CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 18 0000. ref SDS 17 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Blood draw today for meeting with Doctor Egan next Thursday on 121206,
040902 - scheduled on 120906 1100. ref SDS 19 L46O
040904 - ..
040905 - Last full lab was on 120831 1400. ref SDS 18 RP4N
040907 - ..
040908 - Prior full lab was on 120509 1108, ref SDS 17 X45G; and before that on
040909 - 110727 1238, ref SDS 9 RP4N, and this was to prepare for meeting in
040910 - Primary Care a few weeks later on 110803 1400. ref SDS 10 U24I
040912 - ..
040913 - Last partial lab for lipid panel testing cholesterol and for glucose,
040914 - sodium, and total bilirubin was on 120831 1400. ref SDS 18 IM9N and
040915 - ref SDS 18 KK9M
040917 - ..
040918 - Today, in Sacramento. Want to get lab done at VA Mather for use by
040919 - Doctor Egan in Martinez next week on 121206.
040921 - ..
040922 - Called VA Sacramento...
040923 -
040924 - 916 366 5334
040926 - ..
040927 - Talked to Jessica.
040929 - ..
040930 - She said lab is ordered, and can be done at VA in Sacramento.
040932 - ..
040933 - Lab is not open on Saturday.
040935 - ..
040936 - Called Yellow Cab...
040937 -
040938 - 916 444-2222
040940 - ..
040941 - Cab will be here in 20 - 30 minutes.
040942 -
040944 - ..
0410 -
0411 -
0412 - 0854
0413 -
041301 - Cab arrives.
041302 -
041304 - ..
0414 -
0415 -
0416 - 0910
0417 -
041701 - Arrive VA, cab cost $20 with tip, so $40 round trip.
041703 - ..
041704 - Post expense ledger...
041705 -
041708 -
041710 - ..
0418 -
0419 -
0420 - 0912
0421 -
042101 - Picked number for processing to get lab.
042102 -
042103 - While standing to register for blood draw, right foot again suffered
042104 - moderate peripheral neuropathy, causing loss of feeling. Walked a few
042105 - laps through halls of VA. Problem began to subside.
042106 -
042107 -
042108 -
042110 - ..
0422 -
0423 -
0424 - 0944
0425 -
042501 - Number called to order lab.
042502 -
042504 - ..
0426 -
0427 -
0428 - 1020
0429 -
042901 - Called for blood draw...
042902 -
042904 - ..
042905 - Blood Tests Evaluate Health 8 Months After Surgery
042906 -
042907 - Follow up ref SDS 18 RP4N, ref SDS 17 RP4N.
042909 - ..
042910 - Prior CBC on 120509 1108. ref SDS 17 RP4N
042911 - Prior CBC on 120831 1524. ref SDS 18 RP4N
042912 -
042913 - CBC........... 2012 11 30 1001 120831
042914 - Blood Results Results Units Range
042915 - WBC 7.5 H 10.9 K/cmm 4.8 - 10.8
042916 - RBC 4.86 5.37 M/cmm 4.7 - 6.1
042917 - HGB 14.5 16.3 g/dL 14 - 18
042918 - HCT 43.9 48.8 % 42 - 52
042919 - MCV 90.3 90.3 fL 80 - 99
042920 - MCH 29.8 30.3 uug 27 - 34
042921 - MCHC 33.0 33.3 gm/dL 32 - 35.2
042922 - RDW 13.7 13.0 % 11.5 - 14.5
042923 - PLT 254 291 K/cmm 130 - 400
042924 - MPV 8.4 8.4 fL 7 - 10.4
042925 - NEUT % 71.5 78.7 % 40 - 80
042926 - LYMPH % L 18.5 L 13.0 % 20 - 51
042927 - MONO % 7.8 6.9 % 2 - 13
042928 - EOS % 1.2 1.1 % .5 - 7
042929 - BASO % 0.9 0.3 % 0 - 2
042930 - NEUT # 5.4 H 8.6 K/cmm 1.5 - 7.9
042931 - LYMPH # 1.4 1.4 K/cmm 1.2 - 3.4
042932 - MONO # 0.6 0.8 K/cmm .2 - 1.2
042933 - EOS # 0.1 0.1 K/cmm .1 - .5
042934 - BASO # 0.1 0.0 K/cmm 0 - .2
042935 - ESRmVES mm/hr 0 - 10
042936 - ESRxCYT mm/hr 2 - 10
042937 - RETIC % % .66 - 2.85
042938 - RETIC # k/uL 27.9 - 121.6
042940 - ..
042941 - Comments:
042942 -
042943 - a. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.
042945 - ..
