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: May 14, 2012 01:00 PM Monday; Rod Welch

VA Cardiology meeting with Doctor Egan LDL 94 Dropped 150.

1...Summary/Objective
2...Resovastatin 20 Mg Continue Despite LDL 228 Significant Rise
3...Bilirubin Increased 75% with Rosuvastatin 20 MG Cause Peripheral Neuropathy
4...Peripheral Neuropathy Intermittant Severe Bilirubin Increased 75% Rosuvastatin 20 MG
5...Progress Notes Meeting VA Cardiology Department


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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 -