL-CHO
281059 -        07/27/2011 12:58    PLASM     163     81     45       102
281060 -        12/07/2010 09:17    PLASM     151     41     47        96
281061 -        07/21/2010 08:54    PLASM     261 H   87     35 L     209 H
281062 -        06/10/2010 10:33    PLASM     217 H
281063 -    *   12/14/2009 11:10    PLASM     241 H  136     44       170 H
281064 -        08/13/2009 15:09    PLASM     233 H  118     30 L     179 H
281065 -        06/16/2006 10:59    PLASM     238 H
281067 -       ..
281068 -    * Lab at VA San Francisco Medical Center reported on 100928 0706.
281069 -      ref SDS 45 VW6J
281071 -  ..
281072 - The doctor indicated today that treatment with high dose Simvastatin
281073 - 40 mg per day, should be reviewed by Doctor Egan in Cardiology in
281074 - relation to risks of harmful side effects, discussed today, per above.
281075 - ref SDS 0 RP4F
281077 -  ..
281078 - He indicated health goals for patient with high risk for CAD should be
281079 - LDL 70, also noted by Doctor Egan in the meeting at the VA on 110309
281080 - 0900, ref SDS 67 ZM98, and a month later on 110415 0900. ref SDS 69
281081 - EH5H
281083 -  ..
281084 - Additionally, Doctor Sandhu seemed to say that HDL should be double
281085 - LDL for good coronary health.
281087 -  ..
281088 - Doctor Sandhu advised that continuing to reduce weight, reported by
281089 - Janice today, per above, ref SDS 0 M57L, can have a favorable effect
281090 - on achieving healthy cholesterol diagnostics.
281092 -  ..
281093 - Doctor Sandhu plans follow up meeting in March 2012, to assess
281094 - progress on reducing risk factors for cardiothoracic disease.
281096 -  ..
281097 - There was no discussion today of report Merck new drug Anacetrapib
281098 - shows significant improvement in cholesterol; pending further clinical
281099 - trials, reported on 101117 1018. ref SDS 53 U75H
281100 -
281101 -
281102 -
281103 -
2812 -

SUBJECTS
Diabetes Risk Declines Gluecose 102 Reduced from 117 Blood Sugar Fal

4503 -
450401 -  ..
450402 - Diabetes Risk Factor Glucose Lab Tests Declines
450403 - Glucose Blood Sugar Falls Below Diabetes Risk Level
450404 -
450405 - Follow up ref SDS 62 JK8M.
450406 -
450407 - Doctor Sandhu was pleased decline from Glucose 117 to 102, helps
450408 - prevent diabetes, reported in the lab on 110727 1238, ref SDS 73 GM65,
450409 - showing stable with no improvement reducing risk of diabetes...
450410 -
450411 -        LABS:
450412 -        Collection DT       Spec    GLUCOSE  BUN   CREAT      NA
450413 -        07/27/2011 12:58    PLASMA    102    10       0.89    138
450414 -        12/07/2010 09:17    PLASMA    102     8       0.85    137
450415 -        07/21/2010 08:54    PLASMA    117    12       0.89    139
450417 -         ..
450418 -        Collection DT       Spec         K    CL     CO2
450419 -        07/27/2011 12:58    PLASMA      3.9   104     26
450420 -        12/07/2010 09:17    PLASMA      3.8   104     28
450421 -        07/21/2010 08:54    PLASMA      3.9   106     28
450423 -         ..
450424 -        Collection DT       Spec      ALT    AST  ALK PHO   ALBUMIN  T BIL
450425 -        07/27/2011 12:58    PLASM      21    24      81         4.2   2.0 H
450426 -        12/07/2010 09:17    PLASM      22    26     102         3.9   1.0
450427 -        07/21/2010 08:54    PLASM      24    23     109 H       4.0   1.3 H
450429 -         ..
450430 -        Collection DT       Spec      WBC    HGB     HCT       MCV    MCHC   PLT
450431 -        07/27/2011 12:58    BLOOD     7.5    15.5    46.4     91.2   33.4    286
450432 -        12/07/2010 09:17    BLOOD     6.7    14.4    43.3     90.7   33.1    310
450433 -        07/21/2010 08:54    BLOOD     7.3    14.9    44.0     91.2   33.8    344
450435 -         ..
450436 -        SCLU - TSH
450437 -        Collection DT       Spec        Tsh
450438 -        07/27/2011 12:58    SERUM               [no test]
450439 -        12/07/2010 09:17    SERUM       2.61
450440 -        07/21/2010 08:54    SERUM       2.51
450441 -
450442 -
450443 -
4505 -

