CONTACTS
SUBJECTS
VA Cardiology Examination Resovastatin 20 Mg LDL 94 Significant Decl
3703 -
3703 - ..
3704 - Summary/Objective
3705 -
370501 - Follow up ref SDS 8 0000, ref SDS 7 0000.
370502 -
370503 -
370504 -
370505 -
370507 - ..
3706 -
3707 -
3708 - Progress
3709 -
370901 - Resovastatin 20 Mg Continue Despite LDL 228 Significant Rise
370902 -
370903 - Follow up ref SDS 6 DG36, ref SDS 2 DG36.
370904 -
370905 - Congratulated Doctor Egan achieving dramatic decline in cholesterol
370906 - LDL 94, lowest level in patient history, shown in lab last week on
370907 - 120509 1108. ref SDS 9 X45G This improvement reflects the doctor's
370908 - determination to continue Rosuvastatin 20 mg despite multiple
370909 - increases in LDL reported on 120216 1000. ref SDS 6 DG36
370911 - ..
370912 - Reported increased hiking with improved vitals, shown by patient
370913 - history in case study citing the record today and listed on 120101
370914 - 0900. ref SDS 4 SSWX
370916 - ..
370917 - Doctor Egan noted low blood pressure taken before the meting today.
370918 -
370919 -
370920 -
3710 -
SUBJECTS
VA Cardiology Examination Bilirubin 2.5 Increased with Rosuvastatin
5603 -
560401 - ..
560402 - Bilirubin Increased 75% with Rosuvastatin 20 MG Cause Peripheral Neuropathy
560403 - Peripheral Neuropathy Intermittant Severe Bilirubin Increased 75% Rosuvastatin 20 MG
560404 -
560405 - Follow up ref SDS 6 6S9I.
560406 -
560407 - The doctor asked about new symptoms.
560409 - ..
560410 - Dehydration from frequent urination continues, reported during prior
560411 - meeting on 120216 1000. ref SDS 6 A24N
560413 - ..
560414 - Further reported rising peripheral neuropathy in feet and less so but
560415 - some in the right hand. This follows increasing the dose of
560416 - medication to Rosuvastatin 20 mg from 10 mg, reported in the record on
560417 - 120216 1000. ref SDS 6 DG36
560419 - ..
560420 - May align with significant 75% increase in Bilirubin 2.5, shown in the
560421 - recent lab on 120509 1108. ref SDS 9 KK9M
560423 - ..
560424 - There is minimal neuropathy during hikes. Mild Sensations occur after
560425 - .25 to .50 miles, and continue for about a mile or so, then subside
560426 - and do not return for the duration of the hike, either 11 miles in
560427 - Concord, or 3 - 11 miles at Lafayette Reservoir. This first occurred
560428 - on the right foot several months ago starting out on the 11 mile
560429 - Concord hike, reported on 120422 shown in case study on 101010 0744.
560430 - ref SDS 1 RQQT No further episodes to the right foot. There has
560431 - been regular neuropathy in the left foot, while hiking as noted in
560432 - this paragraph.
560433 -
560434 - [On 120906 1100 meeting with Doctor Egan in VA Cardiology
560435 - report peripheral neuropathy parathesia has continued with
560436 - reduced frequency and severity after increasing hiking.
560437 - ref SDS 10 2I4G
560439 - ..
560440 - [On 121206 0900 report to VA continued reduced frequency
560441 - and severity peripheral neuropathy parathesia after hiking
560442 - 700 miles over 3 months. ref SDS 11 PK5K
560444 - ..
560445 - [On 121206 0900 Doctor Egan advised during meeting at VA
560446 - Cardiology Department that taking Rosuvastatin medication
560447 - may not be causing peripheral neuropathy parathesa, and
560448 - something internal may be the real cause, referral to
560449 - Neurology department may be needed. ref SDS 11 GS4H
560451 - ..
560452 - [On 130122 1330 peripheral neuropathy parathesia discussed
560453 - Doctor Stewart in General Surgery at VA Medical Center in
560454 - San Francisco, ref SDS 12 0S3K; preliminary diagnosis
560455 - spinal stenosis, referral made to Neurology Department.
