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: February 16, 2012 10:00 AM Thursday;
Rod Welch
VA meeting with Doctor Egan in Cardiology increase rosuvastatin 20 mg.
1...Summary/Objective
2...VA Objects Receiving Written Communication
3...Hiking Strengthens Coronary Pulmonary System Reduces Blood Pressure
4...Aspirin Not Required Platelets at Mid-Range Normal BP and Pulse
5...Bilirubin Increased with Rosuvastatin 20 MG Cause Peripheral Neuropathy
6...Peripheral Neuropathy Cause Bilirubin Increased with Rosuvastatin 20 MG
7...Resovastatin 20 Mg Continue Despite LDL 228 Significant Rise
8...Cholesterol Lab 3 Months Evaluate Rosuvastatin Replace Simvastatin
9...Progress Notes Meeting VA Cardiology Department
..............
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CONTACTS
SUBJECTS
VA Cardiology Meeting Examination Object Receive Written Communicati
1603 -
1603 - ..
1604 - Summary/Objective
1605 -
160501 - Follow up ref SDS 18 0000. ref SDS 17 0000.
160502 -
160503 -
160504 - [On 120514 1300 hyperlipidemia LDL 94 declined
160505 - significantly after increasing Rosuvastatin 20 mg and
160506 - increasing hiking. ref SDS 30 X45G
160507 -
160508 -
160510 - ..
1606 -
1607 -
1608 - Progress
1609 -
160901 - Agenda for meeting with Doctor Egan is from prior meeting on 110817
160902 - 1030, ref SDS 18 JE5I, and previously on 110415 0900. ref SDS 10 OF8F
160903 -
160905 - ..
160906 - VA Objects Receiving Written Communication
160907 -
160908 - On 110818 1051 letter to VA reports excellent meeting with Cardiology.
160909 - ref SDS 19 XA5I
160911 - ..
160912 - On 111128 0202 another letter to VA reports lab results and
160913 - implementing work plan to increase Rosuvastatin 20 mg from 10 mg,
160914 - ref SDS 26 EA4V, discussed with the doctor during meeting at the VA
160915 - on, ref SDS 18 JQ54
160917 - ..
160918 - Initially, Doctor Egan objected to the letter on 111128. ref SDS 26
160919 - NP5G The doctor was adament today that all communication with
160920 - Cardiology Department should be conversation in the examination room.
160921 - No writings can be submitted to confirm, clarify, correct, supplement,
160922 - nor commend VA work, including documents, discussion, progress notes,
160923 - and test findings and analysis.
160925 - ..
160926 - [On 120222 1427 received medical chart for work today.
160927 - ref SDS 28 KW5G
160929 - ..
160930 - [On 121206 0900 the doctor reviewed and did not further
160931 - complain nor object to letter with agenda for meeting and
160932 - associated links to analyze lab review. ref SDS 33 TS7I
160933 -
160934 -
160935 -
160936 -
1610 -
SUBJECTS
VA Cardiology Examination Prescribe Hiking 11 Miles Per Day 50 Miles
2903 -
290401 - ..
290402 - Hiking Strengthens Coronary Pulmonary System Reduces Blood Pressure
290403 -
290404 - Follow up ref SDS 18 EL9F.
290405 -
290406 - 1. Review patient history implementing VA guidance to hike for
290407 - recovering from CABG, reported on 101010 0744. ref SDS 5
290408 - 45SU
290410 - ..
290411 - Doctor Egan asked about patient continuing exercise to recover from
290412 - heart surgery and reducing risk factors for CAD patients?
290414 - ..
290415 - Reported hiking increased from August through December 2011; The
290416 - doctor feels that hiking over 180 miles in December, shown in case
290417 - study on 101010 0744, ref SDS 5 1Z4M, reflects strong motivation to
290418 - compliment medical care to maintain good health, and in particular
290419 - lower LDL < 70, discussed during the prior meeting on 110817 1030.
290420 - ref SDS 18 DG36, and originally presented on 110309 0900. ref SDS 8
290421 - ZM98
290423 - ..
290424 - Hiking declined in January to 77 miles, due to weather and mental
290425 - fatigue, and so far in February have hiked only 6 miles, as further
290426 - shown in case study on 101010 0744. ref SDS 5 225O Plan to begin
290427 - hiking again when the weather turns warmer in the spring.