SUBJECTS
Default Null Subject Account for Blank Record

4603 -
460401 -  ..
460402 - Vitamin D Treatment Ordered
460403 -
460404 -
460405 - Doctor Sandhu advised he ordered pills to take for increasing
460406 - vitamin D.
460408 -  ..
460409 - We reviewed the report for the lab on 110727, received from the VA
460410 - this past Monday on 110801 1043. ref SDS 74 MJ7H
460412 -  ..
460413 - The lab does not list anything for Vitamind D, shown on 110727 1238.
460414 - ref SDS 73 RP4N
460416 -  ..
460417 - The doctor explained that all of the lab results were not available
460418 - for submission to the customer on 110801, because some tests take up
460419 - to 10 days.
460421 -  ..
460422 - There was not enough time to review how the patient is notified of the
460423 - scope for lab tests in order correlate with actual results for quality
460424 - control.
460426 -  ..
460427 - There was no discussion today of the missing lab test for mercury,
460428 - discussed with Millisa on 110727 1238. ref SDS 73 KG5U
460430 -  ..
460431 - Doctor Sandhu explained prescription for Vitamin D enables patients
460432 - to recover from deficiency.  Milk, oragne juice and similar natural
460433 - dietary foods provide vitamin d through ordinary nutrition, however,
460434 - this takes a large quantities.
460436 -  ..
460437 - The doctor further advised that getting sunshine normally provides
460438 - sufficient vitamin D for people.
460440 -  ..
460441 - Not clear in the record why being outside in the sun for 3 hours a
460442 - day 4 - 5 times a week hiking does not maintain vitamin D.
460443 -
460444 -
460445 -
460446 -
460447 -
4605 -

SUBJECTS
Medical Chart Progress Notes Primary Care Meeting

6103 -
610401 -  ..
610402 - VA Medical Chart for Meeting Today December 23, 2010
610403 -
610404 - Follow up ref SDS 62 188K.
610405 -
610406 - A few weeks later, received Doctor's Sandhu's medical chart with the
610407 - CD submitted by Wilma in ROI Department. ref DRP 2 PTTU
610409 -         ..
610410 -    1.  LOCAL TITLE: Primary Care Scheduled Visit 60297
610411 -        STANDARD TITLE: PRIMARY CARE NOTE
610412 -        DATE OF NOTE: DEC 23, 2010@10:40:53 ENTRY DATE: DEC 23, 2010@10:40:53
610413 -        AUTHOR: SANDHU,HARKESH S EXP COSIGNER:
610414 -        URGENCY: STATUS: COMPLETED
610416 -         ..
610417 -    2.  65 yo MALE with medical problems as listed in problem list came
610418 -        in for f/u.  Pt states he had the egd and it is little better
610419 -        and will be going in for redo in february to do more
610420 -        dialtation.No f/c/n/v/d/malena.
610422 -  ..
610423 - Not clear why medical chart relies on impression from what patient
610424 - states, rather than citing the record submitted to the VA, as
610425 - discussed during the meeting, per above. ref SDS 62 LS8J
610426 -
610427 -
610428 -
6105 -