560456 - ref SDS 12 OE6N
560458 - ..
560459 - While standing, for example preparing a meal in the kitchen for 20
560460 - mintues, or waiting in line at Costco to pay for groceries, mild
560461 - peripheral neuropathy occurs in the right foot. This subsides after
560462 - moving again to the car, and then sitting down to drive, or at home to
560463 - eat or work.
560465 - ..
560466 - Yesterday on 120513, experienced the most severe episode of peripheral
560467 - neruopthy. It began while walking only a short distance from the car
560468 - in the parking lot at a shopping area to the store and then back to
560469 - the car. This affected only the right foot. There were no "pins and
560470 - needles" sensations, rather the foot was numb. This numbness made
560471 - walking very difficult. On returning to the car and sitting down, the
560472 - problem was completely resolved. On reaching home about 10 minutes
560473 - later, there were no further problems walking and no further
560474 - sensations of peripheral neuropathy parathesia that day, reported in
560475 - case study on 101010 0744. ref SDS 1 F97O
560477 - ..
560478 - Periperhal neuropathy (pins and needles) first reported in the record
560479 - on 120422, shown in case study on 101010 0744. ref SDS 1 RQQT
560480 -
560481 -
560482 - [On 120625 another severe episode of peripheral neuropathy
560483 - in right foot that lasted entire hike at American River,
560484 - shown in case study on 101010. ref SDS 1 7G5M
560486 - ..
560487 - [On 120906 1100 meeting with Doctor Egan in VA Cardiology
560488 - report peripheral neuropathy parathesia has continued with
560489 - reduced frequency and severity after increasing hiking.
560490 - ref SDS 10 2I4G
560492 - ..
560493 - [On 121206 0900 report to VA continued reduced frequency
560494 - and severity peripheral neuropathy parathesia after hiking
560495 - 700 miles over 3 months. ref SDS 11 PK5K
560497 - ..
560498 - [On 121206 0900 Doctor Egan advised during meeting at VA
560499 - Cardiology Department that taking Rosuvastatin medication
560500 - may not be causing peripheral neuropathy parathesa, and
560501 - something internal may be the real cause, referral to
560502 - Neurology department may be needed. ref SDS 11 GS4H
560504 - ..
560505 - [On 130122 1330 peripheral neuropathy parathesia discussed
560506 - Doctor Stewart in General Surgery at VA Medical Center in
560507 - San Francisco, ref SDS 12 0S3K; preliminary diagnosis
560508 - spinal stenosis, referral made to Neurology Department.
560509 - ref SDS 12 OE6N
560510 -
560511 -
560512 -
560513 -
5606 -
SUBJECTS
Default Null Subject Account for Blank Record
5703 -
570401 - ..
570402 - Progress Notes Meeting VA Cardiology Department
570403 -
570404 - Follow up
570405 -
570406 - VA file from CD with Progress Notes for meeting on 120514 are stored
570407 - at...
570409 - ..
570410 - F:\05\00003\SM\CC\AGMJ\20120514-083902\welch_052112.pdf
570411 -
570412 - 1. LOCAL TITLE: Cardiology 10501
570413 - STANDARD TITLE: CARDIOLOGY NOTE
570414 - DATE OF NOTE: MAY 14, 2012@08:39
570415 - ENTRY DATE: MAY 14, 2012@08:39:02
570416 - AUTHOR: EGAN,JAMES EXP COSIGNER:
570417 - URGENCY: STATUS: COMPLETED
570422 - ..
570423 - 67 year old MALE followed in Cardiology Clinic for problems
570424 - including
570425 -
570426 - 1. CAD
570427 -
570428 - a) Angina, class II- III 10/2/09
570430 - ..
570431 - b) Abnormal TMST, relatively low work load 9/16/09
570433 - ..
570434 - c) CABGx4v 10/22/09 SFVA (LIMA-->LAD, SVG-->diag,
570435 - SVG-->Ramus,SVG-->PDA).
570436 -
570438 - ..
570439 - 2. Hyperlipidemia
570441 - ..
570442 - 3. Achalasia, S/P laparoscopic myotomy with fundoplication at
570443 - the San Francisco VA December 2009. Subsequently recurrent
570444 - stricture, most recent dilatation 3/22/12.