042946 - WBC and NEUTS declining within range to correct prior elevated lab on
042947 - 120831 1400, ref SDS 18 RP4N, may indicate Fluconazole was effective
042948 - treating esophagus infection candidus possibly caused by Rosuvastatin
042949 - 20 mg for 6 months causing dehydration and dry mouth and throat, and
042950 - diagnosed with biopsy on 120925, and treatment begun on 121004,
042951 - ref SDS 21 2M8J, and shown in case study on 101010 0744. ref SDS 6
042952 - 1W9L
042954 - ..
042955 - Lymph % low increased to near range and significantly higher than
042956 - prior lab on 120831 1400. ref SDS 18 RP4N
042957 -
042958 -
042959 -
042960 -
042961 -
042962 -
0430 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Total Bilirubin 1.6 Improvement Due to Rosuvastatin 10 Reduced from 20 MG
050403 - Salt Sodium Increases to High-range Indicates Conflict with Lab
050404 - Glucose Rises Toward High End Range Indicates Conflict with Lab
050405 -
050406 - Follow up ref SDS 18 KK9M, ref SDS 17 KK9M.
050407 -
050408 - Prior CHEM PROFILE on 120509 1108. ref SDS 17 KK9M
050409 - Prior CHEM PROFILE on 120831 1524. ref SDS 18 KK9M
050410 -
050411 - ELECTROLYTES
050413 - ..
050414 - CHEM PROFILE... 2012 11 30 1001 120831
050415 - PLASMA Results Results Units Range
050416 - GLUCOSE 115 113 mg/dL 74 - 118
050417 - GLUfast mg/dL Ref: <=99
050418 - NA (salt) 144 141 mmol/L 136 - 144
050419 - K (potasium) H 5.2 3.8 mmol/L 3.4 - 4.8
050420 - CL H 107 H 109 mmol/L 98 - 106
050421 - CO2 28.7 24 mmol/L 23 - 33
050422 - BUN 21 16 mg/dL 8 - 26
050423 - CREAT 0.84 1.02 mg/dL .5 - 1.1
050424 - eGFR >60 >60 mL/min Ref: >=60
050425 - CALCIUM 9.3 9.1 mg/dL 8.7 - 10.2
050426 - CA CORR mg/dL 8.7 - 10.2
050427 - PO4 mg/dL 2.4 - 4.5
050428 - MG mg/dL 1.8 - 2.5
050429 - ALK PHO 80 93 IntUnits/L 37 - 107
050430 - T. BIL H 1.6 2.3 mg/dL .3 - 1.2
050431 - D. BILI 0.2 0.3 mg/dL .1 - .4
050432 - AST 22 33 IntUnits/L 8 - 42
050433 - ALT 21 35 IntUnits/L 5 - 55
050434 - ALBUMIN 4.1 4.3 g/dL 3.3 - 4.8
050435 - PROTEIN 6.8 7.5 g/dL 6.5 - 8.1
050436 - LDH IntUnits/L 90 - 208
050437 - AMYLASE Units/L 28 - 100
050438 - LIPASE Units/L 7 - 58
050439 - NH3 mcmol/L 15 - 56
050440 - URIC AC mg/dL 4.8 - 8.7
050441 - Comments: a
050443 - ..
050444 - a. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.
050446 - ..
050447 - b. Evaluation for CREAT:
050448 -
050449 - Effective 7/2/08, new standardized method for
050450 - creatinine in place. Note reference range change.
050451 - Previous range 0.5-1.2 mg/dL.
050453 - ..
050454 - c. Evaluation for ALK PHO:
050455 -
050456 - The normal range is for an adult population less than
050457 - 50 years old. Alk Phos increases with age over 50 to
050458 - about 60% higher values by ages greater than 75 years
050459 - old.
050461 - ..
050462 - d. Evaluation for eGFR:
050463 -
050464 - eGFR Units = mL/min/1.73 square meters
050465 -
050467 - ..
050468 - Chlorine elevated slightly declined to only 1 point above range,
050469 - improving prior lab on 120831 1400, ref SDS 18 WJ5H; has no evident
050470 - correlation with health issues.
050472 - ..
050473 - On 121001 0820 VA online pharmacy shows Doctor Lee ordered Omeprazole
050474 - with 3 new refills to continue new prescripton for Omeprazole 20 mg
050475 - twice per day. ref SDS 20 Q84L Doctor Lee also ordered Fluconazole
050476 - 200 mg without refills - evidently to epxeriment on reducing
050477 - "electrolyte abnormalities," ref SDS 20 RF44, which lab today shows T
050478 - Bilirubin 2.3 elevated 100%, and Chlorine 109 elevated slightly.