290428 -
290429 - [On 120514 1300 hyperlipidemia LDL 94 declined
290430 - significantly after increasing Rosuvastatin 20 mg and
290431 - increasing hiking. ref SDS 30 X45G
290432 -
290433 -
290434 -
290435 -
290436 -
2905 -
SUBJECTS
VA Cardiology Examination Aspirin Not Prescribed Plateletts Mid Rang
4203 -
420401 - ..
420402 - Aspirin Not Required Platelets at Mid-Range Normal BP and Pulse
420403 -
420404 - Follow up ref SDS 18 IY5O.
420405 -
420406 - There was no discussion of aspirin therapy today following up drop in
420407 - platelets 286 to mid-range for the lab on 110727 1238. ref SDS 13 SL4F
420409 - ..
420410 - In the meeting on 110817, Doctor Egan explained platelets elevated
420411 - above mid-range recorded in this case during 2009-2010 can cause blood
420412 - clots that present severe health risks, especially for patients with
420413 - high blood pressure and heart rate and suffering CAD following heart
420414 - surgery (CABG - 4x), as occurred on 091022 0700. ref SDS 2 PQWU At
420415 - that time on 110817, the doctor further advised that the VA prescribes
420416 - aspirin for CAD patients to thin the blood that helps prevent blood
420417 - clots. ref SDS 18 IY5O
420419 - ..
420420 - Platelets were not included in the recent lab on 120209. ref SDS 27
420421 - KK9M
420423 - ..
420424 - Patient history on platelets...
420425 -
420426 - Collection DT PLT Range 130 - 400
420427 - 02/09/2012 11:18 --- ............... ref SDS 27 KK9M
420428 - 11/17/2011 14:27 --- ............... ref SDS 24 KK9M
420429 - 07/27/2011 12:58 286 ............... ref SDS 13 SL4F
420430 - 12/07/2010 09:17 310 ............... ref SDS 6 SL4F
420431 - 07/21/2010 08:54 344 ............... ref SDS 4 OT69
420432 - 08/13/2009 15:09 350 ............... ref SDS 1 075H
420434 - ..
420435 - Platelets at mid-range presents low risk for patients not suffering
420436 - high blood pressure and elevated heart rate, as shown in patient
420437 - history in case study on 101010 0744. ref SDS 5 NQ9F
420438 -
420439 - [On 120509 1108 plateletts 288 steady at mid-range, which
420440 - avoids risk of blood clots that otherwise require aspirin
420441 - treatment. ref SDS 29 RP4N
420443 - ..
420444 - [On 121130 0846 plateletts 254 fall below mid-range,
420445 - ref SDS 32 RP4N; hiking 700 miles and 20 pound weight loss
420446 - over 3 months avoids risk of blood clots without aspirin
420447 - treatment. ref SDS 32 868N
420449 - ..
420450 - [On 140430 0900 discussed concern hiking 11 miles causing
420451 - blood clots due to dehydration; plateletts 303 at
420452 - mid-range, blood pressure and heart rate below normal.
420453 - ref SDS 34 7J7L
420454 -
420455 -
420456 -
420457 -
420458 -
420459 -
4205 -
SUBJECTS
VA Cardiology Examination Bilirubin 1.8 Increased with Rosuvastatin
5303 -
530401 - ..
530402 - Bilirubin Increased with Rosuvastatin 20 MG Cause Peripheral Neuropathy
530403 - Peripheral Neuropathy Cause Bilirubin Increased with Rosuvastatin 20 MG
530404 -
530405 - The lab on 120209 shows Bilirubin 1.8 increased above a healthy range,
530406 - ref SDS 27 KK9M, and nearly 40% higher than prior lab Bilirubin 1.3 on
530407 - 111117 1415. ref SDS 24 KK9M
530408 -
530409 - Collection DT T Bili Range
530410 - 02/09/2012 11:18 1.8 ....0.3 - 1.2.. ref SDS 27 KK9M
530411 - 11/17/2011 14:27 1.3 ............... ref SDS 24 KK9M
530412 - 10/13/2011 14:35 1.3 ............... ref SDS 22 GM65
530413 - 07/27/2011 12:58 2.0 ............... ref SDS 13 GM65
530414 - 12/07/2010 09:17 1.0 ............... ref SDS 6 GM65
530415 - 07/21/2010 08:54 1.3 ............... ref SDS 4 GM65
530416 - 08/13/2009 15:09 1.7 ............... ref SDS 1 VG8R
530418 - ..
