CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
3703 -
3703 - ..
3704 - Summary/Objective
3705 -
370501 - Follow up ref SDS 5 0000.
370502 -
370503 -
370504 -
370506 - ..
3706 -
3707 -
3708 - Progress
3709 -
370901 - Reviewed results lab on 120831...
370902 -
370903 - 1. WBC 10.9 4.8 - 10.8............. 120831 1400, ref SDS 7 RP4N
370904 -
370905 - a. Sore throat from Rosuvastatin dehydration causing dry
370906 - mouth and throat.
370908 - ..
370909 - b. Blisters under arms from hiking.
370911 - ..
370912 - c. Blisters on lower legs.
370914 - ..
370915 - 2. Lymph % 13.0 20 - 51
370916 -
370917 - Lymph 1.4 1.2 - 3.4
370918 -
370919 - Wikipedia
370920 -
370921 - http://en.wikipedia.org/wiki/Lymphocyte
370923 - ..
370924 - A lymphocyte is a type of white blood cell in the
370925 - vertebrate immune system.
370927 - ..
370928 - A low normal to low absolute lymphocyte concentration is
370929 - associated with increased rates of infection after surgery
370930 - or trauma.
370932 - ..
370933 - 3. Neuts 8.6 1.5 - 7.9
370935 - ..
370936 - 4. Neuts % 78.7 40 - 80
370938 - ..
370939 - 5. T Bilirubin 2.3 .3 - 1.2
370941 - ..
370942 - 6. LDL 110 <= 160
370944 - ..
370945 - However, CAD patient has risk factors goal is < 70
370947 - ..
370948 - LDL actually increased from 94 for prior lab on 120509 1108.
370949 - ref SDS 4 IM9N
370951 - ..
370952 - Elevated WBC may be due to sore throat from past month caused by
370953 - dehydration from Rosuvastatin 20 mg.
370955 - ..
370956 - Could also be caused by severe blisters under arms from hiking.
370958 - ..
370959 - WBC can be elevated by hiking exercise, explained by Doctor Johnson at
370960 - Kaiser on 030606 1630. ref SDS 1 JP7G May not have hiked enough this
370961 - period to increase WBC.
370963 - ..
370964 - Reviewed all side effects of Rosuvastatin and Omperazole...
370965 -
370966 - 1. WBC 10.9 4.8 - 10.8......... 120831 1400, ref SDS 7 RP4N
370967 -
370968 - 2. T Bilirubin 2.3 .3 - 1.2.......... 120831 1400, ref SDS 7 KK9M
370970 - ..
370971 - 3. Dizziness
370973 - ..
370974 - Major new problem reported in patient history on 120815 0621.
370975 - ref SDS 6 HU5K, and in case study on 101010 0744. ref SDS 2 TW5J
370977 - ..
370978 - Consultation today aligns with work plan on 120815 0621. ref SDS 6
370979 - LL8I
370980 -
370981 -
370982 -
370983 -
370985 - ..
370986 - Seems to be improving.
370988 - ..
370989 - 4. Periperhal neuropathy reported on 120514 1300. ref SDS 5 6I70
370991 - ..
370992 - On 120625 another severe episode of peripheral neuropathy in right
370993 - foot that lasted entire hike at American River, shown in case study on
370994 - 101010. ref SDS 2 7G5M
370996 - ..
370997 - Since that date, patient history shows reduced frequency and severity
370998 - of peripheral neuropathy parathesia.
370999 -
371000 - [On 121206 0900 report to VA continued reduced frequency
371001 - and severity peripheral neuropathy parathesia after hiking
371002 - 700 miles over 3 months. ref SDS 9 PK5K
371004 - ..
371005 - [On 121206 0900 Doctor Egan advised during meeting at VA
371006 - Cardiology Department that taking Rosuvastatin medication
371007 - may not be causing peripheral neuropathy parathesa, and
371008 - something internal may be the real cause, referral to
371009 - Neurology department may be needed. ref SDS 9 GS4H
371011 - ..
371012 - [On 130122 1330 peripheral neuropathy parathesia discussed
371013 - Doctor Stewart in General Surgery at VA Medical Center in
371014 - San Francisco, ref SDS 10 0S3K; preliminary diagnosis spinal
371015 - stenosis, referral made to Neurology Department.