050479 - ref SDS 18 KK9M
050481 - ..
050482 - Glucose and sodium (NA) show increased concentrations which conflicts
050483 - with patient history, and with hiking 700 miles over 11,000 minutes
050484 - past 3 months, see below. ref SDS 0 868N This record indicates
050485 - erroneous lab results.
050486 -
050487 - [On 121206 0900 Doctor Egan explained electrolytes test may
050488 - have been skewed showing higher labs because Rosuvastatin
050489 - has caused dehydration that increases concentration of
050490 - elements in blood, ref SDS 22 6K4J; same dehydration factor
050491 - may as well have skewed lipid lab showing higher LDL and
050492 - HDL. ref SDS 22 QG6F
050494 - ..
050495 - [On 121212 0941 re-test lab reported Glucsose 111, sodium
050496 - 139, and potasium (K) 4.6, all within range, ref SDS 23
050497 - KK9M, correcting errors from dehydration caused by
050498 - Rosuvastatin, considered by Doctor Egan during meeting at
050499 - VA on 121206 0900. ref SDS 22 6K4J
050501 - ..
050502 - Total Bilirubin 1.6 declined nearly 30% from 2.3 on prior lab 120831
050503 - 1400. ref SDS 18 WJ5H Sharp decline may reflect reducing Rosuvastatin
050504 - 10 mg from 20 mg, prescribed on 120906 1100. ref SDS 19 C739
050505 - Bilirubin reducing to range may align with reducing side effecs of
050506 - dehydration (causing dry throat and esophagus infection), dizziness
050507 - and peripheral neuropathy from taking Rosuvastatin, originally ordered
050508 - on 110817 1030, ref SDS 11 JQ54, Case study on 101010 shows dizziness
050509 - reported on 120815, ref SDS 6 TW5J, led to reducing Rosuvastatin 10 mg
050510 - from 20 mg on 120906, and then dizziness ended on 120918. ref SDS 6
050511 - SJ5J Similarly, peripheral neuropathy declined significantly on
050512 - 120918, shown in case study on 101010. ref SDS 6 UVQR
050513 -
050514 - [On 121206 0900 Doctor Egan prescribes ending treatment
050515 - with Rosuvastatin to reduce severe side effects,
050516 - ref SDS 22 I05F, and shown by elevated T Bilirubin,
050517 - ref SDS 22 NI9L, and try relying on exercise and weight
050518 - loss to lower cholesterol. ref SDS 22 OS5L
050520 - ..
050521 - [On 131017 1000 VA medical chart Progress Notes assessment
050522 - report doctor concerned about chronic hyperbilirubinemia.
050523 - ref SDS 24 PSXT
050525 - ..
050526 - Peripheral neuropathy remains challenging side effect shown in recent
050527 - report from case study on 101010, citing experience on 121201.
050528 - ref SDS 6 ST6K
050529 -
050530 - [On 121206 0900 Doctor Egan concerned about elevated
050531 - potasium (K) 5.2 well above healthy range limit 4.8, and so
050532 - ordered retest to assess effects of dehydration taking
050533 - Rosuvastatin. ref SDS 22 6K56
050534 -
050535 -
050536 -
050537 -
050538 -
0506 -
SUBJECTS
Default Null Subject Account for Blank Record
0603 -
060401 - ..
060402 - LDL 105 Falls Rosuvastatin 50% Less Hike 700 Miles Weight Lose 20 Pounds
060403 -
060404 - Follow up ref SDS 18 IM9N, ref SDS 17 IM9N.
060405 -
060406 - Work plan changed simvastatin 40 mg to rosuvastatin 10 mg on 110817
060407 - 1030. ref SDS 13 DG36 Increase rosuvastatin to 20 mg following lab on
060408 - 111117 1415. ref SDS 14 IM9N, was not effective reducing cholesterol
060409 - LDL < 70, planned in meeting on 110817 1030, ref SDS 13 JQ54
060411 - ..
060412 - On 120214 decided to continue Rosuvastatin 20 mg. ref SDS 16 DG36
060414 - ..
060415 - Results today may indicate weakening response to treatment.
060417 - ..
060418 - Prior LIPID PANEL 120509 1108. ref SDS 17 IM9N
060419 - Prior LIPID PANEL 120831 1525. ref SDS 18 IM9N
060421 - ..
060422 - LIPID PANEL.... 2012 11 30 1001 120831
060423 - PLASMA Results Results Units Range
060424 - CHOL 173 176 mg/dL Ref: <=200
060425 - TRIGLYC 53 94 mg/dL Ref: <=150
060426 - HDL 57 47 mg/dL Ref: >=40
060427 - LDL 105 110 mg/dL Ref: <=160
060428 - LDL Dir mg/dL Ref: <=160
060429 - TRIG NF mg/dL Ref: <=150
060430 - Comments: a
060432 - ..
