CONTACTS
SUBJECTS
CBC Lab WBC VA
1503 -
1503 - ..
1504 - Summary/Objective
1505 -
150501 - Follow up ref SDS 47 0000. ref SDS 32 0000.
150502 -
150503 - Lab today in Martinez shows excellent progress by the VA prescribing
150504 - continued weight loss, exercise, diet control with minimal statin
150505 - medications. Lipid profile TG/HDL ratio indicates LDL-P 626,
150506 - ref SDS 0 4Z66, has fallen further below 1000, and dominate sizes are
150507 - large, buoyant LDL particles protect against arterialsclorosis and
150508 - cardiovascular disease (CVD). ref SDS 0 5C7M Statin drugs lowered
150509 - LDL-C making patient concordant, higher risk for CVD events, than
150510 - occurs for discordant status. ref SDS 47 3V4N Electrolytes lab shows
150511 - potassium increased (K 5.4) above healthy range. ref SDS 0 TN3M T
150512 - Bilirubin continues elevated, indicating possible liver damage.
150513 - ref SDS 0 G34G
150514 -
150515 - [On 140211 0133 letter to medical team at SFVA Med Center
150516 - for agenda to prepare for meeting on 140213, notifies that
150517 - total bilirubin and potassium are elevated in VA lab, and
150518 - Labcorp reports these blood elements are stable.
150519 - ref SDS 50 TV5F
150520 -
150521 -
150522 -
150524 - ..
1506 -
1507 -
1508 - Background
1509 -
150901 - On 131016 1632 submit letter for agenda meeting to review lab results
150902 - scheduled 131017 1000. ref SDS 33 X45G
150904 - ..
150905 - On 140131 0815 ordered another lab - cbc, electrolytes, lipid with NMR
150906 - - from Labcor to get LDL-P. ref SDS 46 X45G
150907 -
150908 -
150909 -
150911 - ..
1510 -
1511 -
1512 - Progress
1513 -
151301 - Blood draw today at VA health care facility for meeting at VA with
151302 - Doctor Alba on 140213, planned in the meeting on 131219 0930.
151303 - ref SDS 43 XF4O The letter to VA asked for instructions to get blood
151304 - draw at VA in San Francisco or in Martinez. Since, the VA has not
151305 - responded, and since the Martinez clinic is closer, had blood drawn
151306 - there today.
151307 -
151308 - [On 140204 1236 letter from VA says to get blood draw for
151309 - lab at VA San Francisco Medical Center (SFMC), ref SDS 49
151310 - PT3M, responding to inquiry in letter to VA on 140128.
151311 - ref SDS 45 TZ96
151313 - ..
151314 - Blood draw today compliments test 2 days ago with Labcorp to perform
151315 - NMR lipid analysis. 140201 1159, ref SDS 47 IM9N
151317 - ..
151318 - Blood draw today follows up previous partial lab on 131015 0724.
151319 - ref SDS 32 KK9M
151321 - ..
151322 - Planned for blood draw Monday or Tuesday next week, but injury
151323 - yesterday, perhaps from excessive hiking the past few months, reported
151324 - in case study on 120101 0900, ref SDS 14 WQ4I, prevents hiking today,
151325 - and possibly tomorrow as well. Since had a good hike yesterday, and
151326 - weight is near 165, decided to get blood draw today, so there is
151327 - correlation between labs, exercise, and weight.
151329 - ..
151330 - Last full lab was on 130529 0818. ref SDS 30 RP4N
151332 - ..
151333 - Prior full lab was on 121130 0846, ref SDS 24 RP4N, 120831 1400.
151334 - ref SDS 20 RP4N, following up 120509 1108, ref SDS 19 X45G; and before
151335 - that on 110727 1238, ref SDS 9 RP4N, and this was to prepare for
151336 - meeting in Primary Care a few weeks later on 110803 1400. ref SDS 10
151337 - U24I
151339 - ..
151340 - Partial lab to resolve skewed results from dehydration was on 121212
151341 - 0941. ref SDS 26 KK9M
151343 - ..
