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: October 15, 2013 07:24 AM Tuesday; Rod Welch

VA full lab with lipid panel test cholesterol and Ac3.

1...Summary/Objective
2...Blood Tests Evaluate Health 8 Months After Surgery
3...Total Bilirubin 1.7 Due to Rosuvastatin Recovery Failing
4...Salt Sodium Decreases Within Range Still Higher than Expected
5...Glucose Decreases Within Range Still Higher than Expected
6...LDL 249 Rises Despite Hike 1200 Miles Weight Lose 15 Pounds
7...Cholesterol LDL Lowered Heavy Exercise
8...Research indicates exercise Lowers Cholesterol Including LDL
....Exercise To Lower Cholesterol
9...Rosuvastatin Switch from Simvastatin Myopathy Side Effects Decline
10...Simvistatin Side Effects Myopathy Muscle Pain Decline Switch to Rosuvastatin
11...Myopathy Muscle Pain Side Effects Simvistatin Decline Switch to Rosuvastatin
12...HGBA1c Diabetes Blood Test
13...Diabetes Blood Test HGBA1c


..............
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CONTACTS 

SUBJECTS
VA Lab WBC Martinez Clinic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0603 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0603 -    ..
0604 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0605 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
060501 - Follow up ref SDS 30 0000. ref SDS 28 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
060502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060506 -            [On 131016 1632 submit letter for agenda meeting to review                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
060507 -            lab results scheduled 131017 1000. ref SDS 32 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
060508 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060509 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060510 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060512 -  ..
0606 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0607 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0608 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0609 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
060901 - Blood draw today for meeting with Doctor Egan Thursday on 131017 at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
060902 - 1000, scheduled.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
060904 -  ..
060905 - Last full lab was on 130529 0818. ref SDS 30 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
060907 -  ..
060908 - Prior full lab was on 121130 0846, ref SDS 24 RP4N, 120831 1400.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
060909 - ref SDS 20 RP4N, following up 120509 1108, ref SDS 19 X45G; and before                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
060910 - that on 110727 1238, ref SDS 9 RP4N, and this was to prepare for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
060911 - meeting in Primary Care a few weeks later on 110803 1400. ref SDS 10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
060912 - U24I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
060914 -  ..
060915 - Last partial lab to resolve skewed results from dehydration was on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
060916 - 121212 0941. ref SDS 26 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
060918 -  ..
060919 - Prior partial for lipid panel testing cholesterol and for glucose,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
060920 - sodium, and total bilirubin was on 120831 1400. ref SDS 20 IM9N and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
060921 - ref SDS 20 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
060922 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060924 -  ..
060925 - Blood Tests Evaluate Health 8 Months After Surgery                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
060926 - 
060927 - Follow up ref SDS 30 RP4N, ref SDS 28 RP4N.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
060929 -  ..
060930 - Prior CBC on 120509 1108. ref SDS 19 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060931 - Prior CBC on 120831 1524. ref SDS 20 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060932 - Prior CBC on 121130 1001. ref SDS 24 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060933 - Prior CBC on 130529 0818. ref SDS 30 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060935 -  ..
060936 - For some reason test results do not include WBC.  The nurse who drew                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
060937 - blood said the doctor ordered a "full" lab, required for a physical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
060938 - examination.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
060939 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060941 -         ..
060942 -        CBC........... 2013 10 15 0825    130529                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060943 -        Blood                Results       Results     Units            Range                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
060944 -        WBC                                    7.4     K/cmm        4.8   -   10.8                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
060945 -        RBC                                    5.09    M/cmm        4.7   -    6.1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
060946 -        HGB                                   15.0     g/dL        14     -   18                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060947 -        HCT                                   46.2     %           42     -   52                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060948 -        MCV                                   90.7     fL          80     -   99                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060949 -        MCH                                   29.5     uug         27     -   34                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060950 -        MCHC                                  32.5     gm/dL       32     -   35.2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
060951 -        RDW                                   14.4     %           11.5   -   14.5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
060952 -        PLT                                  279       K/cmm      130     -  400                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060953 -        MPV                                    8.8     fL           7     -   10.4                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
060954 -        NEUT %                                69.9     %           40     -   80                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060955 -        LYMPH %                         L     19.7     %           20     -   51                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060956 -        MONO %                                 7.8     %            2     -   13                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060957 -        EOS %                                  1.9     %             .5   -    7                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060958 -        BASO %                                 0.7     %            0     -    2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060959 -        NEUT #                                 5.2     K/cmm        1.5   -    7.9                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
060960 -        LYMPH #                                1.5     K/cmm        1.2   -    3.4                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
060961 -        MONO #                                 0.6     K/cmm         .2   -    1.2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
060962 -        EOS #                                  0.1     K/cmm         .1   -     .5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
060963 -        BASO #                                 0.1     K/cmm        0     -     .2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
060964 -        ESRmVES                                        mm/hr        0     -   10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060965 -        ESRxCYT                                        mm/hr        2     -   10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060966 -        RETIC %                                        %             .66  -    2.85                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
060967 -        RETIC #                                        k/uL        27.9   -  121.6                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
060969 -         ..