570446 - ..
570447 - 4. PACs with exercise on ETT 4/6/11
570449 - ..
570450 - 2. The patient was last seen in clinic on 2/16/12 , A&P as follow:
570452 - ..
570453 - This part of Progress Notes repeats from prior notes on 120216...
570454 -
570455 - 1. ASSESSMENT:
570456 -
570457 - 1. CAD,stable, asymptomatic
570458 -
570459 - 2. Hyperlipidemia. Paradoxical increase in LDL since changed
570460 - from 40 mg simva to 10-->20 mg rosuva. Accuracy of more
570461 - recent lab in question due to noncompliance. Also note
570462 - increased bilirubin on LFTs, transaminases OK.
570464 - ..
570465 - 3. Achalasia, S/P laparoscopic myotomy with fundoplication at
570466 - the San Francisco VA December 2009. Subsequently recurrent
570467 - stricture.Followed by Dr Lee.
570469 - ..
570470 - 4. PACs with exercise on ETT 4/6/11
570472 - ..
570473 - 2. PLAN:
570474 -
570475 - 1. Current medications reconciled.
570476 -
570477 - 2. Have rewritten rosuvastatin to 20 mg daily.
570478 -
570479 - 3. RTC 3 months with lipids, LFTs, CK one week prior. In the
570480 - interim he will ry to get back to a more regular exercise
570481 - schedule. If LDL remains at this level will have to
570482 - consider change back to simvastatin or increase to 40 mg
570483 - dose rosuva.
570485 - ..
570486 - 3. Clinical Reminders:
570487 -
570488 - LDL >=100 - High Risk Goal <100:
570489 -
570490 - No lipid treatment change is needed based on patient's
570491 - current status.
570493 - ..
570494 - Comment: Ran out of rosuvastatin x 3 weeks prior to lab
570495 - test
570496 -
570497 - 4. /es/ James Egan, MD
570498 - Staff Physician, Cardiology
570499 - Signed: 02/16/2012 10:50
570501 - ..
570502 - Remainder of Progress Notes pertain to meeting today on 120514...
570503 -
570504 - 3. Seen again with his sister-in-law, seems to be doing very well.
570505 - Is hiking more, 40-60 miles weekly, losing some weight. No
570506 - limitation by dyspnea, no sx suggestive of angina. No
570507 - myopathic sx, has some some mild paresthesias of feet which
570508 - seem to be resolving.
570510 - ..
570511 - 4. No history of dizziness, lightheadedness or syncope.
570512 - No palpitations.
570513 - Denies PND, Orthopnea, Edema
570515 - ..
570516 - 5. PAST MEDICAL HISTORY:
570517 -
570518 - 1. Computerized Problem List is the source for the following:
570519 -
570520 - 1. Vitamin D Deficiency 08/03/11 Sandhu, Harkesh
570522 - ..
570523 - 2. Postsurgical Aortocoronary Bypass Status (ICD-9-CM
570524 - V45.81) 03/09/11 Egan, James
570526 - ..
570527 - 3. Esophageal Stricture 03/05/10 LEE,RANDALL E
570529 - ..
570530 - 4. Screening for Malignant Neoplasms of colon 11/15/11
570531 - LEE,RANDALL E (ICD-9-CM V76.51)
570532 -
570533 - 2010 colonoscopy: no polyp. Next screen 2020
570535 - ..
570536 - 5. Coronary Atherosclerosis (unspecified type 02/02/10
570537 - LEE,RANDALL E vessel, native or graft) (ICD-9-CM 41
570539 - ..
570540 - 6. Coronary Artery Bypass using Venous and 01/04/10
570541 - SANDHU,HARKESH Arterial Grafts (Single Vein Graft),
570542 - Onset 10/00/09 done at vasf
570544 - ..
570545 - CABG was performed at VA San Francisco Medical Center on 091022.
570546 - ref SDS 3 PQWU
570548 - ..
570549 - Onset reported to VA on 090908 1130. ref SDS 2 MY4N
570551 - ..
570552 - VA Progress Notes Cardiology meeting 120514 continue...