151344 - Prior partial for lipid panel testing cholesterol and for glucose,
151345 - sodium, and total bilirubin was on 131015 0724, ref SDS 32 KK9M,
151346 - following up partial lab on 120831 1400. ref SDS 20 IM9N and
151347 - ref SDS 20 KK9M
151348 -
151350 - ..
151351 - Blood Tests Evaluate Health 4 Years After CABG x4 Surgery
151352 -
151353 - Follow up ref SDS 47 RP4N, ref SDS 32 RP4N.
151354 -
151355 - Prior VA CBC on 120509 1108. ref SDS 19 RP4N
151356 - Prior VA CBC on 120831 1524. ref SDS 20 RP4N
151357 - Prior VA CBC on 121130 1001. ref SDS 24 RP4N
151358 - Prior VA CBC on 130529 0818. ref SDS 30 RP4N
151359 - Prior Labcorp CBC on 140201 1159. ref SDS 47 RP4N
151361 - ..
151362 - VA did not order CBC for lab today...
151364 - ..
151365 - CBC........... 2014 02 03 0952 140201 130529
151366 - VA Labcorp VA VA Labcorp
151367 - Blood Results Results Results Units Range Range
151368 - WBC 6.2 7.4 K/cmm 4.8 - 10.8 3.4 - 10.8
151369 - RBC 5.13 5.09 M/cmm 4.7 - 6.1 4.14 - 5.80
151370 - HGB 15.2 15.0 g/dL 14 - 18 12.6 - 17.7
151371 - HCT 44.2 46.2 % 42 - 52 37.5 - 51.0
151372 - MCV 86.0 90.7 fL 80 - 99 79.0 - 97.0
151373 - MCH 29.6 29.5 uug 27 - 34 26.6 - 33.0
151374 - MCHC 34.4 32.5 gm/dL 32 - 35.2 31.5 - 35.7
151375 - RDW 13.7 14.4 % 11.5 - 14.5 12.3 - 15.4
151376 - PLT 303 279 K/cmm 130 - 400 155.0 - 379.0
151377 - MPV 8.8 fL 7 - 10.4
151378 - NEUT % 69 69.9 % 40 - 80 40.0 - 74.0
151379 - LYMPH % 21 L 19.7 % 20 - 51 14.0 - 46.0
151380 - MONO % 8 7.8 % 2 - 13 4.0 - 12.0
151381 - EOS % 1 1.9 % .5 - 7 0.0 - 5.0
151382 - BASO % 1 0.7 % 0 - 2 0.0 - 3.0
151383 - NEUT # 4.3 5.2 K/cmm 1.5 - 7.9 1.4 - 7.0
151384 - LYMPH # 1.3 1.5 K/cmm 1.2 - 3.4 0.7 - 3.1
151385 - MONO # 0.5 0.6 K/cmm .2 - 1.2 0.1 - 0.9
151386 - EOS # 0.1 0.1 K/cmm .1 - .5 0.0 - 0.4
151387 - BASO # 0.1 0.1 K/cmm 0 - .2 0.0 - 0.2
151388 - ESRmVES mm/hr 0 - 10
151389 - ESRxCYT mm/hr 2 - 10
151390 - RETIC % % .66 - 2.85
151391 - RETIC # k/uL 27.9 - 121.6
151392 - Immature Granulocytes 0.0 % 0.0 - 2.0
151393 - Immature Grans (Abs) 0.0 % 0.0 - 0.1
151395 - ..
151396 - Comments:
151397 -
151398 - a. Test not performed at VA today.
151399 -
151400 -
151401 -
151402 -
1515 -
SUBJECTS
Urinalysis Gross Exam Laboratory Test Satisfactory Within Range Labc
2203 -
220401 - ..
220402 - Urinalysis Gross Exam Laboratory Test Satisfactory Within Range
220403 -
220404 - Follow up ref SDS 47 0X72, ref SDS 19 0X72.
220405 -
220406 - Prior Urinalysis test on 101207 0906. ref SDS 8 0X72
220407 - Prior Urinalysis test on 120509 1108. ref SDS 19 0X72
220408 - Prior Urinalysis test on 140201 1159. ref SDS 47 0X72
220410 - ..
220411 - VA did not order urinalysis for lab today...
220413 - ..