060970 -        Comments:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
060971 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060972 -             a.  TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
060973 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060974 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060975 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060976 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060977 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060978 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
060979 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0610 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
VA Lab Electrolytes Chem Profile Glucose 108 Sodium NA 139 Potasium                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
1103 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
110401 -  ..
110402 - Total Bilirubin 1.7 Due to Rosuvastatin Recovery Failing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
110403 - Salt Sodium Decreases Within Range Still Higher than Expected                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
110404 - Glucose Decreases Within Range Still Higher than Expected                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
110405 - 
110406 - Follow up ref SDS 30 KK9M, ref SDS 28 KK9M.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
110407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110408 - Prior CHEM PROFILE on 120509 1108. ref SDS 19 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
110409 - Prior CHEM PROFILE on 120831 1524. ref SDS 20 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
110410 - Prior CHEM PROFILE on 130228 1140. ref SDS 28 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
110411 - Prior CHEM PROFILE on 130529 0818. ref SDS 30 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
110412 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110413 -                           ELECTROLYTES                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
110415 -         ..
110416 -        CHEM PROFILE... 2013 10 15 0825   130529                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110417 -        PLASMA                Results      Results     Units            Range                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
110418 -        GLUCOSE                108      H    120       mg/dL       74     -  118                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110419 -        GLUfast                                        mg/dL       Ref: <=99
110420 -        NA (salt)              139           139       mmol/L     136     -  144                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110421 -        K (potasium)             4.3    H      4.9     mmol/L       3.4   -    4.8                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
110422 -        CL                     105           105       mmol/L      98     -  106                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110423 -        CO2                     37.0          30.0     mmol/L      23     -   33                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110424 -        BUN                     24            18       mg/dL        8     -   26                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110425 -        CREAT                    0.83          0.83    mg/dL         .5   -    1.1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
110426 -        eGFR                   >60           >60       mL/min      Ref: >=60                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
110427 -        CALCIUM                  9.2           9.2     mg/dL        8.7   -   10.2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
110428 -        CA CORR                                        mg/dL        8.7   -   10.2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
110429 -        PO4                                            mg/dL        2.4   -    4.5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
110430 -        MG                                             mg/dL        1.8   -    2.5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
110431 -        ALK PHO                 84            87       IntUnits/L  37     -  107
110432 -  ..
110433 -        T. BIL            H      1.7    H      1.3     mg/dL         .3   -    1.2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
110434 -        D. BILI                < 0.1                   mg/dL         .1   -     .4
110435 -        AST                     20            22       IntUnits/L   8     -   42                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110436 -        ALT                     17            19       IntUnits/L   5     -   55                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110437 -        ALBUMIN                  3.9           4.0     g/dL         3.3   -    4.8                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
110438 -        PROTEIN                  7.1           7.2     g/dL         6.5   -    8.1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
110439 -        LDH                                            IntUnits/L  90     -  208                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110440 -        AMYLASE                                        Units/L     28     -  100                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110441 -        LIPASE                                         Units/L      7     -   58                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110442 -        NH3                                            mcmol/L     15     -   56                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110443 -        URIC AC                                        mg/dL        4.8   -    8.7                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
110444 -        Comments:                 a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
110446 -                  ..
110447 -             a.  TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
110449 -                  ..
