CONTACTS
SUBJECTS
VA Prescribe Atorvastin 10 MG Trial 4 Weeks Evaluate Side Effects In
6003 -
6003 - ..
6004 - Summary/Objective
6005 -
600501 - Follow up ref SDS 50 0000. ref SDS 49 0000.
600502 -
600503 -
600504 -
600505 -
600506 -
600508 - ..
6006 -
6007 -
6008 - Background
6009 -
6010 -
601001 - Lab on 131015, showing cholesterol remained high, 131015 0724,
601002 - ref SDS 35 BE6O, conflict with increased exercise and weight loss,
601003 - discussed in the letter to the medical team yesterday on 131016 1632.
601004 - ref SDS 36 IW57
601006 - ..
601007 - On 131017 1000 VA medical chart Progress Notes assessment report
601008 - patient status CAD stable, asymptomatic. hyperlipidemia not
601009 - controlled. ref SDS 37 T24N
601011 - ..
601012 - On 131017 1000 Doctor Egan proposed referring patient for clinical
601013 - trial to reduce cholesterol with new "targeted" drugs. ref SDS 37 179N
601015 - ..
601016 - On 131017 1000 VA medical chart Progress Notes assessment report
601017 - patient status hyperlipidemia not controlled, ref SDS 37 PSXT; Doctor
601018 - Egan makes referral to SF VA Medical Center for consult on
601019 - participation clinical trials, ref SDS 37 EU9F, with experimental
601020 - agents such as AMG 145 and REGN 727 to resolve multiple statin
601021 - intolerances. ref SDS 37 CN4H
601023 - ..
601024 - On 131103 received letter from VA SF Medical Center scheduling meeting
601025 - on 131121 1000, to consider clinical trial for lowering cholesteral.
601026 - ref SDS 38 YT4N
601028 - ..
601029 - On 131112 New York Times published several articles reporting that the
601030 - day before on 131113, American Heart Association published new
601031 - guidelines for treating CAD patients that expand use of statin
601032 - medication regardless of cholesterol levels, ref SDS 39 0001, and
601033 - further raise the LDL 70 to LDL 190, as a target for cardiovascular
601034 - risk. ref SDS 39 CW6H
601036 - ..
601037 - On 131114 New York Times published several articles reporting that the
601038 - day before on 131113, American Heart Association published new
601039 - guidelines for treating CAD patients. ref SDS 40 SH6G
601041 - ..
601042 - On 131121 1604 meeting with Doctor Alba at San Francisco Medical
601043 - Center - prescribed Atorvastatin 20 mg 4-week trial and evaluate
601044 - adding Zetia 10 mg, schedule follow up on 131219 0930. ref SDS 41 6H6K
601046 - ..
601047 - On 131121 1604 in another record later today, VA prescription RX #
601048 - 5674471 for Atorvastatin 20 mg has been ordered. ref SDS 42 GH5M
601050 - ..
601051 - On 131125 0005 letter from Karen reports VA work plan to take statin
601052 - drug low dose Atvorstatin 10 mg for 4 weeks, then add Zetia 10 mg in
601053 - clinical trial for lowering cholesterol. ref SDS 44 V154
601055 - ..
601056 - On 131125 0005 research seems to indicate this clincial trial of low
601057 - dose Atorvasatatin 10 mg with Zeitia 10 mg has lowered cholesterol LDL
601058 - 70.
601060 - ..
601061 - On 131205 1448 received new prescription for Atvorstatin 20 mg,
601062 - ordered by Doctor Alba today for 4-week trial to assess side effects
601063 - for adding 2nd drug, Zetia 10 mg to lower LDL 249. ref SDS 45 GH5M
601065 - ..
601066 - On 131216 0028 letter to Doctor Alba submit agenda for meeting at VA
601067 - SFMC on 131219. ref SDS 46 HY6O
601069 - ..