220414 - URINALYSIS.....2014 02 03 0952 140201 120509
220415 - VA Labcorp VA VA Labcorp
220416 - Results Results Results Units Range Range
220417 - PH 5.5 6.0 5 - 9 5.0 - 7.5
220418 - PROTEIN NEG NEG mg/dL NEG - TRACE NEG - TRACE
220419 - GLUCOSE NEG NEG mg/dL Ref: NEG NEG
220420 - KETONES NEG NEG mg/dL Ref: NEG NEG
220421 - BILI NEG NEG Ref: NEG NEG
220422 - BILIcnf Ref: NEG
220423 - BLOOD TRACE TRACE Ref: NEG
220424 - NITRITE, URINE NEG NEG Ref: NEG NEG
220425 - UROBILI 0.2 0.2 EU/dL .2 - 1 0.0 - 1.9
220426 - LEU EST NEG Ref: NEG
220427 - SP.GRAV 1.026 1.025 1.003- 1.035 1.005 - 1.030
220428 - COLOR YELLOW YELLOW
220429 - APPEAR CLEAR CLEAR
220430 - WBC ESTERASE NEG
220431 - OCCULT BLOOD NEG NEG
220433 - ..
220434 - Comments:
220435 -
220436 - a. Test not performed at VA today.
220437 -
220438 -
220439 -
220440 -
2205 -
SUBJECTS
VA Lab Electrolytes Chem Profile Glucose 103 Sodium NA 140 Potasium
3503 -
350401 - ..
350402 - Total Bilirubin 1.6 Due to Rosuvastatin Recovery Failing
350403 - Hyperbilirubinemia Persists after Ending Rosuvastatin
350404 - Potasium K 5.4 Elevated above May Affect Heart Function
350405 -
350406 - Follow up ref SDS 47 KK9M, ref SDS 32 KK9M.
350407 -
350408 - Prior CHEM PROFILE on 120509 1108. ref SDS 19 KK9M
350409 - Prior CHEM PROFILE on 120831 1524. ref SDS 20 KK9M
350410 - Prior CHEM PROFILE on 130228 1140. ref SDS 28 KK9M
350411 - Prior CHEM PROFILE on 130529 0818. ref SDS 30 KK9M
350412 - Prior CHEM PROFILE on 131015 0724. ref SDS 32 KK9M
350413 - Prior CHEM PROFILE Labcorp on 140201 1159. ref SDS 47 KK9M
350415 - ..
350416 - ELECTROLYTES - CHEM PROFILE
350418 - ..
350419 - CHEM PROFILE...2014 02 03 0952 140201 131015 130529
350420 - VA Labcorp VA VA VA Labcorp
350421 - PLASMA Results Results Results Results Units Range Range
350422 - GLUCOSE 103 98 108 H 120 mg/dL 74 - 118 65.0 - 99.0
350423 - GLUfast mg/dL Ref: <=99
350424 - NA (salt) 140 140 139 139 mmol/L 136 - 144 134.0 - 144.0
350425 - K (potasium) H 5.4 4.8 4.3 H 4.9 mmol/L 3.4 - 4.8 3.5 - 5.2
350426 - CL 103 102 105 105 mmol/L 98 - 106 97.0 - 108.0
350427 - CO2 30.0 37.0 30.0 mmol/L 23 - 33
350428 - BUN 17 20 24 18 mg/dL 8 - 26 10.0 - 22.0
350429 - CREAT 0.82 0.81 0.83 0.83 mg/dL .5 - 1.1 0.76 - 1.27
350430 - eGFR INA >60 91 >60 >60 mL/min Ref: >=60 >59
350431 - eGFR IA 106 mL/min >59
350432 - CALCIUM 9.3 9.4 9.2 9.2 mg/dL 8.7 - 10.2 8.6 - 10.2
350433 - CA CORR mg/dL 8.7 - 10.2
350434 - PO4 mg/dL 2.4 - 4.5
350435 - MG 85 mg/dL 1.8 - 2.5
350436 - ALK PHO 105 84 87 IntUnits/L 37 - 107 39.0 - 117.0
350437 - ..