110450 -             b.  Evaluation for CREAT:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
110451 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110452 -                 Effective 7/2/08, new standardized method for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
110453 -                 creatinine in place.  Note reference range change.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
110454 -                 Previous range 0.5-1.2 mg/dL.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
110456 -                  ..
110457 -             c.  Evaluation for ALK PHO:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
110458 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110459 -                 The normal range is for an adult population less than                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
110460 -                 50 years old. Alk Phos increases with age over 50 to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
110461 -                 about 60% higher values by ages greater than 75 years                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
110462 -                 old.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
110464 -                  ..
110465 -             d.  Evaluation for eGFR:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
110466 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110467 -                 eGFR Units = mL/min/1.73 square meters                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
110469 -  ..
110470 - Bilirubin increased, and is 25% high even after ending Rosuvastatin 10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
110471 - months ago on 121206 0900, ref SDS 25 OS5L, indicating chornic side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
110472 - effects.  Peripheral neuropathy has declined from most severe effects,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
110473 - but continues with mild symptoms sometimes when standing or walking                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
110474 - slowly, reported during meeting at VA on 121206 0900. ref SDS 25 H766                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
110476 -  ..
110477 - Background on Rosuvastatin causing elevated T Bilirubin with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
110478 - associated severe side effects is reported on 121206 0900, ref SDS 25                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
110479 - NI9L, and further explained in the record on 121130 0846. ref SDS 24                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
110480 - ER4K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
110481 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110482 -            [On 131017 1000 doctor explained patient history of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
110483 -            intermittant and mild peripheral neuropathy that correlates                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
110484 -            with persistent elevated T Bilirubin in lab on 131015,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
110485 -            ref SDS 0 015M, and further reported with vitals, diet and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
110486 -            exercise since prior meeting at VA on 130603, see case                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
110487 -            study on 120101 0900, ref SDS 14 X14N, suggests                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
110488 -            intervention is not required at this time to improve                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110489 -            recovery from side effects taking Rosuvastatin. ref SDS 34                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
110490 -            LV5J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110492 -             ..
110493 -            [On 131017 1000 VA medical chart Progress Notes assessment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
110494 -            report doctor concerned about chronic hyperbilirubinemia.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
110495 -            ref SDS 34 PSXT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
110496 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110497 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110498 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110499 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110500 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110501 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
110503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
1106 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
VA Lab Lipid Cholesterol 321 Increases without Medication Despite Hi                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
1603 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
160401 -  ..
160402 - LDL 249 Rises Despite Hike 1200 Miles Weight Lose 15 Pounds                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
160403 - 
160404 - Follow up ref SDS 30 IM9N, ref SDS 28 IM9N.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
160405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160406 - Lab results today conflict with increased hiking and weight loss past                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160407 - few months, reported in case study on 120101 0900, ref SDS 14 P85O,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
160408 - including Half Dome hike on 130918 0620. ref SDS 31 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
160410 -  ..
160411 - Prior LIPID PANEL 120509 1108. ref SDS 19 IM9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160412 - Prior LIPID PANEL 120831 1525. ref SDS 20 IM9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160413 - Prior LIPID PANEL 130228 1140. ref SDS 28 IM9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160414 - Prior LIPID PANEL 130529 0818. ref SDS 30 IM9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160416 -         ..
160417 -        LIPID PANEL.... 2013 10 15 0825   130529                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160418 -        PLASMA                Results      Results     Units          Range                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
160419 -        CHOL                   321      H    307       mg/dL       Ref: <=200
160420 -        TRIGLYC                109            85       mg/dL       Ref: <=150
160421 -        HDL                     50            50       mg/dL       Ref: >=40                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
160422 -        LDL                    249      H    240       mg/dL       Ref: <=160
160423 -        LDL Dir                                        mg/dL       Ref: <=160
160424 -        TRIG NF                                        mg/dL       Ref: <=150
160425 -        Comments:                 a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160427 -                  ..
160428 -             a.  TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
160430 -                  ..
160431 -             b.  Evaluation for LDL-CHO:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
160432 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160433 -                 RISK CATEGORY LDL GOAL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160434 -                 CHD and CHD risk equivalents            <100 mg/dL
160435 -                 Multiple (2+) risk factors              <130 mg/dL
160436 -                 0-1 risk factor                         <160 mg/dL
160438 -                  ..