060433 - a. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.
060435 - ..
060436 - b. Evaluation for LDL-CHO:
060437 -
060438 - RISK CATEGORY LDL GOAL
060439 - CHD and CHD risk equivalents <100 mg/dL
060440 - Multiple (2+) risk factors <130 mg/dL
060441 - 0-1 risk factor <160 mg/dL
060443 - ..
060444 - HDL Chol. greater than/equal to 60 mg/dL counts as "negative" risk
060445 - factor; its presence removes 1 risk factor from the total count.
060447 - ..
060448 - Ref: Adult Treatment Panel III (ATP III) JAMA 5/16/01 Vol. 285 #19.
060450 - ..
060451 - Follow up prior lipid history on 120209 1118. ref SDS 13 R85N.
060453 - ..
060454 - Collection DT CHOL TRIGL HDL LDL-CHO
060455 - 11/30/2012 10:01 173 53 57 105 ..... ref SDS 0 BE6O
060456 - 08/31/2012 15:25 176 94 47 110 ..... ref SDS 18 U89N
060457 - 05/09/2012 11:24 158 76 49 94 ..... ref SDS 17 U89N
060458 - 02/09/2012 11:18 285 82 41 228 H ..... ref SDS 13 2A4G
060459 - 11/17/2011 14:27 260 84 43 200 H ..... ref SDS 12 2A4G
060460 - 07/27/2011 12:58 163 81 45 102 ..... ref SDS 9 E19L
060461 - 12/07/2010 09:17 151 41 47 96 ..... ref SDS 8 E19L
060462 - 07/21/2010 08:54 261 H 87 35 L 209 H ..... ref SDS 4 E19L
060463 - 06/10/2010 10:33 217 H 83 36 L 164 H ..... ref SDS 3 QV4F
060464 - * 12/14/2009 11:10 241 H 136 44 170 H ..... 100928 0706, ref SDS 5 VW6J
060465 - 08/13/2009 15:09 233 H 118 30 L 179 H ..... 100610 1046, ref SDS 3 U45G
060466 - 06/16/2006 10:59 238 H 68 32 L 192 H ..... 091002 0900, ref SDS 1 LJ5H
060467 -
060468 - * Lab at VA San Francisco Medical Center reported on 100928 0706.
060469 - ref SDS 5 VW6J
060471 - ..
060472 - Graph of LDL history shown on 120209 1118. ref SDS 13 7M42
060474 - ..
060475 - Research on cholesterol reported on 091002 0900. ref SDS 1 2F8K
060477 - ..
060478 - Public literature reports LDL cholesterol labs are difficult to
060479 - measure accurately, shown on 111117 1415. ref SDS 12 MR7O This aligns
060480 - erratic LDL measurements in this case, shown above, ref SDS 0 W25L,
060481 - and noted in patient history on 120209 1118. ref SDS 13 7M42, and
060482 - previously citing 40 increase in just 1 month after declining steadly
060483 - for 4 years, shown on 100721 0800. ref SDS 4 PTPP
060485 - ..
060486 - [On 121206 0900 Doctor Egan explained electrolyte lab may
060487 - have been skewed to show electrolytes abnormally higher
060488 - because Rosuvastatin has caused dehydration that increases
060489 - concentration of blood elements, ref SDS 22 6K4J; similarly
060490 - dehydration may have skewed lipid lab showing higher LDL
060491 - and HDL. ref SDS 22 QG6F
060493 - ..
060494 - [On 121206 0900 Doctor Egan prescribed ending Rosuvastatin
060495 - without switching to another cholesterol drug, and to test
060496 - in 3 months for continued progress reducing LDL < 70.
060497 - ref SDS 22 OS5L
060499 - ..
060500 - After prior lab on 120831....
060501 -
060502 - 1. Hiking Miles Minutes
060503 -
060504 - September 97 1493....... ref SDS 6 T46I
060505 - October 270 4398....... ref SDS 6 IQ7H
060506 - November 323 4808....... ref SDS 6 464M
060507 - ----- ------
060508 - 690 10699 --> 455 hours
060510 - ..
060511 - 2. Weight
060512 -
060513 - Declined from about 200 pounds in August 2012, to 180
060514 - pounds beginning December 2012 (down to 173 after hiking
060515 - 17 miles, reported on 121129 - day before lab on 121130,
060516 - shown in case study on 101010 0744. ref SDS 6 UM4J).
