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: December 6, 2012 09:00 AM Thursday;
Rod Welch
VA meeting Doctor Egan on LDL, Rosuvastatin.
1...Summary/Objective
2...Agenda Submitted for Cardiology Meeting This Morning 0930
3...Meeting Cardiology Followed Agenda Submitted Earlier Today
4...Peripheral Neuropathy Recurrence Possible Referral Neurology
5...Bilirubin Declines Aligns with Peripheral Neuropathy Less Frequent
6...Peripheral Neuropathy Less Frequent Aligns with Bilirubin Declines
7...Postasium Elevated Health Risk CAD Cause Dehydration Rosuvastatin
8...Dehydration Skew Labs Shown by Conflicting Glucose Sodium Potasium
9...Retest Electrolytes Ordered Evaluate Lab Skewed by Dehydration
10...Labs Skewed Dehydration Retest Ordered Verify Patient Condition
11...Clinical Trial Phase I Exercise Weight Lower Cholesterol Reduce Drugs 50%
12...Dehydration Skewed Cholesterol Labs LDL 70 Remains Goal
13...LDL Cholesterol Lab Mixed Results Possibly Skewed by Dehydration
14...Phase II Clinical Trial Cholesterol Manage with Exercise Weight Loss
15...LDL Lower Without Drugs Clinical Trial 3 Months Hiking Weight Loss
16...Rosuvastatin End Rely on Hiking Weight Loss Lower LDL cholesterol
17...Peripheral Neuropathy Parathesia Reduced Dizziness Resolved
18...Rosuvastatin Side Effects Subsided After Reducing Dose
19...Left Shoulder Pain Swinging Arm Hiking Long Distance Not Myopathy
20...Rosacia Recurrance Past 2 Weeks
..............
Click here to comment!
CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 11 0000, ref SDS 10 0000.
040502 -
040503 - Letter to medical team submits agenda for meeting this morning in
040504 - Cardiology to review recent lab and develop work plan. ref SDS 0 D95H
040505 - While waiting 30 minutes to see the doctor walked outside around the
040506 - clinic and suffered peripheral neuropathy in right foot. Subsided on
040507 - increasing pace for 10 minutes. ref SDS 0 ZX7G WBC reduced within
040508 - range shows response to treatment with Fluconalole recovering from
040509 - esophageal infection discovered in biopsy on 120925. ref SDS 0 2Y4F
040510 - Bilirubin lab declining sharply to nearly within range corrects side
040511 - effects of Rosuvastatin after reducing dose 50% past 3 months.
040512 - ref SDS 0 NI9L This further aligns with reduced peripheral
040513 - neuropathy. Recent recurrence, however, indicates other "internal"
040514 - factors may need examination by Neurology Department. ref SDS 0 VL3F
040515 - Sudden increase in glucose, sodium (NA) and potasium (K) conflict with
040516 - patient history, and with hiking 700 miles past 3 months. ref SDS 0
040517 - NI5J The doctor cited potasium rising above healthy range presents
040518 - risk for CAD patients. Dehydration from increased urination side
040519 - effects of Rosuvastatin may skew concentration of labs. Doctor
040520 - ordered retest to verify status. ref SDS 0 6K4J Dehydration could
040521 - also skew labs for cholesterol, masking effects of increased exercise
040522 - and weight loss over past 3 months. ref SDS 0 2N4G Doctor Egan ended
040523 - Rosuvastatin to eliminate side effects of peripheral neuropathy and
040524 - dehydration. Phase II clinical trial labs ordered in 3 months testing
040525 - progress to reduce LDL < 70 relying on hiking and weight loss without
040526 - medication. ref SDS 0 OS5L Left shoulder pain swinging arm on long
040527 - hikes seems different from myopathy caused previously taking
040528 - Simvastatin. ref SDS 0 OE9I Recurrence of rosacia on forehead above
040529 - right eye will be reported in Progress Notes. ref SDS 0 SU6F
040530 -
040531 -
040532 -
040533 -
040535 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Agenda Submitted for Cardiology Meeting This Morning 0930
040902 -
040903 - This morning submitted letter to Doctor Egan with copy to primary
040904 - care physician, Doctor Sandhu, and saying...