160439 -                 HDL Chol. greater than/equal to 60 mg/dL counts as "negative" risk                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160440 -                 factor; its presence removes 1 risk factor from the total count.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160442 -                  ..
160443 -                 Ref: Adult Treatment Panel III (ATP III) JAMA 5/16/01 Vol. 285 #19.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160445 -  ..
160446 - Follow up prior lipid history on 121130 0846. ref SDS 24 W25L.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160448 -         ..
160449 -        Collection DT          CHOL    TRIGL    HDL     LDL-CHO                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
160450 -        10/15/2013 08:25       321 H    109     50       249 H  ..... ref SDS 0 BE6O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160451 -        05/29/2013 08:18       307 H     85     50       240 H  ..... ref SDS 28 BE6O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
160452 -        02/28/2013 08:39       310 H     73     47       248 H  ..... ref SDS 28 BE6O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
160453 -        11/30/2012 10:01       173       53     57       105    ..... ref SDS 24 BE6O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
160454 -        08/31/2012 15:25       176       94     47       110    ..... ref SDS 20 U89N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
160455 -        05/09/2012 11:24       155       76     49        94    ..... ref SDS 19 U89N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
160456 -        02/09/2012 11:18       285       82     41       228 H  ..... ref SDS 15 2A4G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
160457 -        11/17/2011 14:27       260       84     43       200 H  ..... ref SDS 13 2A4G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
160458 -        07/27/2011 12:58       163       81     45       102    ..... ref SDS 9 E19L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
160459 -        12/07/2010 09:17       151       41     47        96    ..... ref SDS 8 E19L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
160460 -        07/21/2010 08:54       261 H     87     35 L     209 H  ..... ref SDS 4 E19L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
160461 -        06/10/2010 10:33       217 H     83     36 L     164 H  ..... ref SDS 3 QV4F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
160462 -      * 12/14/2009 11:10       241 H    136     44       170 H  ..... 100928 0706, ref SDS 5 VW6J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160463 -        08/13/2009 15:09       233 H    118     30 L     179 H  ..... 100610 1046, ref SDS 3 U45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160464 -        06/16/2006 10:59       238 H     68     32 L     192 H  ..... 091002 0900, ref SDS 1 LJ5H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160465 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160466 -      * Lab at VA San Francisco Medical Center reported on 100928 0706.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160467 -        ref SDS 5 VW6J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
160469 -  ..
160470 - Graph of LDL history shown on 120209 1118. ref SDS 15 7M42                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160472 -  ..
160473 - Research on cholesterol reported on 091002 0900. ref SDS 1 2F8K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160474 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160475 -            [On 131016 1632 submit letter for agenda meeting to review                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
160476 -            lab results scheduled 131017 1000. ref SDS 32 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160477 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160478 -            [On 131017 1000 meeting Doctor Egan determined that since                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
160479 -            patient is very active phyically, hiking 1200 miles past 5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160480 -            months, including Half Dome on 130918, and since the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160481 -            patient remain asymptomatic, there is no need to perform                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160482 -            another treadmill stress test to evaluate for blocked                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160483 -            arteries due to elevated cholesterol in the lab on 131015.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160484 -            ref SDS 35 ZZ6N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160486 -             ..
160487 -            [On 131017 1000 meeting Doctor Egan at VA on increasing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160488 -            exercise and evaluate new drugs on clinical trials to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160489 -            manage cholesterol. ref SDS 33 D95H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160491 -             ..
160492 -            [On 131103 1739 received letter from SFVA schedule meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
160493 -            on 131120 1000, to develop clinical trial care for lowering                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160494 -            cholesterol. ref SDS 36 Q27Z                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
160495 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160497 -  ..
160498 - Cholesterol LDL Lowered Heavy Exercise                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
160499 - Research indicates exercise Lowers Cholesterol Including LDL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
160500 - 
160501 - Lab today showing cholesterol increased over past 5 months, since                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160502 - prior lab on 130529 0818, ref SDS 30 IM9N, appears conflicting with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
160503 - research...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
160504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160505 -    Webmd                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
160506 -    Cholesterol & Triglycerides Health Center                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160508 -     ..