530419 - Elevated Bilirubin taking statin drugs like Rosuvastatin may cause
530420 - impaired liver function, shown in research on 111013 1404. ref SDS 22
530421 - LC8J
530422 -
530423 - [On 120514 1300 T bilirubin 2.5 increased 75% causing
530424 - dehydration from frequent dehydration, and peripheral
530425 - neuropathy intermittant severe episodes due to increasing
530426 - Rosuvastation 20 mg causing liver damage. ref SDS 30 3I7G
530428 - ..
530429 - Additionally, statin drugs, like Rosuvastatin, that sometimes have
530430 - side effects that elevate bilirubin (mostly people above 50), can
530431 - cause fluid loss from increased urination, peripheral neurpoathy, pale
530432 - skin, tingling feeling, reported on 110802 1639, ref SDS 14 QI3K
530434 - ..
530435 - Total Bilirubin 1.8 in recent lab on 120209, rising from 1.3 in prior
530436 - two labs, most recently on 111117, ref SDS 24 KK9M, may reflect
530437 - increasing Rosubastatin 20 mg from 10 mg on 111128, reported in case
530438 - study on patient history on 101010 0744. ref SDS 5 NV7I
530440 - ..
530441 - Bilirubin above healthy range aligns with Rosuvastatin 20 mg begun on
530442 - 111128, shown in case study on 101010 0744, ref SDS 5 NV7I, and
530443 - following lab that measured LDL 200 on 111117 1415, ref SDS 24 IM9N,
530444 - and increased from Rosuvastatin 10 mg prescribed on trial in the
530445 - meeting at the VA on 110817. ref SDS 18 DG36
530446 -
530447 -
530448 -
530449 -
530450 -
5305 -
SUBJECTS
VA Cardiology Examination Resovastatin 20 Mg LDL 228 Significant Ris
6703 -
670401 - ..
670402 - Resovastatin 20 Mg Continue Despite LDL 228 Significant Rise
670403 -
670404 - Follow up ref SDS 18 DG36.
670405 -
670406 - Doctor Egan disappointed interim lab LDL 200, shown in lab on 111117
670407 - 1415, ref SDS 24 IM9N, and that recent lab LDL 228 on 120209 1118.
670408 - ref SDS 27 IM9N
670409 -
670410 - [On 120514 1300 hyperlipidemia LDL 94 declined
670411 - significantly after increasing Rosuvastatin 20 mg and
670412 - increasing hiking. ref SDS 30 X45G
670414 - ..
670415 - Doctor Egan prescribed continuing rosuvastatin 20 mg, implementing
670416 - analysis on 110817, ref SDS 18 FE4H, to increase dose after
670417 - rosuvastatin 10 mg failed to lower LDL cholesterol, and in fact caused
670418 - significant increase in LDL cholesterol, reported in recent lab last
670419 - week on 120209 1118. ref SDS 27 2A4G
670420 -
670421 -
670423 - ..
670424 - Cholesterol Lab 3 Months Evaluate Rosuvastatin Replace Simvastatin
670425 -
670426 - Follow up ref SDS 18 JQ5F.
670427 -
670428 - Doctor Egan ordered another lab in 3 months to evaluate and adjust
670429 - rosuvastatin 20 mg, as required for lowering LDL < 70.
670430 -
670431 -
670432 -
670433 -
670434 -
670435 -
670436 -
6705 -
SUBJECTS
Default Null Subject Account for Blank Record
6803 -
680401 - ..
680402 - Progress Notes Meeting VA Cardiology Department
680403 -
680404 - Follow up
680405 -
680406 - VA file from CD with Progress Notes for meeting on 120514 are stored
680407 - at...
680409 - ..
680410 - F:\05\00003\SM\CC\AGMJ\20120514-083902\welch_052112.pdf
680411 -
680411 - F:\05\00003\SM\CC\AGMJ\20120216-084412\
680411 -
680411 -
680412 - 1. LOCAL TITLE: Cardiology 10501
680413 - STANDARD TITLE: CARDIOLOGY NOTE
680414 - DATE OF NOTE: MAY 14, 2012@08:39
680415 - ENTRY DATE: MAY 14, 2012@08:39:02
680416 - AUTHOR: EGAN,JAMES EXP COSIGNER:
680417 - URGENCY: STATUS: COMPLETED
680422 - ..
