THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com


S U M M A R Y


DIARY: December 10, 2013 02:28 PM Tuesday; Rod Welch

VA SFMC letter prepare meeting Dec 19, treat hyperlipidemia arterialsclorsis.

1...Summary/Objective
2...Hyperlipidemia Not Controlled Cholesterol Elevated Despite Exercise
3...Cholesterol Elevated Despite Exercise Discuss Clinical Trial
4...Clinical Trial Considered Lower Cholesterol Without Statin Drugs


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CONTACTS 

SUBJECTS
VA Prescribe Atorvastin 10 MG Trial 4 Weeks Evaluate Side Effects In                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
1303 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1303 -    ..
1304 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
1305 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
130501 - Follow up ref SDS 45 0000. ref SDS 44 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
130502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130506 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130508 -  ..
1306 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1307 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1308 - Background                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
1309 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1310 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
131001 - Lab on 131015, showing cholesterol remained high, 131015 0724,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
131002 - ref SDS 38 BE6O, conflict with increased exercise and weight loss,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
131003 - discussed in the letter to the medical team yesterday on 131016 1632.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131004 - ref SDS 39 IW57                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131006 -  ..
131007 - On 131017 1000 VA medical chart Progress Notes assessment report                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
131008 - patient status CAD stable, asymptomatic. hyperlipidemia not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
131009 - controlled. ref SDS 40 T24N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
131011 -  ..
131012 - On 131017 1000 Doctor Egan proposed referring patient for clinical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
131013 - trial to reduce cholesterol with new "targeted" drugs. ref SDS 40 179N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
131015 -  ..
131016 - On 131017 1000 VA medical chart Progress Notes assessment report                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
131017 - patient status hyperlipidemia not controlled, ref SDS 40 PSXT; Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
131018 - Egan makes referral to SF VA Medical Center for consult on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
131019 - participation clinical trials, ref SDS 40 EU9F, with experimental                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
131020 - agents such as AMG 145 and REGN 727 to resolve multiple statin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
131021 - intolerances. ref SDS 40 CN4H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
131023 -  ..
131024 - On 131103 received letter from VA SF Medical Center scheduling meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
131025 - on 131121 1000, to consider clinical trial for lowering cholesteral.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
131026 - ref SDS 41 YT4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131027 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131028 -            Thursday November 21, 2013 1000 METAB-FELLOW-THRUSDAY Clinic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
131030 -  ..
131031 - On 131112 New York Times published several articles reporting that the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
131032 - day before on 131113, American Heart Association published new                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
131033 - guidelines for treating CAD patients that expand use of statin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
131034 - medication regardless of cholesterol levels, ref SDS 42 0001, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
131035 - further raise the LDL 70 to LDL 190, as a target for cardiovascular                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
131036 - risk. ref SDS 42 CW6H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
131038 -  ..
131039 - On 131114 New York Times published several articles reporting that the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
131040 - day before on 131113, American Heart Association published new                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
131041 - guidelines for treating CAD patients. ref SDS 43 SH6G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
131043 -  ..
131044 - On 131121 1000 meeting with Doctor Diana Alba, Va San Francisco                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131045 - Medical Center prescribes Atorvastatin 10 MG 4 weeks. ref SDS 44 HY6O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
131047 -  ..
131048 - On 131121 1000 at 1125 meeting with Karen and Doctor Shunk, Va San                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
131049 - Francisco Medical Center seemed to support Doctor Alba's prescription                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131050 - for Atorvastatin 10 MG 4 weeks; further suggested trying Chia seeds to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
131051 - lower cholesterol without medication. ref SDS 44 MS7G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
131053 -  ..
131054 - On 131125 0005 letter to Karen submits understandings from meetings at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
131055 - VA on 131121 with Doctor Alba, ref SDS 45 UK43, and requests that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
131056 - Karen submit to Doctor Alba. ref SDS 45 UK5J  Presented patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131057 - history showing increased exercise lowered cholesterol, but later                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
131058 - cholesterol rose even while increasing exercise. ref SDS 45 UK6R                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
131059 - Notified VA taking Atorvastatin 40 mg on 4-week trial. ref SDS 45 UK49                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
131060 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131061 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131062 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131063 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131065 -  ..
1311 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1312 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1313 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1314 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
131401 - Hyperlipidemia Not Controlled Cholesterol Elevated Despite Exercise                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
131402 - Cholesterol Elevated Despite Exercise Discuss Clinical Trial                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
131403 - Clinical Trial Considered Lower Cholesterol Without Statin Drugs                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
131404 - 
131405 - Follow up ref SDS 45 HY6O, ref SDS 44 HY6O.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
131406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131407 - Received letter from Doctor Alba saying...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
131408 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131409 -    1.  Subject:  RE: VA Meeting 21 Nov 2013, Clinical Trials Non-statin Solutions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
131410 -        Date:  2013-12-10 12:21                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
131417 -         ..
131418 -    2.  Just following up with you to make sure that you recevied the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
131419 -        Atorvastatin. Any issues?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
131421 -  ..
131422 - Doctor Alba follows up her letter planning another meeting at VA on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
131423 - 131219, received on 131125 0005. ref SDS 45 I67O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
131424 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131425 -            [On 131216 0028 letter to Doctor Alba and medical team                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
131426 -            submits pending issues to discuss during meeting on 131219,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
131427 -            ref SDS 46 8N50, and lists TG/HDL-C ratio and LDL-P issues.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
131428 -            ref SDS 46 6T49                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
131430 -  ..
131431 - Letter from Doctor Alba concludes...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
131432 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131433 -    3.  Best,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
131434 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
131435 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
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1315 -