371016 - ref SDS 10 OE6N
371018 - ..
371019 - 5. Sore throat due to dehydration
371021 - ..
371022 - Seems to be improving.
371024 - ..
371025 - Doctor Egan was pleased with evident improving side effects taking
371026 - Rosuvastatin 20 mg.
371027 -
371028 -
371030 - ..
371031 - LDL Lower Reduce Drugs 50% Increase Hiking Weight Loss Clinical Trial
371032 - Phase I Clinical Trial Lower LDL Hiking Weight Reduce Rosuvastatin 50%
371033 - Rosuvastatin Reduce 50% Test Exercise and Weight Loss Trial Reduce LDL
371034 - Clinical Trial Phase I Reduce Drugs 50% Lower LDL Exercise Weight Loss
371035 -
371036 - Want to continue Rosuvastatin medication toward reducing LDL below
371037 - 70.
371039 - ..
371040 - Discussed reducing dose Rosuvastatin 20 mg to 10 mg. This will test
371041 - whether increased exercise through hiking and weight loss can control
371042 - cholesterol, specifically LDL and HDL with less reliance on drugs.
371044 - ..
371045 - Reducing Rosuvastatin will hopefully reduce side effects of
371046 - peripheral neuropathy and dehydration.
371048 - ..
371049 - Doctor Egan prescribed dose reduction for Rosuvastatin 10 mg.
371050 -
371051 - [On 121130 0846 Total Bilirubin declined 30% to nearly
371052 - within range for first time, ref SDS 8 KK9M, since starting
371053 - Rosuvastatin on 110817 1030. ref SDS 3 JQ54 Side effects
371054 - dizziness and peripheral neuropathy improve significantly.
371055 - ref SDS 8 ER4K
371057 - ..
371058 - Doctor Egan did more research and found Omeprazole can cause side
371059 - effects of dizziness.
371061 - ..
371062 - He recommended reducing dose from 40 mg to 20 mg per day, i.e.,
371063 - taking only 1 pill per day.
371065 - ..
371066 - This was agreed.
371068 - ..
371069 - Customer will receive new prescription for Rosuvastatin 20 mg, which
371070 - are cut in half to take 10 mg per day.
371072 - ..
371073 - Until new prescription is received, customer will take Rosuvastatin
371074 - 20 mg once ever other day to average 10 mg per day.
371076 - ..
371077 - Doctor Egan ordered lab in 3 months to evaluate effects of dose
371078 - reduction, so if LDL rises significantly, can consider returning to
371079 - Rosuvastatin 20 mg, and or other measures.
371081 - ..
371082 - Next meeting scheduled on Thursday, 121206 0930. Will get another lab
371083 - on Monday, 121203.
371084 -
371085 - [On 121130 0846 Total Bilirubin declined 30% to nearly
371086 - within range for first time since being treated with
371087 - Rosuvastatin. ref SDS 8 ER4K
371088 -
371089 -
371090 -
371091 -
3711 -
SUBJECTS
Default Null Subject Account for Blank Record
3803 -
380401 - ..
380402 - Progress Notes Meeting VA Cardiology Department
380403 -
380404 - Follow up ref SDS 5 S16N.
380405 -
380406 - VA file from CD with Progress Notes for meeting on 120906 are stored
380407 - at...
380408 - ..
380409 - F:\05\00003\SM\CC\AGMJ\20120906-083220\welch_091812.pdf
380410 -
380411 - 1. LOCAL TITLE: Cardiology 10501
380412 - STANDARD TITLE: CARDIOLOGY NOTE
380413 - DATE OF NOTE: SEP 06, 2012@08:32 ENTRY DATE: SEP 06, 2012@08:32:20
380414 - AUTHOR: EGAN,JAMES EXP COSIGNER:
380415 - URGENCY: STATUS: COMPLETED
380420 - ..
380421 - 67 year old MALE followed in Cardiology Clinic for problems
380422 - including
380423 -
380424 - 1. CAD
380425 -
380426 - a) Angina, class II- III 10/2/09
380428 - ..
380429 - b) Abnormal TMST, relatively low work load 9/16/09
380431 - ..
380432 - c) CABGx4v 10/22/09 SFVA (LIMA-->LAD, SVG-->diag,
380433 - SVG-->Ramus,SVG-->PDA).