SUBJECTS
Afflictions List Case Management Medical Chart Progress Notes Primar

8303 -
830401 -  ..
830402 - VA medical chart continues...
830403 -
830404 -    3.  Computerized Problem List is the source for the following:
830405 -
830406 -             1.  Esophageal Stricture 03/05/10 LEE,RANDALL E.......
830407 -
830408 -             2.  Screening for Malignant Neoplasms of colon 02/02/10
830409 -                 LEE,RANDALL E (ICD-9-CM V76.51)
830411 -                  ..
830412 -             3.  Coronary Atherosclerosis (unspecified type 02/02/10
830413 -                 LEE,RANDALL E vessel, native or graft) (ICD-9-CM 41
830415 -                  ..
830416 -             4.  Coronary Artery Bypass using Venous and 01/04/10
830417 -                 SANDHU,HARKESH Arterial Grafts (Single Vein Graft),
830418 -                 Onset 10/00/09 done at vasf
830420 -  ..
830421 - CABG was performed at VA San Francisco Medical Center on 091022.
830422 - ref SDS 12 PQWU
830424 -  ..
830425 - VA medical chart continues...
830426 -
830427 -             5.  Surgical Thoracoscopy with Esophagomyotomy 01/04/10
830428 -                 SANDHU,HARKESH (Heller Type), Onset 12/16/09 at vasf
830430 -                  ..
830431 -             6.  Hyperlipidemia * (ICD-9-CM 272.4) 10/02/09 EGAN,JAMES
830433 -                  ..
830434 -             7.  Inflamed Seborrheic Keratosis (ICD-9-CM 702.11)
830435 -                 03/12/07 LIN,BERTHA
830437 -                  ..
830438 -             8.  Rosacea * (ICD-9-CM 695.3) 03/12/07 LIN,BERTHA
830440 -                  ..
830441 -             9.  Dermatitis * (ICD-9-CM 692.9) 03/12/07 LIN,BERTHA
830443 -                  ..
830444 -            10.  Tinea Unguium * (ICD-9-CM 110.1) 03/12/07 LIN,BERTHA
830446 -                  ..
830447 -            11.  Tinea * (ICD-9-CM 110.9) 03/12/07 LIN,BERTHA
830449 -                  ..
830450 -            12.  Rosacea conjunctivitis (ICD-9-CM 372.31) 03/02/07
830451 -                 MARGULIES,LINDA
830453 -                  ..
830454 -            13.  Rosacea * (ICD-9-CM 695.3) 03/02/07 MARGULIES,LINDA
830456 -                  ..
830457 -            14.  Blepharitis NOS 02/21/07 MARGULIES,LINDA
830459 -                  ..
830460 -            15.  Achalasia * (ICD-9-CM 530.0) 12/22/05 SANDHU,HARKESH
830462 -                  ..
830463 -            16.  Abn.  LFT's 08/16/05 SANDHU,HARKESH
830465 -                  ..
830466 -            17.  Obesity 06/29/05 SANDHU,HARKESH
830468 -                  ..
830469 -            18.  Rosacea 06/29/05 SANDHU,HARKESH
830471 -                  ..
830472 -            19.  Tinea Unguium 06/29/05 SANDHU,HARKESH
830473 -
830474 -
8305 -

SUBJECTS
Medications Active List VA Medical Chart Progress Notes Primary Care

A103 -
A10401 -         ..
A10402 -    4.  Active Outpatient Medications (excluding Supplies):
A10404 -         ..
A10405 -        Active Outpatient Medications                                 Status
A10406 -        =========================================================================
A10407 -
A10408 -             1.  OMEPRAZOLE 20MG EC CAP TAKE TWO CAPSULES BY MOUTH
A10409 -                 ACTIVE
A10410 -
A10411 -                 TWICE A DAY 15 MINUTES BEFORE A MEAL FOR SEVERE
A10412 -                 ACID REFLUX AND ESOPHAGEAL NARROWING. **DOSE
A10413 -                 INCREASE**
A10415 -                  ..
A10416 -             2.  SIMVASTATIN 80MG TAB TAKE ONE-HALF TABLET BY MOUTH ACTIVE
A10417 -                 EVERY EVENING - FOR CHOLESTEROL*USE PILL CUTTER* DO
A10419 -                  ..
A10420 -                 NOT TAKE WITH GRAPEFRUIT JUICE.
A10421 -
A10422 -
A10423 -
A105 -

SUBJECTS
Default Null Subject Account for Blank Record

A203 -
A20401 -         ..
A20402 -    5.  Physical Examination...
A20403 -
A20404 -        1.  Most recent vitals:
A20405 -
A20406 -            1.  Temperature:     96.7 F    [35.9 C] (12/23/2010 10:36)
A20407 -            2.  Pulse:           68        (12/23/2010 10:36)
A20408 -            3.  Respirations:    20        (12/23/2010 10:36)
A20409 -            4.  B/P:             118/70    (12/23/2010 10:36)
A20410 -            5.  Height:          66 in     [167.6 cm] (12/10/2010 09:50)
A20411 -            6.  Weight:          193.8 lb  [88.1 kg] (12/23/2010 10:34)
A20412 -            7.  BMI:             31.3
A20413 -            8.  Pain:            0         (12/23/2010 10:34)
A20415 -             ..
A20416 -        2.  HEENT:    nc, at, perrl,eomi,no dns,no wax and nl tm
A20418 -             ..
A20419 -        3.  NECK:     no lymph nodes,trachea central,no bruit,no mass
A20420 -                      and no thyroid enlargment
A20422 -             ..
A20423 -        4.  LUNGS:    clear to auscultation and percussion
A20425 -             ..
A20426 -        5.  CARDIAC:  nl s1s2 no murmur,
A20428 -             ..
A20429 -        6.  ABDOMEN:  Soft, nontender, BS active, no HSM, no masses
A20431 -             ..
A20432 -        7.  EXT:      No cyanosis,clubbing or edema.
A20434 -             ..
A20435 -        8.  NEURO:    alert and oriented x3 , cn 2 -12 intact and
A20436 -                      no gross motor or sensory abnormality found
A20437 -
A20438 -
A205 -