040905 -
040906 - 1. Subject: Agenda Meeting VA Lab Review CAD Recovery
040907 - Date: Thu, 06 Dec 2012 08:05:26 -0800
040912 - ..
040913 - 2. Dear Doctor Egan,
040915 - ..
040916 - 3. Made some progress past 3 months with increased exercise to 700
040917 - miles and weight loss 20 pounds.
040919 - ..
040920 - 4. Lab review shows potential to eliminate Rosuvastatin that will
040921 - in turn avoid side effects, while continuing to lower LDL and
040922 - increase HDL. Lab shows progress on throat disorders, but
040923 - cites injuries to hip and shoulder from hiking, as further set
040924 - out in the record today with agenda for meeting at 0900 this
040925 - morning. ref SDS 0 TS7I
040927 - ..
040928 - 5. See you soon.
040930 - ..
040931 - 6. Sincerely,
040933 - ..
040934 - 7. Rod
040935 -
040936 -
040938 - ..
040939 - Arrived 0855 for 0900 meeting. Gale at the reception counter said the
040940 - meeting is actually at 0930. Kathy and I walked around the building a
040941 - few times, and then walked into the hospital across the street just to
040942 - explore, since have never been in that facility. A nurse at one of
040943 - the counters indicated this is mainly a rehab center.
040945 - ..
040946 - During this slow, social walk peripheral neuropathy occurred in right
040947 - foot and increased to mild severity. On scale of 1 - 10, this was 4.
040948 - Picked up pace walking around the outside of the clinic. In about 10
040949 - minutes, tingling subsided.
040951 - ..
040952 - Returned to Cardiology at 0930. Nurse took vitals. For some reason
040953 - higher than this morning, shown in case study on 101010 0744.
040954 - ref SDS 2 GC6N
040955 -
040956 - Time Left BP HR Right BP HR Differentials
040957 - 0615........... 120 67 51 112 67 51 8 0 0
040958 - 0618........... 116 66 51 112 69 52 4 -3 -1
040959 - 0623........... 116 61 51 109 67 50 7 -6 1
040960 - 0628........... 114 62 51 113 62 48 1 0 3
040961 -
040962 -
040963 -
040964 -
0410 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
0504 - 0930
050501 - ..
050502 - Meeting Cardiology Followed Agenda Submitted Earlier Today
050503 -
050504 - Doctor Egan started the meeting OA 0945. He reported having received
050505 - the letter submitted this morning, per above, ref SDS 0 D95H, and that
050506 - he read this record cited in the letter with associated links relevant
050507 - to issues presented today, including lab review on 121130. ref SDS 15
050508 - RP4N There may have been progress on patient communications following
050509 - the meeting on 120216 1000. ref SDS 9 3M4H
050511 - ..
050512 - Following the meeting, this record was transformed into a report on
050513 - discussion and work plans.
050515 - ..
050516 - Reviewed results of lab on 121130. ref SDS 15 RP4N
050517 -
050518 - 121130 120831
050519 - 1. WBC 7.5 10.9 4.8 - 10.8
050520 -
050521 - Reduction of WBC within range aligns with patient history...
050522 -
050523 - a. Sore throat from Rosuvastatin dehydration causing dry
050524 - mouth and sore throat.
050526 - ..
050527 - Rosuvastatin 10 mg reduced from 20 mg in meeting with
050528 - Doctor Egan at VA on 120906. ref SDS 11 W16H
050530 - ..
050531 - Biopsy on 120925 discovered esophageal infection candida.
050532 - Doctor Lee prescribed Fluconazole, beginning on 121004,
050533 - received from VA, reported in case study on 101010 0744.