350438 - T. BIL H 2.1 H 1.6 H 1.7 H 1.3 mg/dL .3 - 1.2 0.0 - 1.2
350439 - D. BILI 0.3 0.34 < 0.1 mg/dL .1 - .4 0.00 - 0.40
350440 - Bilirubin, Indir 1.26 H mg/dL 0.10 - 0.80
350441 - AST 23 21 20 22 IntUnits/L 8 - 42 0.0 - 40.0
350442 - ALT 21 19 17 19 IntUnits/L 5 - 55 0.0 - 44.0
350443 - ALBUMIN 4.1 4.4 3.9 4.0 g/dL 3.3 - 4.8 3.6 - 4.8
350444 - PROTEIN 6.7 6.5 7.1 7.2 g/dL 6.5 - 8.1 6.0 - 8.5
350445 - Globulin, Total 2.1 g/dL 1.4 - 4.5
350446 - A/G Ratio 2.1 1.1 - 2.5
350447 - LDH 180.0 IntUnits/L 90 - 208 0.0 - 225.0
350448 - GGT 9.0 IU/L 0.0 - 65.0
350449 - Iron, Serum 114.0 ug/dL 40.0 - 155.0
350450 - AMYLASE Units/L 28 - 100
350451 - LIPASE Units/L 7 - 58
350452 - NH3 mcmol/L 15 - 56
350453 - URIC AC mg/dL 4.8 - 8.7
350454 - Cholesterol, Total 162.0 mg/dL 100.0 - 199.0
350455 - Triglycerides 64.0 mg/dL 0.0 - 149.0
350457 - ..
350458 - Comments:
350459 -
350460 - a. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.
350462 - ..
350463 - b. Evaluation for CREAT:
350464 -
350465 - Effective 7/2/08, new standardized method for
350466 - creatinine in place. Note reference range change.
350467 - Previous range 0.5-1.2 mg/dL.
350469 - ..
350470 - c. Evaluation for ALK PHO:
350471 -
350472 - The normal range is for an adult population less than
350473 - 50 years old. Alk Phos increases with age over 50 to
350474 - about 60% higher values by ages greater than 75 years
350475 - old.
350477 - ..
350478 - d. Evaluation for eGFR:
350479 -
350480 - eGFR Units = mL/min/1.73 square meters
350482 - ..
350483 - e. Ordering Provider: Vamc San Francisco
350484 - Report Released: Feb 03, 2014 @ 1232
350485 - Reporting Lab: Martinez OPC/CREC
350486 - 150 Muir Road Martinez, CA 94553 4668
350487 - Performing Lab: Martinez OPC/CREC
350488 - 150 Muir Road Martinez, CA 94553 4668
350490 - ..
350491 - Notes on Electrolytes Lab
350492 -
350493 -
350494 - 1. T Bilirubin 2.1................. ref SDS 0 015M
350495 -
350496 - Bilirubin 2.1 in lab today, remains 50% high after ending
350497 - Rosuvastatin 14 months ago on 121206 0900, ref SDS 25 OS5L,
350498 - indicating chornic side effects. Peripheral neuropathy has
350499 - declined from most severe effects; there have been no symptoms
350500 - for past 9 months, since 130614, reported in case study on
350501 - 120101 0900. ref SDS 14 TSUY Prior to 130614, there were no
350502 - episodes for several months reported on 130402, ref SDS 14
350503 - RURT, until episode occurred on 130210. ref SDS 14 PV8I Major
350504 - peripheral neuopathy both feet on 130107. ref SDS 14 8H5F
350506 - ..
350507 - Background on Rosuvastatin causing elevated T Bilirubin with
350508 - associated severe side effects is reported on 121206 0900, ref SDS 25
350509 - NI9L, and further explained in the record on 121130 0846. ref SDS 24
350510 - ER4K
350512 - ..
350513 - On 131017 1000 doctor explained patient history of intermittant and
350514 - mild peripheral neuropathy that correlates with persistent elevated T
350515 - Bilirubin in lab on 131015, ref SDS 32 015M, and further reported with
350516 - vitals, diet and exercise since prior meeting at VA on 130603, see
350517 - case study on 120101 0900, ref SDS 14 X14N, suggests intervention is
350518 - not required at this time to improve recovery from side effects taking
350519 - Rosuvastatin. ref SDS 35 LV5J
350521 - ..