380434 -
380436 - ..
380437 - 2. Hyperlipidemia
380439 - ..
380440 - 3. Achalasia, S/P laparoscopic myotomy with fundoplication at
380441 - the San Francisco VA December 2009. Subsequently recurrent
380442 - stricture, most recent dilatation 3/22/12.
380444 - ..
380445 - 4. PACs with exercise on ETT 4/6/11
380447 - ..
380448 - 2. The patient was last seen in clinic on 5/14/12 , A&P as follow:
380450 - ..
380451 - This part of Progress Notes repeats from prior notes on 120514...
380452 -
380453 - 1. ASSESSMENT:
380454 -
380455 - 1. CAD, stable asymptomatic.
380456 -
380457 - 2. Hyperlipidemia, marked improvement on rosuvastatin 20 mg
380458 - daily.
380460 - ..
380461 - 3. PACs with exercise on ETT 4/6/11
380463 - ..
380464 - 4. Paresthesias, uncertain etiology. Possibly but low
380465 - likelihood realted to rosuvastatin.
380467 - ..
380468 - 5. Hyperbilirubinemia, possible relationship to rosuvastatin
380470 - ..
380471 - 2. PLAN:
380472 -
380473 - 1. Current medications reconciled, no changes made.
380474 -
380475 - 2. Will continue current dose of rosuvastatin but will
380476 - continue to monitor bilirubin.
380478 - ..
380479 - 3. Will discuss hyperbilirubinemia and paresthesias with
380480 - Dr Sandhu at his appointment today.
380482 - ..
380483 - 4. RTC 4 months with lipids, CMP just prior.
380485 - ..
380486 - 5. Encouraged to continue hiking and planned weight loss.
380487 -
380488 - 3. /es/ James Egan, MD
380489 - Staff Physician, Cardiology
380490 - Signed: 05/14/2012 13:38
380492 - ..
380493 - Remainder of Progress Notes pertain to meeting today on 120906...
380494 -
380495 - 3. Currently seems to be doing well generally. Still hiking long
380496 - distances without symptoms suggestive of angina and without
380497 - significant limitation by dyspnea.
380498 -
380499 - 1. Several non-cardiac complaints including
380500 -
380501 - 1. intermittent paresthesias of lower extremity,
380502 -
380503 - 2. transient non-vertiginous lightheadedness,
380505 - ..
380506 - 3. dry mouth,
380507 -
380508 - 3. elevated WBC.
380509 -
380510 - 4. Would like to try decreasing rosuvastatin to 10 mg
380511 - daily to see whether any of these or elevated bilirubin
380512 - improve.
380514 - ..
380515 - 2. No palpitations.
380517 - ..
380518 - 3. Denies PND, Orthopnea, Edema
380520 - ..
380521 - 4. PAST MEDICAL HISTORY:
380522 -
380523 - 1. Computerized Problem List is the source for the following:
380524 -
380525 - 1. Vitamin D Deficiency 08/03/11 Sandhu, Harkesh
380527 - ..
380528 - 2. Postsurgical Aortocoronary Bypass Status (ICD-9-CM
380529 - V45.81) 03/09/11 Egan, James
380531 - ..
380532 - 3. Esophageal Stricture 03/05/10 LEE,RANDALL E
380534 - ..
380535 - 4. Screening for Malignant Neoplasms of colon 11/15/11
380536 - LEE,RANDALL E (ICD-9-CM V76.51)
380537 -
380538 - 2010 colonoscopy: no polyp. Next screen 2020
380540 - ..
380541 - 5. Coronary Atherosclerosis (unspecified type 02/02/10
380542 - LEE,RANDALL E vessel, native or graft) (ICD-9-CM 41
380544 - ..
380545 - 6. Coronary Artery Bypass using Venous and 01/04/10
380546 - SANDHU,HARKESH Arterial Grafts (Single Vein Graft),
380547 - Onset 10/00/09 done at vasf
380549 - ..
380550 - CABG was performed at VA San Francisco Medical Center on 091022.
380551 - ref SDS 3 PQWU
380553 - ..
380554 - Onset reported to VA on 090908 1130. ref SDS 2 MY4N
380556 - ..