050534 - ref SDS 2 1W9L Treatment ended on 121024, also shown in
050535 - case study. ref SDS 2 QQ7K
050537 - ..
050538 - While infection seems resolved shown by WBC dropping witin
050539 - range, slight sore throat recurred, and continues.
050541 - ..
050542 - On 120925 Doctor Lee at VA in Sacramento made referral for
050543 - follow up examination of Heller Myotomy surgery on 091216
050544 - to resolve achalasia, and specifically at this time reflux
050545 - laying on left side, shown in record on 120925 0900,
050546 - ref SDS 12 6J9G On 121013 Doctor Stewart and Doctor Vaughn
050547 - made examination at VA Medical Center in San Francisco
050548 - discovered horse voice disorder. ref SDS 13 AE7K Barrium
050549 - swallow test was ordered and performed on 121113.
050550 - ref SDS 14 4X5H Doctor Stewart made referral for ENT
050551 - examination of voice disorder, scheduled for 121221.
050553 - ..
050554 - b. Blisters under arms from hiking resolved.
050556 - ..
050557 - c. Blisters on lower legs resolved.
050558 -
050559 -
050560 -
050561 - 121130 120831
050562 - ..
050563 - 2. Lymph % 18.5 13.0 20 - 51
050564 -
050565 - Significant increase to near normal.
050567 - ..
050568 - No discussion during meeting today.
050569 -
050570 -
050571 -
0506 -
SUBJECTS
Default Null Subject Account for Blank Record
0603 -
060401 - ..
060402 - Peripheral Neuropathy Recurrence Possible Referral Neurology
060403 - Bilirubin Declines Aligns with Peripheral Neuropathy Less Frequent
060404 - Peripheral Neuropathy Less Frequent Aligns with Bilirubin Declines
060405 -
060406 -
060407 - 121130 120831
060408 - 3. T Bilirubin 1.6 2.3 .3 - 1.2 ......... 121130 0846, ref SDS 15 KK9M
060410 - ..
060411 - Sharp decline may reflect reducing Rosuvastatin 10 mg from 20 mg
060412 - ordered by Doctor Egan on 120906, ref SDS 11 C739, and implemented in
060413 - patient history shown in case study on 101010 0744. ref SDS 2 SQ6H
060414 - Lab review on 121130, further correlates lower bilirubin with reduced
060415 - peripheral neuropathy. ref SDS 15 ER4K
060417 - ..
060418 - Peripheral neuropathy recent recurrance, including today, per above,
060419 - ref SDS 0 D95H, indicates continuing challenge taking Rosuvastatin 10
060420 - mg, reported with lab review on 121130 0846, ref SDS 15 ER4K, and
060421 - citing record on 121201 shown in case study on 101010 0744.
060422 - ref SDS 2 ZD5H
060423 -
060424 - [...below on 121206 0900 Doctor Egan prescribes ending
060425 - treatment with Rosuvastatin to reduce severe side effects,
060426 - listed below, ref SDS 0 I05F, and shown by elevated T
060427 - Bilirubin, above, ref SDS 0 NI9L, and try relying on
060428 - exercise and weight loss to lower cholesterol. ref SDS 0
060429 - OS5L
060431 - ..
060432 - [On 131017 1000 doctor explained patient history of
060433 - intermittant and mild peripheral neuropathy that correlates
060434 - with persistent elevated T Bilirubin in lab on 131015,
060435 - ref SDS 19 015M, and further reported with vitals, diet and
060436 - exercise since prior meeting at VA on 130603, see case
060437 - study on 120101 0900, ref SDS 8 X14N, suggests
060438 - intervention is not required at this time to improve
060439 - recovery from side effects taking Rosuvastatin. ref SDS 20
060440 - LV5J
060442 - ..