601070 - On 131219 0930 meeting Doctor Alba at San Francisco VA Medical Center
601071 - ordered Ezedimibe 10 mg prescription for adding to Atorvastatin, and
601072 - ordered blood test to evaluate changes in lipid profile. 131219 0930,
601073 - ref SDS 47 NJ6G
601075 - ..
601076 - On 131230 1450, received Ezetimibe in US mail, ref SDS 48 5N3O,
601077 - ordered by Doctor Alba on 131219, 131219 0930, ref SDS 47 6H6K; begin
601078 - trial to manage cholesterol with Atorvastatin 10 mg and Ezetimibe 10
601079 - mg, planned during meeting at VA on 131121 0930. ref SDS 41 6H6K
601081 - ..
601082 - On 140114 0845 letter to Diana request Progress Notes meeting 131219,
601083 - ref SDS 49 HY6O, and ask about expanding scope pending lab to include
601084 - LDL-P. ref SDS 49 2140
601086 - ..
601087 - On 140115 1842 letter Diana will look for Progress Notes meeting
601088 - 131219, ref SDS 50 HY6O; investigating prospects for ordering lab test
601089 - LDL-P, ref SDS 50 CE80; VA claims patient cholesterol and LDL are above
601090 - target. ref SDS 50 CE91 VA further claims testing LDL-P not effective
601091 - in this case because LDL-C is not optimal. ref SDS 50 FF4H
601093 - ..
601094 - On 140116 0814 letter thanks Doctor Alba for investigting to find
601095 - Progress Notes for meeting at VA on 131219. ref SDS 0 HY6O Cite
601096 - research indicating patient with discordant LDL-C high and LDL-P low,
601097 - shown in patient lab on 131015, constitutes least risk for
601098 - arterialsclorosis disorder, CVD, mycardial infarction. ref SDS 0 735Y
601099 -
601100 -
601101 -
601103 - ..
6012 -
6013 -
6014 - Progress
6015 -
601501 - Progress Notes Submit for Meeting at VA SFMC 131219
601502 - Hyperlipidemia Control Exercise Diet Medication Atorvastatin Ezetimibe
601503 -
601504 - Follow up ref SDS 50 HY6O, ref SDS 49 HY6O.
601505 -
601506 - Letter to Diana Alba, MD says...
601507 -
601508 -
601509 - 1. Subject: Lab Lipid Panal Include LDL-P Evaluate Discordance
601510 - Date: 2014-01-16 09:57
601514 - ..
601515 - 2. Dear Doctor Alba,
601517 - ..
601518 - 3. Thanks very much for your letter yesterday on 140115,
601519 - ref SDS 50 HY6O Look forward to getting the Progress Notes for
601520 - our meeting on 131219, as related in your letter.
601521 -
601522 - [On 140128 1327 letter asks VA for Progress Notes reporting
601523 - meeting at VA on 131219. ref SDS 51 TZ81
601524 -
601525 -
601526 -
601528 - ..
601529 - LDL-P Add to Pending Lab Evaluate Discordant
601530 - Hyperlipidemia Patient Discordant Test Pending Lab LDL-P
601531 -
601532 - Follow up ref SDS 50 CE80, ref SDS 49 2140.
601533 -
601534 - Letter to Doctor Alba's continues...
601536 - ..
601537 - 4. Your letter says in part...
601538 -
601539 - 1. LDL-P is usually measured to assess risk for cardiovascular
601540 - disease, in patients with OPTIMAL levels of LDL. For these
601541 - patients, measuring and lowering LDL-P is considered a primary
601542 - goal of therapy due to its stronger association with
601543 - cardiovascular risk.
601545 - ..
601546 - 2. In your case, your LDL-C is not at optimal levels.
601548 - ..
601549 - 5. This representation appears conflicting with medical literature
601550 - saying in part...
601552 - ..