680423 - 67 year old MALE followed in Cardiology Clinic for problems
680424 - including
680425 -
680426 - 1. CAD
680427 -
680428 - a) Angina, class II- III 10/2/09
680430 - ..
680431 - b) Abnormal TMST, relatively low work load 9/16/09
680433 - ..
680434 - c) CABGx4v 10/22/09 SFVA (LIMA-->LAD, SVG-->diag,
680435 - SVG-->Ramus,SVG-->PDA).
680437 - ..
680438 - 2. Hyperlipidemia
680440 - ..
680441 - 3. Achalasia, S/P laparoscopic myotomy with fundoplication at
680442 - the San Francisco VA December 2009. Subsequently recurrent
680443 - stricture, most recent dilatation 3/22/12.
680445 - ..
680446 - 4. PACs with exercise on ETT 4/6/11
680448 - ..
680449 - 2. The patient was last seen in clinic on 2/16/12 , A&P as follow:
680451 - ..
680452 - This part of Progress Notes repeats from prior notes on 120216...
680453 -
680454 - 1. ASSESSMENT:
680455 -
680456 - 1. CAD,stable, asymptomatic
680457 -
680458 - 2. Hyperlipidemia. Paradoxical increase in LDL since changed
680459 - from 40 mg simva to 10-->20 mg rosuva. Accuracy of more
680460 - recent lab in question due to noncompliance. Also note
680461 - increased bilirubin on LFTs, transaminases OK.
680463 - ..
680464 - 3. Achalasia, S/P laparoscopic myotomy with fundoplication at
680465 - the San Francisco VA December 2009. Subsequently recurrent
680466 - stricture.Followed by Dr Lee.
680468 - ..
680469 - 4. PACs with exercise on ETT 4/6/11
680471 - ..
680472 - 2. PLAN:
680473 -
680474 - 1. Current medications reconciled.
680475 -
680476 - 2. Have rewritten rosuvastatin to 20 mg daily.
680477 -
680478 - 3. RTC 3 months with lipids, LFTs, CK one week prior. In the
680479 - interim he will ry to get back to a more regular exercise
680480 - schedule. If LDL remains at this level will have to
680481 - consider change back to simvastatin or increase to 40 mg
680482 - dose rosuva.
680484 - ..
680485 - 3. Clinical Reminders:
680486 -
680487 - LDL >=100 - High Risk Goal <100:
680488 -
680489 - No lipid treatment change is needed based on patient's
680490 - current status.
680492 - ..
680493 - Comment: Ran out of rosuvastatin x 3 weeks prior to lab
680494 - test
680495 -
680496 - 4. /es/ James Egan, MD
680497 - Staff Physician, Cardiology
680498 - Signed: 02/16/2012 10:50
680500 - ..
680501 - Remainder of Progress Notes pertain to meeting today on 120514...
680502 -
680503 - 3. Seen again with his sister-in-law, seems to be doing very well.
680504 - Is hiking more, 40-60 miles weekly, losing some weight. No
680505 - limitation by dyspnea, no sx suggestive of angina. No
680506 - myopathic sx, has some some mild paresthesias of feet which
680507 - seem to be resolving.
680509 - ..
680510 - 4. No history of dizziness, lightheadedness or syncope.
680511 - No palpitations.
680512 - Denies PND, Orthopnea, Edema
680514 - ..
680515 - 5. PAST MEDICAL HISTORY:
680516 -
680517 - 1. Computerized Problem List is the source for the following:
680518 -
680519 - 1. Vitamin D Deficiency 08/03/11 Sandhu, Harkesh
680521 - ..
680522 - 2. Postsurgical Aortocoronary Bypass Status (ICD-9-CM
680523 - V45.81) 03/09/11 Egan, James
680525 - ..
680526 - 3. Esophageal Stricture 03/05/10 LEE,RANDALL E
680528 - ..
680529 - 4. Screening for Malignant Neoplasms of colon 11/15/11
680530 - LEE,RANDALL E (ICD-9-CM V76.51)
680531 -
680532 - 2010 colonoscopy: no polyp. Next screen 2020
680534 - ..
680535 - 5. Coronary Atherosclerosis (unspecified type 02/02/10
680536 - LEE,RANDALL E vessel, native or graft) (ICD-9-CM 41
680538 - ..
680539 - 6. Coronary Artery Bypass using Venous and 01/04/10
680540 - SANDHU,HARKESH Arterial Grafts (Single Vein Graft),
680541 - Onset 10/00/09 done at vasf
680543 - ..