060443 - Doctor Egan advised today that Rosuvastatin 10 mg may not be causing
060444 - peripheral neuropathy, and in particular recent recurrance, including
060445 - today, per above. ref SDS 0 H766 He said that something "internal"
060446 - may be the cause, and asked if Doctor Sandhu has made referral to
060447 - neurology for examination?
060449 - ..
060450 - Referral for neurology may be indicated.
060451 -
060452 - [On 130122 1330 peripheral neuropathy parathesia discussed
060453 - Doctor Stewart in General Surgery at VA Medical Center in
060454 - San Francisco, ref SDS 17 0S3K; preliminary diagnosis
060455 - spinal stenosis, referral made to Neurology Department.
060456 - ref SDS 17 OE6N
060457 -
060458 -
060459 -
0605 -
SUBJECTS
Default Null Subject Account for Blank Record
0703 -
070401 - ..
070402 - Postasium Elevated Health Risk CAD Cause Dehydration Rosuvastatin
070403 - Dehydration Skew Labs Shown by Conflicting Glucose Sodium Potasium
070404 - Retest Electrolytes Ordered Evaluate Lab Skewed by Dehydration
070405 - Labs Skewed Dehydration Retest Ordered Verify Patient Condition
070406 -
070407 -
070408 - 121130 120831
070409 - 4. GLUCOSE 115 113 mg/dL 74 - 118....... 121130 0846, ref SDS 15 WJ5H
070410 - 5. NA (salt) 144 141 mmol/L 136 - 144
070411 - 6. K (potasium) H 5.2 3.8 mmol/L 3.4 - 4.8
070413 - ..
070414 - Discussed conflict in lab showing glucose and sodium rising while
070415 - hiking 700 miles in 11,000 minutes past 3 months, shown in lab review
070416 - on 121130 0846. ref SDS 15 868N Explained black coat hiking is covered
070417 - with white salt pouring out of body, and there has been no change in
070418 - diet adding salt nor sugar. While daily consumption of sugar and salt
070419 - may be higher than for most patients, they were decreased over past 3
070420 - months, and have never shown this level of concentration.
070421 - Accordingly, increased hiking would be expected to lower these labs
070422 - rather than cause rising levels.
070424 - ..
070425 - Doctor Egan advised that NA (sodium) may have increased toward high
070426 - end of range rather than significantly decreased, because of
070427 - dehydration caused by Rosuvastatin 10 mg prescribed to lower LDL, per
070428 - below. ref SDS 0 2N4G
070429 -
070430 - [On 121212 0941 follow up, ref SDS 16 KK9M
070432 - ..
070433 - Patient reported today that urinating has increased even without
070434 - increased fluids, i.e., drinking water or anything. For example, last
070435 - night 5 - 6 times, similar to effect of Lasix that causes body to lose
070436 - liquid.
070438 - ..
070439 - Another signal of dehydration is increased cramping in legs and back
070440 - on stretching or turning in odd manner. This normally occurs after
070441 - long hikes, but in past 3 weeks or so problem seems to be continual.
070443 - ..
070444 - The doctor explained Labs measure concentration of elements, like
070445 - glucose, sodium... in the bloodstream, which is mostly water.
070446 - Accordingly, increased urination increases concentration of sodium in
070447 - the blood, and so may account for evident error in electrolytes lab,
070448 - per above. ref SDS 0 NI5J
070450 - ..
070451 - Patient further questioned accuracy of glucose. Hiking 700 miles
070452 - (roughtly 11 miles per day) for past 3 months should have lowered both
070453 - glucose and salt, but lab on 121130 reports rise. ref SDS 0 NI5J
070455 - ..
070456 - Doctor Egan was more concerned about potasium (K) rising above target
070457 - range for good health. He explained this effects electrical signals
070458 - to the heart, and so has significant impact for CAD.
070460 - ..
070461 - This analysis raises prospect that entire lab was skewed by loss of
070462 - liquid through increased urination causing dehydration, a side effect
070463 - of Rosuvastatin, reported on 110802 1639. ref SDS 3 IT9N Rosuvastatin
070464 - was prescribed on 110817 1030, ref SDS 6 DG36, and treatment started
070465 - on 110824, see discussion below. ref SDS 0 OS5L
070467 - ..