160509 -    Exercise To Lower Cholesterol                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160510 -    
160511 -    By Susan Davis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160512 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160513 -              http://www.webmd.com/susan-davis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160515 -     ..
160516 -    Reviewed on November 14, 2008                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160517 -    by Cynthia Dennison Haines, MD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160518 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160519 -              http://www.webmd.com/cynthia-dennison-haines                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
160521 -         ..
160522 -    1.  You may have heard that exercise is one of the best ways to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160523 -        lower your cholesterol. But how does it work? And what type of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160524 -        exercise is most effective?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160526 -         ..
160527 -    2.  The Exercise-Cholesterol Link                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160528 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160529 -        Researchers aren't entirely sure how exercise lowers                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
160530 -        cholesterol, but they are beginning to have a clearer idea.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160531 -        "Lots of people, even lots of doctors, assume that exercise                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160532 -        lowers cholesterol," says Amit Khera, MD, director of the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160533 -        University of Texas, Southwestern, Medical Center's Program in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160534 -        Preventive Cardiology. "But until recently, most of us weren't                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160535 -        sure just what the connection was."                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
160537 -         ..
160538 -    3.  One way exercise can help lower cholesterol is by helping you                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160539 -        lose -- or maintain -- weight.  Being overweight tends to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160540 -        increase the amount of low-density lipoprotein (LDL) in your                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160541 -        blood, the kind of lipoprotein that's been linked to heart                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160542 -        disease.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160544 -         ..
160545 -    4.  Part of the confusion about the effect of exercise on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
160546 -        cholesterol stems from the fact that most early cholesterol                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160547 -        studies focused on both exercise and dietary changes, making it                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160548 -        hard to tease out which of these factors was actually making                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160549 -        the difference.  But recent studies have more carefully                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
160550 -        examined the effect of exercise alone, making it easier to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160551 -        evaluate the relationship between exercise and cholesterol.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160553 -         ..
160554 -    5.  Researchers now believe there are several mechanisms involved.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160555 -        First, exercise stimulates enzymes that help move LDL from the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160556 -        blood (and blood-vessel walls) to the liver.  From there, the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160557 -        cholesterol is converted into bile (for digestion) or excreted.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160558 -        So the more you exercise, the more LDL your body expels.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160560 -         ..
160561 -    6.  Second, exercise increases the size of the protein particles                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160562 -        that carry cholesterol through the blood. (The combination of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160563 -        protein particles and cholesterol are called "lipoproteins;"                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160564 -        it's the LDLs that have been linked to heart disease).  Some of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160565 -        those particles are small and dense; some are big and fluffy.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160566 -        "The small, dense particles are more dangerous than the big,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160567 -        fluffy ones because the smaller ones can squeeze into the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160568 -        [linings of the heart and blood vessels] and set up shop                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160569 -        there," says Khera. "But now it appears that exercise increases                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160570 -        the size of the protein particles that carry both good and bad                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160571 -        lipoproteins."                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160573 -         ..
160574 -    7.  How Much Exercise Does It Take To Lower Cholesterol?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
160575 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160576 -        Exactly how much exercise is needed to lower cholesterol has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160577 -        been a matter of some debate.  In general, most public health                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160578 -        organizations recommend, at a minimum, 30 minutes per day of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160579 -        moderate to vigorous exercise , such as walking, jogging,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160580 -        biking, or gardening.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
160582 -         ..
160583 -    8.  But a 2002 study by researchers at Duke University Medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160584 -        Center found that more intense exercise is actually better than                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160585 -        moderate exercise for lowering cholesterol.  In a study of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160586 -        overweight, sedentary people who did not change their diet, the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160587 -        researchers found that those who got moderate exercise (the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160588 -        equivalent of 12 miles of walking or jogging per week) did                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160589 -        lower their LDL level somewhat.  But the people who did more                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160590 -        vigorous exercise (the equivalent of 20 miles of jogging a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160591 -        week) lowered it even more.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160593 -         ..
160594 -    9.  The people who exercised vigorously also raised their levels of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160595 -        high-density lipoprotein (HDL) -- the "good" kind of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
160596 -        lipoprotein that actually helps clear cholesterol from the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160597 -        blood. "We found it requires a good amount of high intensity                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160598 -        exercise to significantly change HDL," says William Kraus, MD,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160599 -        an assistant professor of medicine at Duke and the lead author                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160600 -        on the study. "Just walking is not enough."                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160602 -         ..
