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: January 28, 2014 01:27 PM Tuesday; Rod Welch

VA letter scope pending lab include LDL-P, report weight 165.

1...Summary/Objective
2...Progress Notes Submit for Meeting at VA SFMC 131219
3...Hyperlipidemia Control Exercise Diet Medication Atorvastatin Ezetimibe
4...LDL-P Add to Pending Lab Evaluate Discordant
5...Hyperlipidemia Patient Discordant Test Pending Lab LDL-P


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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 53 0000. ref SDS 51 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
600502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
600503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
600504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
600506 -  ..
6006 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
6007 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
6008 - Background                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
6009 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
6010 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
601001 - Lab on 131015, showing cholesterol remained high, 131015 0724,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
601002 - ref SDS 36 BE6O, conflict with increased exercise and weight loss,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
601003 - discussed in the letter to the medical team yesterday on 131016 1632.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
601004 - ref SDS 37 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 38 T24N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
601011 -  ..
601012 - On 131017 1000 Doctor Egan proposed referring patient for clinical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
601013 - trial to reduce cholesterol with new "targeted" drugs. ref SDS 38 179N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
601015 -  ..
601016 - On 131017 1000 VA medical chart Progress Notes assessment report                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
601017 - patient status hyperlipidemia not controlled, ref SDS 38 PSXT; Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
601018 - Egan makes referral to SF VA Medical Center for consult on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
601019 - participation clinical trials, ref SDS 38 EU9F, with experimental                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
601020 - agents such as AMG 145 and REGN 727 to resolve multiple statin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
601021 - intolerances. ref SDS 38 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 39 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 40 0001, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
601033 - further raise the LDL 70 to LDL 190, as a target for cardiovascular                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
601034 - risk. ref SDS 40 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 41 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 42 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 43 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 45 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 46 GH5M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
601065 -  ..
601066 - On 131216 0028 letter to Doctor Alba submit agenda for meeting at VA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
601067 - SFMC on 131219. ref SDS 47 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 48 NJ6G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
601075 -  ..
601076 - On 131230 1450, received Ezetimibe in US mail, ref SDS 49 5N3O,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
601077 - ordered by Doctor Alba on 131219, 131219 0930, ref SDS 48 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 42 6H6K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
601081 -  ..
601082 - On 140114 0845 letter to Diana request Progress Notes meeting 131219,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
601083 - ref SDS 50 HY6O, and ask about expanding scope pending lab to include                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
601084 - LDL-P. ref SDS 50 2140                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
601086 -  ..
601087 - On 140115 1842 letter Diana will look for Progress Notes meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
601088 - 131219, ref SDS 52 HY6O; investigating prospects for ordering lab test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
601089 - LDL-P, ref SDS 52 CE80; VA claims patient cholesterol and LDL are above                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
601090 - target. ref SDS 52 CE91  VA further claims testing LDL-P not effective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
601091 - in this case because LDL-C is not optimal. ref SDS 52 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 53 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 53 735Y                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
601100 -  ..
601101 - On 140128 1327 letter asks again about Progress Notes meeting 131219,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
601102 - ref SDS 0 HY6O; report hiking 11 miles per day continued, weight hit                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
601103 - 165, ref SDS 0 TZ8U; ask where to get lab at VA Martinez, in San                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
601104 - Francisco, or at UCSF. ref SDS 0 TZ96  No side effects from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
601105 - Atorvastatin and Ezetimibe. ref SDS 0 TZ99                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
601106 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601107 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601108 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601110 -  ..
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 53 HY6O, ref SDS 51 HY6O.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
601505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601506 - Letter to Diana Alba, MD says...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
601507 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601508 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601509 -    1.  Subject:  Pending Lab Include LDL-P Evaluate Discordance                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601510 -        Date:  2014-01-28 13:56                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
601514 -         ..
601515 -    2.  Dear Doctor Alba,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
601517 -         ..
601518 -    3.  Patient......... 0144                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
601520 -         ..
601521 -    4.  Following up the letter on 140116, ref SDS 53 HY6O - have you                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
601522 -        had a chance to locate Progress Notes for the meeting on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601523 -        131219, planned in your letter on 140115?  Please submit a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
601524 -        copy.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
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 53 CE80, ref SDS 51 CE80.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
601533 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601534 - Letter to Doctor Alba's continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
601536 -         ..
601537 -    5.  Good news - fair weather enables continued exercise toward                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
601538 -        weight loss.  As planned in the meeting on 131219, finally hit                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
601539 -        165 last week on 140121 (see case study dated 120101, line                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
601540 -        101240. ref SDS 12 A39H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
601542 -         ..
601543 -    6.  You can see in the study that weight bounced back, but hoping                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
601544 -        to stabilize at 165 over the next few weeks, then tackle 160,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
601545 -        based on lab results.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
601547 -         ..
601548 -    7.  You were looking for more research on discordance to test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
601549 -        LDL-P. [...reported in Doctor Alba's letter on 140115 1842.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
601550 -        ref SDS 51 PH5I...].  Any luck?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
601552 -         ..
601553 -    8.  Should hit 165 again this week or next, and will then get the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
601554 -        lab.  Please let me know if I should come to SFMC or UCSF for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
601555 -        the blood draw.  Should we do it locally in Martinez? [...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
601556 -        following up letter to VA on 140116 0814. ref SDS 53 H253...]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
601557 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601558 -            [On 140131 0815 have not received instructions from VA on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
601559 -            getting lab to test LDL-P, so ordered test. ref SDS 54 OO5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
601560 -            lab blood draw at Labcorp in Walnut Creek on Ygnacio Valley                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
601561 -            Road. ref SDS 54 NT6T                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
601563 -             ..
601564 -            [On 140201 1159 obtained blood draw for testing LDL-P at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
601565 -            Labcor on Health Testing Centers order # 27716. ref SDS 55                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
601566 -            KQ4L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601568 -             ..
601569 -            [On 140203 1147 obtained blood draw at VA to cross check                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
601570 -            Labcorp blood test. 140203 1147, ref SDS 56 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
601572 -             ..
601573 -            [On 140204 1236 letter from VA says to get blood draw for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
601574 -            lab at VA San Francisco Medical Center (SFMC), ref SDS 57                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
601575 -            PT3M, responding to inquiry in letter to VA on 140128.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
601576 -            ref SDS 0 TZ96                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
601578 -         ..
601579 -    9.  There have been no evident side effects of atorvastatin 10 mg                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
601580 -        and ezetimibe 10 mg.  There is a slight rash above left eye.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
601581 -        You can see from patient history treatment for rosacia by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
601582 -        Doctor Margulies beginning on 070221. ref SDS 1 BM62                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
601584 -         ..
601585 -   10.  There is also some rash below the knees on both legs, but this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
601586 -        may be sun exposure during hiking.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
601588 -         ..
601589 -   11.  Assuming these are not related to atorvastatin and ezetimibe,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
601590 -        there are no side effects from the current treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
601592 -         ..
601593 -   12.  Otherwise, seem healthy.  Vitals are good.  Shoulders have                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
601594 -        recovered enough from taking Rosuvastatin to enable doing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
601595 -        pushups again.  Very fortunate.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
601597 -         ..
601598 -   13.  Looking forward to meeting on 140213.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
601599 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601605 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601606 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601607 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601608 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601609 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601610 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601611 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601612 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601613 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601614 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601615 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601616 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
601617 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
6017 -