570553 -
570554 - 7. Surgical Thoracoscopy with Esophagomyotomy 01/04/10
570555 - SANDHU,HARKESH (Heller Type), Onset 12/16/09 at vasf
570557 - ..
570558 - 8. Hyperlipidemia * (ICD-9-CM 272.4) 10/02/09 EGAN,JAMES
570560 - ..
570561 - 9. Inflamed Seborrheic Keratosis (ICD-9-CM 702.11)
570562 - 03/12/07 LIN,BERTHA
570564 - ..
570565 - 10. Rosacea * (ICD-9-CM 695.3) 03/12/07 LIN,BERTHA
570567 - ..
570568 - 11. Dermatitis * (ICD-9-CM 692.9) 03/12/07 LIN,BERTHA
570570 - ..
570571 - 12. Tinea Unguium * (ICD-9-CM 110.1) 03/12/07 LIN,BERTHA
570573 - ..
570574 - 13. Tinea * (ICD-9-CM 110.9) 03/12/07 LIN,BERTHA
570576 - ..
570577 - 14. Rosacea conjunctivitis (ICD-9-CM 372.31) 03/02/07
570578 - MARGULIES,LINDA
570580 - ..
570581 - 15. Rosacea * (ICD-9-CM 695.3) 03/02/07 MARGULIES,LINDA
570583 - ..
570584 - 16. Blepharitis NOS 02/21/07 MARGULIES,LINDA
570586 - ..
570587 - 17. Achalasia * (ICD-9-CM 530.0) 12/22/05 SANDHU,HARKESH
570589 - ..
570590 - 18. Abn. LFT's 08/16/05 SANDHU,HARKESH
570592 - ..
570593 - 19. Obesity 06/29/05 SANDHU,HARKESH
570595 - ..
570596 - 20. Rosacea 06/29/05 SANDHU,HARKESH
570598 - ..
570599 - 21. Tinea Unguium 06/29/05 SANDHU,HARKESH
570601 - ..
570602 - 2. Patient has answered NKA (no known allergies)
570604 - ..
570605 - 6. Active Outpatient Medications (including Supplies):
570606 -
570607 - 1. OMEPRAZOLE 20MG EC CAP TAKE TWO CAPSULES BY MOUTH TWICE A
570608 - ACTIVE DAY 15 MINUTES BEFORE A MEAL FOR SEVERE ACID REFLUX
570609 - AND ESOPHAGEAL NARROWING. **DOSE INCREASE**
570611 - ..
570612 - 2. ROSUVASTATIN CA 40MG TAB TAKE ONE-HALF TABLET BY MOUTH
570613 - ACTIVE ONCE DAILY - TO LOWER CHOLESTEROL. REPLACES
570614 - SIMVASTATIN *USE PILL CUTTER* (APPROVED)
570616 - ..
570617 - 7. PHYSICAL EXAM - Date: 120514 1306
570618 -
570619 - T....................... 98.0 F (36.7 C)
570620 - P....................... 92
570621 - R....................... 16
570622 - B/P..................... 103/72
570623 - Wt...................... 189.90 (80.68 KG) (ACTUAL STANDING WEIGHT)
570624 - Body Mass Index......... 31*
570625 - Pulse Oximetry.......... 95%
570626 - Pain.................... 0 - No pain
570628 - ..
570629 - 8. Head atraumatic, PERRL.
570630 - Carotid upstrokes normal, no bruits noted
570631 - Thyroid normal to palpation.
570632 - JVP wnl.
570633 - Cor:Regular, no sig mrg.
570634 - Lungs clear of rales, ronchi and wheezes.
570635 - Extremities without cyanosis, clubing or edema.
570637 - ..
570638 - 9. PLASMA 05/09 02/09 11/17 Reference
570639 - 2012 2012 2011
570640 - 11:24 11:56 14:27 Units Ranges
570641 - -------------------------------------------------------------------------------
570642 - CHOL 158 285 H 260 H mg/dL Ref: <=200
570643 - TRIGLYC 76 82 84 mg/dL Ref: <=150
570644 - HDL 49 41 43 mg/dL Ref: >=40
570645 - LDL 94 228 H 200 H mg/dL Ref: <=160
570647 - ..