350522 - On 131017 1000 VA medical chart Progress Notes assessment report
350523 - doctor concerned about chronic hyperbilirubinemia. ref SDS 35 PSXT
350524 -
350525 - [On 140211 0133 letter to medical team at SFVA Med Center
350526 - for agenda to prepare for meeting on 140213, notifies that
350527 - total bilirubin and potassium are elevated in VA lab, and
350528 - Labcorp reports these blood elements are stable.
350529 - ref SDS 50 TV5F
350531 - ..
350532 - [On 140508 1133 follow up lab by Labcorp shows Total
350533 - Bilirubin 1.3 elevated, but improved only slightly above
350534 - range. ref SDS 54 015M
350536 - ..
350537 - 2. Potasium K 5.4 Elevated above range......... ref SDS 0 ZG5O
350538 -
350539 - Doctor Egan was concerned last year about potasium (K) rising
350540 - above range for good health. He explained potasium effects
350541 - electrical signals to the heart, and so has significance for
350542 - CVD, reported during meeting at VA on 121206 0900. ref SDS 25
350543 - 6K56
350545 - ..
350546 - At that time on 121206, the doctor cited medication conflicts
350547 - as possibly causing elevated potasium. ref SDS 25 FI7L Doctor
350548 - Egan further considered dehydration (urination) caused by
350549 - Rosuvastatin may have skewed lab results for electrolytes on
350550 - 121130, and so ordered re-test. ref SDS 25 6K4J
350552 - ..
350553 - On 121212 0941 re-test lab reported Glucose 111, sodium 139,
350554 - and potasium (K) 4.6, all within range, ref SDS 26 KK9M,
350555 - correcting errors noted by Doctor Egan during meeting at VA on
350556 - 121206 0900. ref SDS 25 6K4J
350558 - ..
350559 - At this time, there is no evident cause of dehydration that
350560 - might reconcile elevated potasium (K 5.4).
350561 -
350562 - [On 140211 0133 letter to medical team at SFVA Med Center
350563 - for agenda to prepare for meeting on 140213, notifies that
350564 - total bilirubin and potassium are elevated in VA lab, and
350565 - Labcorp reports these blood elements are stable.
350566 - ref SDS 50 TV5F
350568 - ..
350569 - [On 140430 0900 letter from Doctor Egan, Cardiology
350570 - Physician at Martinez Clinic, notes medical team did not
350571 - address elevated potassium in labs, and again notifies
350572 - that this condition represents exposure to "electrical
350573 - problems" with the heart. ref SDS 52 UV5I
350575 - ..
350576 - [On 140505 0936 Doctor Egan notified that medical team at
350577 - VA Medical Center in San Francisco was notified about
350578 - concerns on elevated potassium (K) and Total Bilirubin,
350579 - ref SDS 53 YV4L, shown in labs reported in the record on
350580 - 140203 1147. ref SDS 48 ZG5O
350582 - ..
350583 - [On 140508 1133 follow up blood test by Labcorp shows
350584 - potassium (K) 5.6 elevated above range. ref SDS 54 ZG5O
350585 -
350586 -
350587 -
350588 -
3506 -
SUBJECTS
VA Lab Lipid Cholesterol 160 Decrease with Medication Hiking 1000 Mi
4903 -
490401 - ..
490402 - LDL-C 81 LDL-P 861 LDL Size Large Hike 1000 Miles Weight Lose 15 Pounds
490403 -
490404 - Follow up ref SDS 47 IM9N, ref SDS 32 IM9N.
490405 -
490406 - Good lab results today align with increased hiking and weight loss
490407 - past 3 months, reported in case study on 120101 0900, ref SDS 14 LO5O,
490408 - and reflect changes in diet with adding minimal medication, reported
490409 - on 140202, in the same study. ref SDS 14 GH4M See analysis below
490410 - calculating LDL-P 626 based on TG/HDL ratios (see para 2 and 3),
490411 - ref SDS 0 4Z6H, calculated from Labcorp test results reported on
490412 - 140201 1159. ref SDS 47 BE6O
490414 - ..