070468 - The doctor advised that tomatos and bananas, both prominent in patient
070469 - history, e.g., 121130 shown in case study on 101010 0744, ref SDS 2
070470 - X75H, are rich in potassium. Doctor Egan further explained that
070471 - ordinary diet does not cause increased potasium. He seemed to say
070472 - that medication conflicts can cause potasium lab to rise.
070474 - ..
070475 - Since Omeprazole has been taken with Rosuvastatin for past 18 months,
070476 - beginning on 110824 (see case study on 101010 0744. ref SDS 2 KF8O),
070477 - and since potasium has never been elevated, this seems to support
070478 - analysis today that dehydration explains elevated electrolytes.
070479 -
070480 - [...below on 121206 0900 analysis indicating LDL and HDL
070481 - might be skewed higher by excessive dehydration.
070482 - ref SDS 0 QG6F
070484 - ..
070485 - Doctor Egan ordered retest to verify electrolytes labs.
070487 - ..
070488 - Test will be performed tomorrow.
070490 - ..
070491 - Might delay test until Monday on 121210, to allow time for reduced
070492 - urination after ending Rosuvastatin (ordered today, per below.
070493 - ref SDS 0 OS5L This might restore normal concentration levels in the
070494 - blood, unless something else is driving dehydration.
070495 -
070496 -
070497 -
0705 -
SUBJECTS
Default Null Subject Account for Blank Record
0803 -
080401 - ..
080402 - Clinical Trial Phase I Exercise Weight Lower Cholesterol Reduce Drugs 50%
080403 - Dehydration Skewed Cholesterol Labs LDL < 70 Remains Goal
080404 - LDL Cholesterol Lab Mixed Results Possibly Skewed by Dehydration
080405 -
080406 - Follow up ref SDS 11 C739.
080407 -
080408 - 121130 120831
080409 - ..
080410 - 7. LDL 105 110 <= 160 ........... 121130 0846, ref SDS 15 BE6O
080411 - HDL 57 47 >= 140
080413 - ..
080414 - On 120906 LDL cholesterol increased slightly. At that time 3 months
080415 - ago, decided to reduce Rosuvastatin 10 mg by 50% from 20 mg, and test
080416 - lowering LDL cholesterol and increasing HDL through exercise and
080417 - weight loss. ref SDS 11 C739
080419 - ..
080420 - Doctor Egan indicated during the meeting that he reviewed analysis
080421 - hiking 700 miles and weight loss past 3 months shown with the record
080422 - for the recent lab on 121130 0846. ref SDS 15 868N
080424 - ..
080425 - These lab results may justify ending Rosuvastatin to avoid side
080426 - effects of peripheral neuropathy and dehydration, per discussion on
080427 - skewed labs for electrolytes, above, ref SDS 0 NI5J, while continuing
080428 - to reduce LDL and increase HDL cholesterol to manage CAD.
080429 -
080430 - [...below on 121206 0900 Doctor Egan prescribes ending
080431 - treatment with Rosuvastatin to reduce severe side effects,
080432 - listed below, ref SDS 0 I05F, and shown by elevated T
080433 - Bilirubin, above, ref SDS 0 NI9L, and try relying on
080434 - exercise and weight loss to lower cholesterol. ref SDS 0
080435 - OS5L
080437 - ..
080438 - Continuing level of effort hiking 700 miles over next 3 months will be
080439 - challenged by winter weather and by injuries to shoulder and hip,
080440 - cited in lab review on 121130 0846. ref SDS 15 SY4L
080441 -
080442 -
080443 -
080444 -
0805 -
SUBJECTS
Default Null Subject Account for Blank Record
0903 -
090401 - ..