160603 -   10.  According to Kraus's findings, however, even though moderate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160604 -        exercise was not as effective in reducing LDL or increasing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160605 -        HDL, it did keep cholesterol levels from rising.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
160607 -         ..
160608 -   11.  Bottom line? Some exercise is better than none; more exercise                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160609 -        is better than some.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
160611 -         ..
160612 -   12.  How Much Will It Help?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
160613 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160614 -        Just how much of an effect exercise has on cholesterol is also                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160615 -        a matter of debate. "We've found that the people who benefit                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160616 -        the most are those who had the worst diet and exercise habits                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160617 -        to begin with," says Roger Blumenthal, MD, director of the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160618 -        Ciccarone Preventive Cardiology Center at Johns Hopkins                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
160619 -        University. "Some of those people reduce their LDL by 10-15%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160620 -        and increase their HDL by 20%."                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160622 -         ..
160623 -   13.  Getting Started                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160624 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160625 -        If you haven't been exercising regularly already, it's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
160626 -        important to start slowly.  Be sure to check in with your                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160627 -        doctor, so that he or she can evaluate your current                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
160628 -        cardiovascular health.  This could mean blood tests or a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160629 -        treadmill test to see how your heart reacts when you exercise.)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160631 -         ..
160632 -        Once you're cleared to begin working out, follow these                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
160633 -        guidelines:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160634 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160635 -        1.  Choose a form of exercise you can do for 10-20 minutes at a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160636 -            time, with at least moderate intensity, such as walking,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160637 -            biking, swimming, jogging, or using an exercise machine at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160638 -            low speed).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160640 -             ..
160641 -        2.  Know that while the intensity may be moderate, the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
160642 -            "exercise volume," which means the amount of time you spend                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160643 -            exercising, has to be pretty high.  The American Heart                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160644 -            Association recommends working up to 30 minutes of physical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160645 -            activity per day, or 60 minutes per day if you're also                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160646 -            trying to lose weight.  Remember: you can get your exercise                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160647 -            in 10 minutes increments if need be, as long as it adds up                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160648 -            to 30 minutes by the end of the day.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160650 -             ..
160651 -        3.  Find an activity you love, whether it's walking your dog,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160652 -            playing tag with your kids, swimming laps at a pool, or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160653 -            bicycling through your community.  Finding a buddy to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160654 -            exercise with can be helpful, too, both for moral support                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160655 -            and to help make exercise more enjoyable.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160657 -             ..
160658 -        4.  Even better, find several activities you love, so you can                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160659 -            vary your routine.  This helps you exercise more than one                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160660 -            set of muscles, as well as enjoying different work-out                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160661 -            environments.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
160663 -         ..
160664 -   14.  Of course, exercise alone won't guarantee a low cholesterol                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160665 -        level.  Genetics, weight, age, gender, and diet all contribute                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160666 -        to an individual's cholesterol profile.  The most effective way                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160667 -        to ensure a healthy cholesterol level is to modify your diet                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160668 -        and, if need be, take cholesterol-lowering medications.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
160670 -         ..
160671 -   15.  But exercise has many advantages beyond lowering cholesterol.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160672 -        Exercise has been shown to keep bones strong, reduce the risk                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160673 -        of cancer, diabetes, stroke, and obesity, and to improve mood.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160674 -        "Even if the improvements in your cholesterol profile are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160675 -        modest, there are many, many other benefits," says Blumenthal.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160676 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160677 -            [On 131017 1000 meeting Doctor Egan determined that since                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
160678 -            patient is very active phyically, hiking 1200 miles past 5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160679 -            months, including Half Dome on 130918, and since the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160680 -            patient remain asymptomatic, there is no need to perform                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160681 -            another treadmill stress test to evaluate for blocked                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160682 -            arteries due to elevated cholesterol in the lab on 131015.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160683 -            ref SDS 35 ZZ6N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160685 -             ..