601553 - "The highest risk and lowest risk groups are those with
601554 - discordant LDL-C and LDL-P. The high risk group has high LDL-P
601555 - and low LDL-C, while the lowest risk group has high LDL-C with
601556 - low LDL-P. Only a minority of physicians would know that there
601557 - is a segment of the population with elevated LDL-C who are at
601558 - low risk! The same conclusion will be drawn from the next
601559 - study." (...shown in research on 131125 - see line GM0688 para
601560 - 9. ref SDS 43 FI3G
601561 -
601562 - [On 140204 1236 VA letter says patient "misunderstood" the
601563 - meaning of "discordance" between LDL-C and LDL-P from this
601564 - literature; offers no opposing evidentiary literature.
601565 - ref SDS 55 SU6H
601567 - ..
601568 - 6. This theme seems to predominate current thinking from
601569 - exhaustive studies on lipid management, as shown throughout
601570 - research on 131125. Your work plan to research for more
601571 - literature will help clarify our aims managing lipids to
601572 - reconcile high levels of exercise, weight control, and diet
601573 - with evident conflict in lipid lab on 131015 showing LDL 249,
601574 - at very high level. ref SDS 35 W25L Is this a healthy or
601575 - unhealthy condition?
601577 - ..
601578 - Follows up prior letter to the team citing evident conflict between
601579 - exercise and weight loss, and high levels of LDL; asking if seeming
601580 - good health masks actual high risk condition, reported on 131125 0005.
601581 - ref SDS 43 UK91
601582 -
601583 - [On 120101 0900 case study showing 140121 finally hit 165
601584 - on scales; next objective is to stabalize this weight, then
601585 - work toward 160, based on lab results. ref SDS 12 A39H
601587 - ..
601588 - [On 140201 1159 obtained blood draw for testing LDL-P at
601589 - Labcor on Health Testing Centers order # 27716. ref SDS 54
601590 - KQ4L
601592 - ..
601593 - Letter to Doctor Alba continues...
601594 -
601595 - 7. Very thankful the VA and UCSF are working hard to cover all the
601596 - bases in my case with medication that complements exercise and
601597 - diet. Since your letter mentions no changes to current diet, I
601598 - assume your review found this is adequate for good heart
601599 - health.
601601 - ..
601602 - 8. Hopeful next lab can include LDL-P to determine if high LDL on
601603 - prior labs is healthy or presents high risk for
601604 - arteriosclerosis. [...following up letter to VA on 131125 0005.
601605 - ref SDS 43 UK91, and more recent letter 2 days ago on 140114
601606 - 0845. ref SDS 49 2140...].
601608 - ..
601609 - 9. Evidently, LDL-P which includes measurement of particle size,
601610 - is performed with NMR testing, VAP, GGE (Berkeley), et al [...
601611 - shown in research on 131125 0005. ref SDS 43 2T4J...]. If the
601612 - team feels this is not a good time to make an LDL-P evaluation,
601613 - I am fine with that decision. This just seems like a good
601614 - opportunity to test for discordance assessing patient care in
601615 - conjunction with doing 11 mile daily hikes.
601616 -
601617 - [On 140128 1327 letter asks VA for instructions on where to
601618 - get lab. ref SDS 52 TZ96
601620 - ..
601621 - [On 140131 0815 have not received instructions from VA on
601622 - getting lab to test LDL-P, so ordered test. ref SDS 53 OO5G
601623 - lab blood draw at Labcorp in Walnut Creek on Ygnacio Valley
601624 - Road. ref SDS 53 NT6T
601626 - ..
601627 - [On 140201 1159 obtained blood draw for Lipid NMR test
601628 - LDL-P at Labcor on Health Testing Centers order # 27716.
601629 - ref SDS 54 KQ4L
601631 - ..
601632 - 10. Your consideration is deeply appreciated.
601633 -
601639 -
601640 -
601641 -
601642 -
601643 -
601644 -
601645 -
601646 -
601647 -
601648 -
601649 -
6017 -