090402 - Phase II Clinical Trial Cholesterol Manage with Exercise Weight Loss
090403 - LDL Lower Without Drugs Clinical Trial 3 Months Hiking Weight Loss
090404 - Rosuvastatin End Rely on Hiking Weight Loss Lower LDL cholesterol
090405 -
090406 - Today, Doctor Egan prescribed ending Rosuvastatin ordered previously
090407 - during the meeting at the VA on 110817, ref SDS 6 DG36, to replace
090408 - Simvastatin and begun on 110824, as shown in case study on 101010
090409 - 0744. ref SDS 2 KF8O The doctor ordered another lab in 3 months to
090410 - test lowering LDL cholesterol without drug medications, and continuing
090411 - hiking exercise and weight loss, as shown in record reviewing the
090412 - recent lab on 121130. ref SDS 15 868N
090413 -
090414 - [On 131017 1000 doctor explained patient history of
090415 - intermittant and mild peripheral neuropathy that correlates
090416 - with persistent elevated T Bilirubin in lab on 131015,
090417 - ref SDS 19 015M, and further reported with vitals, diet and
090418 - exercise since prior meeting at VA on 130603, see case
090419 - study on 120101 0900, ref SDS 8 X14N, suggests intervention
090420 - is not required at this time to improve recovery from side
090421 - effects taking Rosuvastatin. ref SDS 20 LV5J
090423 - ..
090424 - [On 131017 1000 VA medical chart Progress Notes assessment
090425 - report doctor concerned about chronic hyperbilirubinemia.
090426 - ref SDS 20 PSXT
090428 - ..
090429 - Doctor Egan emphasized objective for CAD patient to reduce LDL < 70
090430 - after having heart surgery (CABG 4x) on 091022 0700. ref SDS 1 PQWU
090431 - The doctor indicated that increasing HDL 57 was likely due to
090432 - increased exercise, and was very positive and in some respects reduces
090433 - risks of LDL > 70, found in the recent lab.
090435 - ..
090436 - [On 101010 0744 patient history medication, diet, exercise
090437 - and vitals reports ending Rosuvastatin today. ref SDS 2
090438 - GC6N
090440 - ..
090441 - Explanation today of dehydration through frequent urination caused by
090442 - Rosuvastatin affecting concentrations of labs for Bilirubin,
090443 - ref SDS 0 NI9L, Glucose and sodium, possibly potassium, might also
090444 - affect LDL and HDL, i.e., LDL and HDL might both be lower, per above
090445 - discussion. ref SDS 0 NI5J
090446 -
090447 -
090448 -
090449 -
0905 -
SUBJECTS
Default Null Subject Account for Blank Record
1003 -
100401 - ..
100402 - Peripheral Neuropathy Parathesia Reduced Dizziness Resolved
100403 - Rosuvastatin Side Effects Subsided After Reducing Dose
100404 -
100405 - Side effects of Rosuvastatin are listed in the record on 110802 1639.
100406 - ref SDS 4 AT4J
100407 -
100408 - 1. Dizziness
100409 -
100410 - Completely resolved by ending Rosuvastatin, and so ending major
100411 - disorder reported during meeting at VA on 120906 1100.
100412 - ref SDS 11 5L6H
100414 - ..
100415 - 2. Urination increased frequency, reported on 111128 0202.
100416 - ref SDS 7 EB3R
100418 - ..
100419 - 3. Periperhal neuropathy follow up report at prior meeting on
100420 - 120906 1100, ref SDS 11 2I4G, and originally reported to the VA
100421 - on 120514 1300. ref SDS 10 6I70
100423 - ..