160686 -            [On 131017 1000 meeting Doctor Egan at VA on increasing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160687 -            exercise and evaluate new drugs on clinical trials to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
160688 -            manage cholesterol. ref SDS 33 D95H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160689 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160690 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160691 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160692 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160693 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160694 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160695 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
1607 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Default Null Subject Account for Blank Record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2003 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
200401 -  ..
200402 - Rosuvastatin Switch from Simvastatin Myopathy Side Effects Decline                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
200403 - Simvistatin Side Effects Myopathy Muscle Pain Decline Switch to Rosuvastatin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
200404 - Myopathy Muscle Pain Side Effects Simvistatin Decline Switch to Rosuvastatin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
200405 - 
200406 - Follow up ref SDS 19 D26G, ref SDS 15 D26G.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
200407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200408 - Prior Cardiac Enzymes Profile on 120209 1118. ref SDS 15 D26G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
200409 - Prior Cardiac Enzymes Profile on 120509 1108. ref SDS 19 D26G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
200410 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200411 -        CARDIAC ENZYMES.2013 10 15 0825   120509                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200412 -        PLASMA                Results      Results    Units            Range                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
200413 -        CK                      110          152 IntUnits/L       36     -  340                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
200414 -        TRPONIN                                       ng/ml        0     -    0.07                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200415 -        CK-MB                                         ng/ml        0.6   -    3.5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
200416 -        MYOGLOB                                       ng/ml       20     -   82                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
200418 -             ..
200419 -        a.  TEST PERFORMED BY VAMC SACRAMENTO, 10535 HOSPITAL WAY,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200420 -            MATHER CA.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200422 -  ..
200423 - Research on 111013 explains Creatine Kinase CK, relates to muscle                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200424 - disorders caused by cholesterol medications with statins. 111013 1404,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
200425 - ref SDS 12 J54K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200427 -  ..
200428 - Decrease in CK lab may align with reduced side effects of muscle pain                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200429 - in left shoulder.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200430 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200431 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200432 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200433 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200434 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200435 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2005 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Default Null Subject Account for Blank Record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
4003 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
400401 -  ..
400402 - HGBA1c Diabetes Blood Test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
400403 - Diabetes Blood Test HGBA1c                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
400404 - 
400405 - Follow up ref SDS 8 IL4N, ref SDS 4 IL4N.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400407 - Prior HGBA1c Profile on 100721 0800. ref SDS 4 IL4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
400408 - Prior HGBA1c Profile on 101207 0906. ref SDS 8 IL4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
400409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400410 -        HGBA1c......... 2013 10 15 0825   101207                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400411 -        BLOOD                 Results      Results     Units            Range                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
400412 -        HGBA1c                   5.5          5.7      %            4.1   -    6                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400413 -        eAG                    111                     mg/dL       74 :   -  118                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400415 -         ..
400416 -        Comments:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
400417 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400418 -        b.  TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400419 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400420 -            eAG = Calculated Estimated Average Daily Glucose and may be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400421 -            easier for patients to understand than an A1c result.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
400422 -            Calculation: 28.7 x HGBA1c - 46.7                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
400424 -             ..
400425 -            Ordering Provider:  Harkesh S. Sandhu MD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400426 -            Report Released:    Oct 15, 2013 @ 1309                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
400428 -             ..
400429 -            Reporting Lab:      MARTINEZ OPC/CREC                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
400430 -                                150 MUIR ROAD MARTINEZ, CA 94553-4668                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400432 -             ..
400433 -            Performing Lab:     MARTINEZ OPC/CREC                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
400434 -                                150 MUIR ROAD MARTINEZ, CA 94553-4668                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400435 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400437 -  ..
400438 - This test for diabetes was ordered by Doctor Abrams during a meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400439 - at the San Francisco VA Medical Center on 130227 0930. ref SDS 27 8T5L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
400440 - However, it is not reported for the lab performed the next day on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
400441 - 130228 1140, ref SDS 28 RP4N, nor in the follow up lab 3 months later                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
400442 - on 130529 0818. ref SDS 30 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400444 -  ..
400445 - HGGA1c was performed previously on 101207 0906, ref SDS 8 IL4N, and 5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
400446 - months earlier on 100721 0800. ref SDS 4 IL4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400448 -  ..
400449 - Report today shows no evidence of diabetes.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
400450 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400451 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400452 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400453 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400454 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400455 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400456 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400457 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
4005 -