680544 - CABG was performed at VA San Francisco Medical Center on 091022.
680545 - ref SDS 3 PQWU
680547 - ..
680548 - Onset reported to VA on 090908 1130. ref SDS 2 MY4N
680550 - ..
680551 - VA Progress Notes Cardiology meeting 120514 continue...
680552 -
680553 - 7. Surgical Thoracoscopy with Esophagomyotomy 01/04/10
680554 - SANDHU,HARKESH (Heller Type), Onset 12/16/09 at vasf
680556 - ..
680557 - 8. Hyperlipidemia * (ICD-9-CM 272.4) 10/02/09 EGAN,JAMES
680559 - ..
680560 - 9. Inflamed Seborrheic Keratosis (ICD-9-CM 702.11)
680561 - 03/12/07 LIN,BERTHA
680563 - ..
680564 - 10. Rosacea * (ICD-9-CM 695.3) 03/12/07 LIN,BERTHA
680566 - ..
680567 - 11. Dermatitis * (ICD-9-CM 692.9) 03/12/07 LIN,BERTHA
680569 - ..
680570 - 12. Tinea Unguium * (ICD-9-CM 110.1) 03/12/07 LIN,BERTHA
680572 - ..
680573 - 13. Tinea * (ICD-9-CM 110.9) 03/12/07 LIN,BERTHA
680575 - ..
680576 - 14. Rosacea conjunctivitis (ICD-9-CM 372.31) 03/02/07
680577 - MARGULIES,LINDA
680579 - ..
680580 - 15. Rosacea * (ICD-9-CM 695.3) 03/02/07 MARGULIES,LINDA
680582 - ..
680583 - 16. Blepharitis NOS 02/21/07 MARGULIES,LINDA
680585 - ..
680586 - 17. Achalasia * (ICD-9-CM 530.0) 12/22/05 SANDHU,HARKESH
680588 - ..
680589 - 18. Abn. LFT's 08/16/05 SANDHU,HARKESH
680591 - ..
680592 - 19. Obesity 06/29/05 SANDHU,HARKESH
680594 - ..
680595 - 20. Rosacea 06/29/05 SANDHU,HARKESH
680597 - ..
680598 - 21. Tinea Unguium 06/29/05 SANDHU,HARKESH
680600 - ..
680601 - 2. Patient has answered NKA (no known allergies)
680603 - ..
680604 - 6. Active Outpatient Medications (including Supplies):
680605 -
680606 - 1. OMEPRAZOLE 20MG EC CAP TAKE TWO CAPSULES BY MOUTH TWICE A
680607 - ACTIVE DAY 15 MINUTES BEFORE A MEAL FOR SEVERE ACID REFLUX
680608 - AND ESOPHAGEAL NARROWING. **DOSE INCREASE**
680610 - ..
680611 - 2. ROSUVASTATIN CA 40MG TAB TAKE ONE-HALF TABLET BY MOUTH
680612 - ACTIVE ONCE DAILY - TO LOWER CHOLESTEROL. REPLACES
680613 - SIMVASTATIN *USE PILL CUTTER* (APPROVED)
680615 - ..
680616 - 7. PHYSICAL EXAM - Date: 120514 1306
680617 -
680618 - T....................... 98.0 F (36.7 C)
680619 - P....................... 92
680620 - R....................... 16
680621 - B/P..................... 103/72
680622 - Wt...................... 189.90 (80.68 KG) (ACTUAL STANDING WEIGHT)
680623 - Body Mass Index......... 31*
680624 - Pulse Oximetry.......... 95%
680625 - Pain.................... 0 - No pain
680627 - ..
680628 - 8. Head atraumatic, PERRL.
680629 - Carotid upstrokes normal, no bruits noted
680630 - Thyroid normal to palpation.
680631 - JVP wnl.
680632 - Cor:Regular, no sig mrg.
680633 - Lungs clear of rales, ronchi and wheezes.
680634 - Extremities without cyanosis, clubing or edema.
680636 - ..
680637 - 9. PLASMA 05/09 02/09 11/17 Reference
680638 - 2012 2012 2011
680639 - 11:24 11:56 14:27 Units Ranges
680640 - -------------------------------------------------------------------------------
680641 - CHOL 158 285 H 260 H mg/dL Ref: <=200
680642 - TRIGLYC 76 82 84 mg/dL Ref: <=150
680643 - HDL 49 41 43 mg/dL Ref: >=40
680644 - LDL 94 228 H 200 H mg/dL Ref: <=160
680646 - ..