570648 - These valuations align with VA lab on 120509 1108. ref SDS 9 0297
570650 - ..
570651 - VA Progress Notes Cardiology meeting 120514 continue...
570652 -
570653 - 10. ---- CHEM PROFILE ----
570654 - PLASMA 05/09 02/09 11/17 Reference
570655 - 2012 2012 2011
570656 - 11:24 11:56 14:27 Units Ranges
570657 - -------------------------------------------------------------------------------
570658 - GLUCOSE 108 113 108 mg/dL 74 - 118
570659 - GLUfast mg/dL Ref: <=99
570660 - NA 138 142 139 mmol/L 136 - 144
570661 - K 4.2 4.8 4.1 mmol/L 3.4 - 4.8
570662 - CL 105 105 103 mmol/L 98 - 106
570663 - CO2 27 28 30 mmol/L 23 - 33
570664 - BUN 17 17 11 mg/dL 8 - 26
570665 - CREAT 0.94 0.95 0.89 mg/dL .5 - 1.1
570666 - eGFR >60 >60 >60 mL/min Ref: >=60
570667 - CALCIUM 8.7 9.3 9.0 mg/dL 8.7 - 10.2
570668 - CA CORR mg/dL 8.7 - 10.2
570669 - PO4 mg/dL 2.4 - 4.5
570670 - MG mg/dL 1.8 - 2.5
570671 - ALK PHO 86 98 95 IntUnits/L 37 - 107
570672 - T. BIL 2.5 H 1.8 H 1.3 H mg/dL .3 - 1.2
570673 - D. BILI 0.3 0.2 mg/dL .1 - .4
570674 - AST 25 24 25 IntUnits/L 8 - 42
570675 - ALT 21 26 24 IntUnits/L 5 - 55
570676 - ALBUMIN 4.1 4.2 4.4 g/dL 3.3 - 4.8
570677 - PROTEIN 7.1 7.4 7.4 g/dL 6.5 - 8.1
570678 -
570680 - ..
570681 - 11. Collection DT Spec WBC HGB HCT MCV MCHC PLT
570682 - 07/27/2011 12:58 BLOOD 7.5 15.5 46.4 91.2 33.4 286
570683 - 12/07/2010 09:17 BLOOD 6.7 14.4 43.3 90.7 33.1 310
570684 -
570685 -
570686 - 12. ---- CARDIAC ENZYMES ----
570687 - PLASMA 05/09 02/09 11/17 Reference
570688 - 2012 2012 2011
570689 - 11:24 11:56 14:27 Units Ranges
570690 - -------------------------------------------------------------------------------
570691 - CK 152 126 101 IntUnits/L 36 - 340
570693 - ..
570694 - 13. ASSESSMENT:
570695 -
570696 - 1. CAD, stable asymptomatic.
570697 -
570698 - 2. Hyperlipidemia, marked improvement on rosuvastatin 20 mg
570699 - daily.
570701 - ..
570702 - 3. PACs with exercise on ETT 4/6/11
570704 - ..
570705 - 4. Paresthesias, uncertain etiology. Possibly but low
570706 - likelihood realted to rosuvastatin.
570708 - ..
570709 - 5. Hyperbilirubinemia, possible relationship to rosuvastatin
570711 - ..
570712 - 14. PLAN:
570713 -
570714 - 1. Current medications reconciled, no changes made.
570715 -
570716 - 2. Will continue current dose of rosuvastatin but will
570717 - continue to monitor bilirubin.
570719 - ..
570720 - 3. Will discuss hyperbilirubinemia and paresthesias with
570721 - Dr Sandhu at his appointment today.
570723 - ..
570724 - 4. RTC 4 months with lipids, CMP just prior.
570726 - ..
570727 - 5. Encouraged to continue hiking and planned weight loss.
570728 -
570729 - 15. /es/ James Egan, MD
570730 - Staff Physician, Cardiology
570731 - Signed: 05/14/2012 13:38
570732 -
570733 -
570734 -
570735 -
570736 -
570737 -
570738 -
570739 -
570740 -
570741 -
570742 -
570743 -
570744 -
5708 -