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


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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 -