380557 - VA Progress Notes Cardiology meeting 120514 continue...
380558 -
380559 - 7. Surgical Thoracoscopy with Esophagomyotomy 01/04/10
380560 - SANDHU,HARKESH (Heller Type), Onset 12/16/09 at vasf
380562 - ..
380563 - 8. Hyperlipidemia * (ICD-9-CM 272.4) 10/02/09 EGAN,JAMES
380565 - ..
380566 - 9. Inflamed Seborrheic Keratosis (ICD-9-CM 702.11)
380567 - 03/12/07 LIN,BERTHA
380569 - ..
380570 - 10. Rosacea * (ICD-9-CM 695.3) 03/12/07 LIN,BERTHA
380572 - ..
380573 - 11. Dermatitis * (ICD-9-CM 692.9) 03/12/07 LIN,BERTHA
380575 - ..
380576 - 12. Tinea Unguium * (ICD-9-CM 110.1) 03/12/07 LIN,BERTHA
380578 - ..
380579 - 13. Tinea * (ICD-9-CM 110.9) 03/12/07 LIN,BERTHA
380581 - ..
380582 - 14. Rosacea conjunctivitis (ICD-9-CM 372.31) 03/02/07
380583 - MARGULIES,LINDA
380585 - ..
380586 - 15. Rosacea * (ICD-9-CM 695.3) 03/02/07 MARGULIES,LINDA
380588 - ..
380589 - 16. Blepharitis NOS 02/21/07 MARGULIES,LINDA
380591 - ..
380592 - 17. Achalasia * (ICD-9-CM 530.0) 12/22/05 SANDHU,HARKESH
380594 - ..
380595 - 18. Abn. LFT's 08/16/05 SANDHU,HARKESH
380597 - ..
380598 - 19. Obesity 06/29/05 SANDHU,HARKESH
380600 - ..
380601 - 20. Rosacea 06/29/05 SANDHU,HARKESH
380603 - ..
380604 - 21. Tinea Unguium 06/29/05 SANDHU,HARKESH
380606 - ..
380607 - 2. Patient has answered NKA (no known allergies)
380609 - ..
380610 - 5. Active Outpatient Medications (including Supplies):
380611 -
380612 - 1. OMEPRAZOLE 20MG EC CAP TAKE TWO CAPSULES BY MOUTH TWICE A
380613 - ACTIVE DAY 15 MINUTES BEFORE A MEAL FOR SEVERE ACID REFLUX
380614 - AND ESOPHAGEAL NARROWING. **DOSE INCREASE**
380616 - ..
380617 - 2. ROSUVASTATIN CA 40MG TAB TAKE ONE-HALF TABLET BY MOUTH
380618 - ACTIVE ONCE DAILY - TO LOWER CHOLESTEROL. REPLACES
380619 - SIMVASTATIN *USE PILL CUTTER* (APPROVED)
380621 - ..
380622 - 6. PHYSICAL EXAM - Date: 120906 1103
380623 -
380624 - T....................... 98.6 F (37.0 C)
380625 - P....................... 69
380626 - R....................... 18
380627 - B/P..................... 119/70
380628 - Wt...................... 197.00 (89.55 KG) (ACTUAL STANDING WEIGHT)
380629 - Body Mass Index......... 32*
380630 - Pulse Oximetry.......... 99%
380631 - Pain.................... 0 - No pain
380633 - ..
380634 - 7. Head atraumatic, PERRL.
380635 - JVP wnl.
380636 - Cor:Regular, no ectopy. No sig mrg.
380637 - Lungs clear of rales, ronchi and wheezes.
380638 - Extremities without cyanosis, clubing or edema.
380640 - ..
380641 - 8. PLASMA 05/31 05/09 Reference
380642 - 2012 2012
380643 - 15:24 11:24 Units Ranges
380644 - -------------------------------------------------------------------------
380645 - CHOL 176 158 mg/dL Ref: <=200
380646 - TRIGLYC 94 76 mg/dL Ref: <=150
380647 - HDL 47 49 mg/dL Ref: >=40
380648 - LDL 110 94 mg/dL Ref: <=160
380650 - ..
380651 - These valuations align with VA lab on 120831 1400. ref SDS 7 KB5L
380653 - ..
380654 - VA Progress Notes Cardiology meeting 120514 continue...