SUBJECTS
Default Null Subject Account for Blank Record

A303 -
A30401 -         ..
A30402 -        LABS:
A30403 -        Collection DT       Spec    GLUCOSE  BUN   CREAT      NA       K    CL    CO2
A30404 -        12/07/2010 09:17    PLASMA    102     8       0.85    137     3.8   104    28
A30405 -        07/21/2010 08:54    PLASMA    117    12       0.89    139     3.9   106    28
A30407 -         ..
A30408 -        Collection DT       Spec      ALT    AST  ALK PHO   ALBUMIN  T BIL
A30409 -        12/07/2010 09:17    PLASM      22    26     102         3.9   1.0
A30410 -        07/21/2010 08:54    PLASM      24    23     109 H       4.0   1.3 H
A30412 -         ..
A30413 -        Collection DT       Spec      WBC    HGB     HCT       MCV   MCHC   PLT
A30414 -        12/07/2010 09:17    BLOOD       6.7  14.4    43.3      90.7  33.1   310
A30415 -        07/21/2010 08:54    BLOOD       7.3  14.9    44.0      91.2  33.8   344
A30417 -         ..
A30418 -        SCLU - TSH
A30419 -        Collection DT       Spec      Tsh
A30420 -        12/07/2010 09:17    SERUM       2.61
A30421 -        07/21/2010 08:54    SERUM       2.51
A30423 -         ..
A30424 -        Collection DT       Spec      CHOL  TRIGL    HDL     LDL-CHO
A30425 -        12/07/2010 09:17    PLASM     151    41      47        96
A30426 -        07/21/2010 08:54    PLASM     261 H  87      35 L     209 H
A30427 -
A30428 -
A30429 -
A305 -