680647 - These valuations align with VA lab on 120509 1108. ref SDS 9 0297
680649 - ..
680650 - VA Progress Notes Cardiology meeting 120514 continue...
680651 -
680652 - 10. ---- CHEM PROFILE ----
680653 - PLASMA 05/09 02/09 11/17 Reference
680654 - 2012 2012 2011
680655 - 11:24 11:56 14:27 Units Ranges
680656 - -------------------------------------------------------------------------------
680657 - GLUCOSE 108 113 108 mg/dL 74 - 118
680658 - GLUfast mg/dL Ref: <=99
680659 - NA 138 142 139 mmol/L 136 - 144
680660 - K 4.2 4.8 4.1 mmol/L 3.4 - 4.8
680661 - CL 105 105 103 mmol/L 98 - 106
680662 - CO2 27 28 30 mmol/L 23 - 33
680663 - BUN 17 17 11 mg/dL 8 - 26
680664 - CREAT 0.94 0.95 0.89 mg/dL .5 - 1.1
680665 - eGFR >60 >60 >60 mL/min Ref: >=60
680666 - CALCIUM 8.7 9.3 9.0 mg/dL 8.7 - 10.2
680667 - CA CORR mg/dL 8.7 - 10.2
680668 - PO4 mg/dL 2.4 - 4.5
680669 - MG mg/dL 1.8 - 2.5
680670 - ALK PHO 86 98 95 IntUnits/L 37 - 107
680671 - T. BIL 2.5 H 1.8 H 1.3 H mg/dL .3 - 1.2
680672 - D. BILI 0.3 0.2 mg/dL .1 - .4
680673 - AST 25 24 25 IntUnits/L 8 - 42
680674 - ALT 21 26 24 IntUnits/L 5 - 55
680675 - ALBUMIN 4.1 4.2 4.4 g/dL 3.3 - 4.8
680676 - PROTEIN 7.1 7.4 7.4 g/dL 6.5 - 8.1
680677 -
680679 - ..
680680 - 11. Collection DT Spec WBC HGB HCT MCV MCHC PLT
680681 - 07/27/2011 12:58 BLOOD 7.5 15.5 46.4 91.2 33.4 286
680682 - 12/07/2010 09:17 BLOOD 6.7 14.4 43.3 90.7 33.1 310
680683 -
680684 -
680685 - 12. ---- CARDIAC ENZYMES ----
680686 - PLASMA 05/09 02/09 11/17 Reference
680687 - 2012 2012 2011
680688 - 11:24 11:56 14:27 Units Ranges
680689 - -------------------------------------------------------------------------------
680690 - CK 152 126 101 IntUnits/L 36 - 340
680692 - ..
680693 - 13. ASSESSMENT:
680694 -
680695 - 1. CAD, stable asymptomatic.
680696 -
680697 - 2. Hyperlipidemia, marked improvement on rosuvastatin 20 mg
680698 - daily.
680700 - ..
680701 - 3. PACs with exercise on ETT 4/6/11
680703 - ..
680704 - 4. Paresthesias, uncertain etiology. Possibly but low
680705 - likelihood realted to rosuvastatin.
680707 - ..
680708 - 5. Hyperbilirubinemia, possible relationship to rosuvastatin
680710 - ..
680711 - 14. PLAN:
680712 -
680713 - 1. Current medications reconciled, no changes made.
680714 -
680715 - 2. Will continue current dose of rosuvastatin but will
680716 - continue to monitor bilirubin.
680718 - ..
680719 - 3. Will discuss hyperbilirubinemia and paresthesias with
680720 - Dr Sandhu at his appointment today.
680722 - ..
680723 - 4. RTC 4 months with lipids, CMP just prior.
680725 - ..
680726 - 5. Encouraged to continue hiking and planned weight loss.
680727 -
680728 - 15. /es/ James Egan, MD
680729 - Staff Physician, Cardiology
680730 - Signed: 05/14/2012 13:38
680731 -
680732 -
680733 -
680734 -
680735 -
680736 -
680737 -
680738 -
680739 -
680740 -
680741 -
680742 -
680743 -
680744 -
680745 -
680746 -
680747 -
6808 -