380655 -
380656 - 9. ---- CHEM PROFILE ----
380657 - PLASMA 05/31 05/09 Reference
380658 - 2012 2012
380659 - 15:24 11:24 Units Ranges
380660 - -------------------------------------------------------------------------
380661 - GLUCOSE 113 108 mg/dL 74 - 118
380662 - GLUfast mg/dL Ref: <=99
380663 - NA 141 138 mmol/L 136 - 144
380664 - K 3.8 4.2 mmol/L 3.4 - 4.8
380665 - CL H 109 105 mmol/L 98 - 106
380666 - CO2 24 27 mmol/L 23 - 33
380667 - BUN 16 17 mg/dL 8 - 26
380668 - CREAT 1.02 0.94 mg/dL .5 - 1.1
380669 - eGFR >60 >60 mL/min Ref: >=60
380670 - CALCIUM 9.1 8.7 mg/dL 8.7 - 10.2
380671 - CA CORR mg/dL 8.7 - 10.2
380672 - PO4 mg/dL 2.4 - 4.5
380673 - MG mg/dL 1.8 - 2.5
380674 - ALK PHO 93 86 IntUnits/L 37 - 107
380675 - T. BIL H 2.3 H 2.5 mg/dL .3 - 1.2
380676 - D. BILI 0.3 0.3 mg/dL .1 - .4
380677 - AST 33 25 IntUnits/L 8 - 42
380678 - ALT 35 21 IntUnits/L 5 - 55
380679 - ALBUMIN 4.3 4.1 g/dL 3.3 - 4.8
380680 - PROTEIN 7.5 7.1 g/dL 6.5 - 8.1
380681 -
380683 - ..
380684 - 10. BLOOD 05/31 05/09 Reference
380685 - 2012 2012
380686 - 15:24 11:24 Units Ranges
380687 - -------------------------------------------------------------
380688 - WBC H 10.9 6.8 K/cmm 4.8 - 10.8
380689 - RBC 5.37 5.06 M/cmm 4.7 - 6.1
380690 - HGB 16.3 15.0 g/dL 14 - 18
380691 - HCT 48.8 45.8 % 42 - 52
380692 - MCV 90.3 90.7 fL 80 - 99
380693 - MCH 30.3 29.7 uug 27 - 34
380694 - MCHC 33.3 32.8 gm/dL 32 - 35.2
380695 - RDW 13.0 13.6 % 11.5 - 14.5
380696 - PLT 291 288 K/cmm 130 - 400
380697 - MPV 8.4 8.7 fL 7 - 10.4
380699 - ..
380700 - 11. EKG - NONE FOUND
380702 - ..
380703 - 12. ASSESSMENT:
380704 -
380705 - 1. CAD, stable asymptomatic.
380706 -
380707 - 2. Hyperlipidemia, Some concern with reducing rosuva as LDL is
380708 - already above goal but I am willing to attempt this for a
380709 - short period to assess for improvement in any of the above
380710 - noted symptoms.
380712 - ..
380713 - 3. Achalasia. Note that omeprazole may cause both dizziness
380714 - and paresthesias. I would favor a trial of a lower dosage.
380716 - ..
380717 - 4. Transient lightheadedness possibly due to hypotension.
380718 - Advised to caryy water on hikes and hydrate continuously
380719 - (Doesn't carry now).
380721 - ..
380722 - 13. PLAN:
380723 -
380724 - 1. Current medications reconciled, no changes made.
380725 -
380726 - 2. Decrease omeprazole to 20 mg daily for now, will discuss
380727 - with Dr Lee 9/25/12.
380729 - ..
380730 - 3. Decrease rosuvastatin to 10 mg daily with fasting lipids
380731 - and CMP 3 months.
380733 - ..
380734 - 4. RTC 4 months with lipids, CMP just prior.
380735 -
380736 -
380737 - 14. /es/ James Egan, MD
380738 - Staff Physician, Cardiology
380739 - Signed: 05/14/2012 13:38
380740 -
380741 -
380742 -
380743 -
380744 -
380745 -
380746 -
380747 -
380748 -
380749 -
380750 -
380751 -
380752 -
380753 -
380754 -
380755 -
380756 -
380757 -
380758 -
380759 -
380760 -
3808 -