100424 - Mostly resolved for several months with increased hiking to 700
100425 - miles past 3 months, per above, ref SDS 0 0R3L, but recent
100426 - moderate recurrance while waiting to get blood draw at VA on
100427 - 121130 0846. ref SDS 15 PH3M, and again today while waiting to
100428 - meet with Doctor Egan, per above, ref SDS 0 H766, indicates
100429 - continuing challenges, reported on 121201 and shown in case
100430 - study on 101010 0744. ref SDS 2 ZD5H
100431 -
100432 - [On 131017 1000 doctor explained patient history of
100433 - intermittant and mild peripheral neuropathy that correlates
100434 - with persistent elevated T Bilirubin in lab on 131015,
100435 - ref SDS 19 015M, and further reported with vitals, diet and
100436 - exercise since prior meeting at VA on 130603, see case
100437 - study on 120101 0900, ref SDS 8 X14N, suggests intervention
100438 - is not required at this time to improve recovery from side
100439 - effects taking Rosuvastatin. ref SDS 20 LV5J
100441 - ..
100442 - Doctor Egan advised today discussing correlation with taking
100443 - Rosuvastatin 10 mg to manage cholesterol may not be causing peripheral
100444 - neuropathy, ref SDS 0 VL3F, and in particular recent recurrance,
100445 - including today, also above. ref SDS 0 H766 He said that something
100446 - "internal" may be the cause, and asked if Doctor Sandhu has made
100447 - referral to neurology for examination?
100449 - ..
100450 - Referral for neurology may be indicated.
100451 -
100452 - [On 130122 1330 peripheral neuropathy parathesia discussed
100453 - Doctor Stewart in General Surgery at VA Medical Center in
100454 - San Francisco, ref SDS 17 0S3K; preliminary diagnosis
100455 - spinal stenosis, referral made to Neurology Department.
100456 - ref SDS 17 OE6N
100458 - ..
100459 - [On 130227 0930 Doctor Abrams in VA Neurology Department
100460 - made clinical examination and reported there is no evidence
100461 - of spinal stenosis nor diabetes. ref SDS 18 UT6T
100462 -
100464 - ..
100465 - 4. Sore throat due to dehydration
100466 -
100467 - Horse voice will be examined by ENT on 121221. Doctor Lee has
100468 - advanced next EGD dilation from April to 130110 (January 10).
100469 -
100470 -
100471 -
1005 -
SUBJECTS
Default Null Subject Account for Blank Record
1103 -
110401 - ..
110402 - Left Shoulder Pain Swinging Arm Hiking Long Distance Not Myopathy
110403 -
110404 - Left shoulder pain is markedly different from myopathy pain caused by
110405 - Simvastatin, and which contributed to switching to Rosuvastatin in the
110406 - meeting at the VA on 110817 1030. ref SDS 6 DG36
110408 - ..
110409 - In the prior case last year, left shoulder hurt to lift the arm in any
110410 - direction above horizontal, reported during meeting at VA on 110817
110411 - 1030, ref SDS 5 QF6W, and citing daily report on 101224 in case study
110412 - on 101010 0744. ref SDS 2 554N This seemed like a muscle issue caused
110413 - by side effects taking Simvastatin, and discussed with Doctor Sandhu
110414 - on 110803 1400. ref SDS 15 RP4F
110416 - ..
110417 - Painful left shoulder in this case beginning 2 weeks ago OA 121126,
110418 - shown in case study on 101010 0744, ref SDS 2 9X4L, seems to occur
110419 - from swinging the arm hiking long distances. There is no pain lifting
110420 - the arm above horizontal nor placing left hand behind head, as
110421 - occurred with Simvastatin.
110422 -
110423 -
110424 -
110425 -
1105 -
SUBJECTS
Default Null Subject Account for Blank Record
1203 -
120401 - ..
120402 - Rosacia Recurrance Past 2 Weeks
120403 -
120404 - Doctor Egan will report in Progress Notes rosacia recurrence evident
120405 - above right eye. May be caused by increased perspiration from
120406 - hiking, and/or some exposure to sun on a few days when hiking without
120407 - a hat because of cloud cover.
120408 -
120409 -
120410 -
120411 -
120412 -
120413 -
120414 -
120415 -
120416 -
120417 -
120418 -
120419 -
1205 -