060517 -
060519 - ..
060520 - 3. Vitals.........see daily reporting...e.g., 121127..... ref SDS 6 TK5H
060521 -
060522 - Blood pressure declined from average 128 70 to 122 65
060523 - combining data for both arms, and with right arm on side
060524 - of CABG showing lowest results.
060525 -
060526 - Heart rate resting declined from about 57 to 50
060528 - ..
060529 - Published guidance for cardio vascular health, reported
060530 - in the record on 100305 1000. ref SDS 2 SU6K
060532 - ..
060533 - Guidance on heart rate also listed on 100305 1000.
060534 - ref SDS 2 MR4N
060536 - ..
060537 - 4. Medication
060538 -
060539 - Rosuvastatin 10 mg reduced 50% past 3 months from 20 mg
060540 - per day prior 6 months.
060542 - ..
060543 - Mixed results hiking 700 miles and 11,000 minutes (455 hours) with 20
060544 - pound weight loss caused cholesterol 173 and HDL 105 to fall slightly.
060545 - TRIGLYC 53 reduced nearly 50% from 94. HDL 57 increased about 25%
060546 - from 47, well above any prior lab in patient history.
060548 - ..
060549 - Patient history of LDL rising above 200 on 2nd cycle after falling to
060550 - nearly 90 over past several years was avoided with hiking 700 miles
060551 - and weight loss. Historically LDL should have increased significantly
060552 - this cycle relying primarily on Rosuvastatin 10 mg medication. Slight
060553 - decline rather than steep increase signals favorable results, despite
060554 - benefits of Rosuvastatin having expired, as occurred previously with
060555 - Simvastatin, reported on 110727 1238. ref SDS 9 PTPP
060557 - ..
060558 - Benefits of triglycerides 53 falling 50% is not evident in the record.
060560 - ..
060561 - Typically HDL 57 rising 25% is favorable, but not as favorable as
060562 - declining LDL < 70.
060564 - ..
060565 - Slight decrease in LDL 105 while reducing Rosuvastatin 10 mg by 50%
060566 - may signal favorable results for exercise and weight loss protocol.
060568 - ..
060569 - Continuing current protocol of 700 miles and 15 pound weight loss to
060570 - 165 pounds over next 3 months might achieve breakthrough reducing HDL
060571 - toward goal of < 70.
060573 - ..
060574 - Ending Rosuvastatin while continuing exercise and weight loss protocol
060575 - for next 3 months might also achieve further decline in LDL and
060576 - increased HDL.
060578 - ..
060579 - Ending Rosuvastatin will end side effects of peripheral neuropathy and
060580 - dehydration, see report today waiting for blood draw, above.
060581 - ref SDS 0 PH3M, and reported in case study on 101010 0744. ref SDS 6
060582 - ST6K
060583 -
060584 - [On 121206 0900 Doctor Egan prescribed ending Rosuvastatin
060585 - without switching to another cholesterol drug, and to test
060586 - in 3 months for continued progress reducing LDL < 70.
060587 - ref SDS 22 OS5L
060589 - ..
060590 - Maintaining 700 miles hiking may be problematic due to loss of focus,
060591 - and with winter weather and rising injuries...
060592 -
060593 - 1. Left hip
060594 - 2. Left shoulder
060595 - 3. Left knee
060597 - ..
060598 - Of the three injuries, left knee is most severely damaged, but so far
060599 - responds well to Glucosamine Chondroitin. Need similar remedy for hip
060600 - and shoulder. Shoulder can be protected somewhat by not swinging the
060601 - arm for part of a hike.
060603 - ..
060604 - Left shoulder pain is markedly different from myopathy pain caused by
060605 - Simvastatin, and which contributed to switching Rosuvastatin in the
060606 - meeting at the VA on 110817 1030. ref SDS 11 DG36
060608 - ..
060609 - In the prior case left shoulder hurt to lift the arm in any direction
060610 - above horizontal, reported during meeting at VA on 110817 1030,
060611 - ref SDS 11 QF6W, and citing daily report on 101224 in case study on
060612 - 101010 0744. ref SDS 6 554N This seemed like a muscle issue caused by
060613 - side effects taking Simvastatin, and discussed with Doctor Sandhu on
060614 - 110803 1400. ref SDS 10 RP4F
060616 - ..
060617 - Painful left shoulder in this case seems to occur from swinging the
060618 - arm hiking long distances. There is no pain lifting the arm above
060619 - horizontal nor placing left hand behind head, as occurred with
060620 - Simvastatin.
060621 -
060622 -
060623 -
060624 -
060625 -
060626 -
060627 -
060628 -
060629 -
060630 -
0607 -