SUBJECTS
Default Null Subject Account for Blank Record

A403 -
A40401 -         ..
A40402 -        ASSESSMENT AND PLAN:
A40403 -
A40404 -             1.  Cad s/p cabg ; doing well............... ref SDS 62 LW6G
A40406 -                  ..
A40407 -             2.  S/P EGD : report still pending.......... ref SDS 62 4N4O
A40409 -                  ..
A40410 -             3.  Hyperchol ;Ldl at goal. will cont
A40411 -                 current care. call in
A40412 -                 may for f/u............................. ref SDS 62 ST6G
A40414 -  ..
A40415 - Follow up in May, aligns with understandings from meeting with the
A40416 - doctor this morning, to get a blood draw in June to be prepared for
A40417 - another meeting Primary Care in July. ref SDS 62 9P83
A40418 -
A40419 -            [On 110603 1523 scheduled meeting on 110719 0830, with
A40420 -            Doctor Sandhu in Primary Care at VA in Martinez; blood draw
A40421 -            for lab report will be performed a week or so earlier.
A40422 -            ref SDS 71 6I5H; supports Doctor Egan's work plan to assess
A40423 -            cholesterol during meeting at VA on 110807. ref SDS 69 MG3I
A40424 -
A40426 -         ..
A40427 -        Clinical Reminders:
A40428 -
A40429 -             1.  Influenza Vaccine Sept 10 - Apr 11:
A40430 -
A40431 -                 Influenza Immunization ordered.......... ref SDS 62 OR6H
A40432 -
A40434 -  ..
A40435 - Myocardial Infarction Heart Disease Risks Reduced Aspirin
A40436 - Aspirin Avoid Heart Attack Side Effects Ulcers Bleeding
A40437 -
A40438 - Follow up ref SDS 62 454F.
A40439 -
A40440 -             2.  Consider Aspirin for risk of MI:
A40441 -
A40442 -                 The patient was educated on the benefits and risks of
A40443 -                 daily aspirin therapy for the prevention of myocardial
A40444 -                 infarction in patients at risk.  The patient was also
A40445 -                 informed of the risks of gastric ulcers and bleeding.
A40447 -  ..
A40448 - There was no discussion during the meeting today of aspirin and
A40449 - mycardial infarction during the meeting today, nor of gastric ulcers
A40450 - and bleeeding (see research below).
A40451 -
A40452 -            [On 110406 1230 discussion in Cardiology on taking aspirin
A40453 -            to reduce risk of heart disease and stroke for patients
A40454 -            with history of CABG, noted that not all patients take
A40455 -            aspirin; and, did not mention that taking aspirin risks
A40456 -            side effects that cause gastric ulcers and bleeding.
A40457 -            ref SDS 68 5F5J, as noted in the medical chart today, on
A40458 -            101223 1030. ref SDS 62 454F
A40460 -  ..
A40461 - There was no discussion of conflicts taking aspirin with Omeprazole,
A40462 - currently prescribed 80 mg per day, reported on 101210 0930.
A40463 - ref SDS 57 HW8H
A40464 -
A40465 -
A40470 -
A40471 -
A40473 -  ..
A405 -
A406 -
A407 - 1430
A408 -
A40801 - After the meeting, research on the Internet indicates "myocardial
A40802 - infarction (MI) is another name for heart attack....
A40803 -
A40804 -        Wikipedia says in part...
A40806 -         ..
A40807 -        Myocardial infarction
A40808 -
A40809 -              http://en.wikipedia.org/wiki/Myocardial_infarction
A40811 -         ..
A40812 -        Myocardial infarction (MI) or acute myocardial infarction
A40813 -        (AMI), commonly known as a heart attack, is the interruption
A40814 -        of blood supply to a part of the heart, causing heart cells to
A40815 -        die. This is most commonly due to occlusion (blockage) of a
A40816 -        coronary artery following the rupture of a vulnerable
A40817 -        atherosclerotic plaque, which is an unstable collection of
A40818 -        lipids (fatty acids) and white blood cells (especially
A40819 -        macrophages) in the wall of an artery. The resulting ischemia
A40820 -        (restriction in blood supply) and oxygen shortage, if left
A40821 -        untreated for a sufficient period of time, can cause damage or
A40822 -        death (infarction) of heart muscle tissue (myocardium).
A40824 -         ..
A40825 -        The risk of a recurrent myocardial infarction decreases with
A40826 -        strict blood pressure management and lifestyle changes,
A40827 -        chiefly smoking cessation, regular exercise, a sensible diet
A40828 -        for patients with heart disease, and limitation of alcohol
A40829 -        intake.
A40831 -  ..
A40832 - Currently, blood pressure is typically below 120/70 with pulse in low
A40833 - 60s upper 50s, and high 40s on waking up in the morning, reported in
A40834 - case study on 101010 0744. ref SDS 46 6Q8N
A40836 -  ..
A40837 - Aspirin was taken to reduce symptoms of flu, and this was effective on
A40838 - 101010 0744. ref SDS 46 09AB
A40840 -  ..
A40841 - Would help to get analysis of evidence for need to take aspirin based
A40842 - on diagnostics in the lab, reported on 101207, ref SDS 56 PP8W, and
A40843 - patient history on vitals listed in the record on 101010 0744.
A40844 - ref SDS 46 QJ5I  Aspirin was prescribed along with 10 other drugs to
A40845 - recover from heart surgery, reported on 091104 0718. ref SDS 18 1Q6P
A40846 - On 091218, met with cardiothoracic medical team at the VA in San
A40847 - Francisco.  Understood medications were ended, ref SDS 29 Z98L, due to
A40848 - good recovery from heart surgery 2 months earlier on 091022.
A40849 - ref SDS 12 PQWU
A40851 -  ..
A40852 - It may turn out that decision to take aspirin is independent of lab
A40853 - tests...
A40855 -  ..
A40856 - Angiogram (cardiac catheterization) examination on 091021, discovered
A40857 - 3 very severe blood vessel stenoses (strictures/blockages), listed in
A40858 - the record recently reviewing the medical chart. 100928 0706,
A40859 - ref SDS 45 H24L  During surgery a 4th stenosis was found and
A40860 - corrected
A40861 - with bypass, reported the next day on
A40863 -  ..
A40864 - Patient history shows practice of heavy exercise hiking 6 - 14 miles
A40865 - per day 5 days a week, for 5 years leading up to diagnosis of stenoses
A40866 - on 091021.  Indeed, stenosis caused chest pain while hiking that led
A40867 - patient to seek medical care, reported on 090908 1130. ref SDS 9 MY4N
A40868 -
A40869 -
A40870 -
A40871 -
A40872 -
A40873 -
A40874 -
A40875 -
A40876 -
A40877 -
A40878 -
A409 -