490415 - Prior LIPID PANEL 120509 1108. ref SDS 19 IM9N
490416 - Prior LIPID PANEL 120831 1525. ref SDS 20 IM9N
490417 - Prior LIPID PANEL 130228 1140. ref SDS 28 IM9N
490418 - Prior LIPID PANEL 130529 0818. ref SDS 30 IM9N
490419 - Prior LIPID PANEL 131015 0724, ref SDS 32 IM9N
490420 - Prior LIPID PANEL Labcorp, 140201 1159, ref SDS 47 IM9N
490422 - ..
490423 - LIPIDS
490425 - ..
490426 - LIPID Panel....2014 02 03 0952 140201 131015 130529
490427 - VA Labcorp VA VA VA Labcorp
490428 - NMR LipoProfile Results Results Results Results Units Range Range
490429 - LDL
490430 - LDL-P 861.0 nmol/L < 1000
490431 - <ow < 1000
490432 - Moderate 1000 - 1299
490433 - Borderline High 1300 - 1599
490434 - High 1600 - 2000
490435 - Very High > 2000
490437 - ..
490438 - Lipids
490439 - CHOL 160 156 321 H 307 mg/dL Ref: <=200 < 200
490440 - TRIGLYC 47 68 109 85 mg/dL Ref: <=150 < 150
490441 - HDL-C 58 61 50 50 mg/dL Ref: >=40 >= 40
490442 - LDL-C 93 81 249 H 240 mg/dL Ref: <=160 < 100
490443 - LDL Dir mg/dL Ref: <=160
490444 - TRIG NF mg/dL Ref: <=150
490446 - ..
490447 - LDL and HDL Particles
490448 - HDL-P (Total) 31.4 umol/L >= 30.5
490449 - Small LDL-P < 90.0 umol/L <=527.0
490450 - LDL Size 21.3 nm > 20.5
490452 - ..
490453 - --------------------------------------------------------
490454 - ** INTERPRETATIVE INFORMATION**
490455 - PARTICLE CONCENTRATION AND SIZE
490457 - ..
490458 - LDL AND HDL PARTICLES Percentile in Reference Population
490459 - HDL-P (total) High 75th 50th 25th Low
490460 - >34.9 34.9 30.5 26.7 <25.7
490461 - ..
490462 - Small LDL-P Low 25th 50th 75th High
490463 - <117 117 527 839 >839
490465 - ..
490466 - LDL Size <- Large (Pattern A)-> <- (Pattern B) ->
490467 - 23.0 20.6 20.5 19.0
490468 -
490469 - --------------------------------------------------------
490470 - Insulin Resistance Score
490471 - LP-IR Score < 25.0 <= 45.0
490472 -
490473 - The LP-IR Score combines information from lipoprotein
490474 - particle concentration and size to give improved
490475 - assessment of insulin resistance and diabetes risk.
490476 - Small LDL-P, LDL Particle Size, HDL-Particle, and
490477 - LP-IR Score have been validated by LipoScience
490478 - but not cleared by US FDA; the clinical utility
490479 - of these test results has not been fully established.
490481 - ..
490482 - INSULIN RESISTANCE MARKER
490483 -
490484 - <--Insulin Sensitive Insulin Resistant-->
490485 - Percentile in Reference Population
490486 -
490487 - Insulin Resistance Score
490488 - LP-IR Score Low 25th 50th 75th High
490489 - <27 27 45 63 >63
490491 - ..
490492 - Comments:
490493 -
490494 - a. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.
490496 - ..
490497 - b. Evaluation for LDL-CHO:
490498 -
490499 - RISK CATEGORY LDL GOAL
490500 - CHD and CHD risk equivalents <100 mg/dL
490501 - Multiple (2+) risk factors <130 mg/dL
490502 - 0-1 risk factor <160 mg/dL
490504 - ..
490505 - HDL Chol. greater than/equal to 60 mg/dL counts as "negative" risk
490506 - factor; its presence removes 1 risk factor from the total count.
490508 - ..
490509 - Ref: Adult Treatment Panel III (ATP III) JAMA 5/16/01 Vol. 285 #19.
490511 - ..
490512 - Ordering Provider: Vamc San Francisco
490513 - Report Released: Feb 03, 2014 @ 1232
490514 - Reporting Lab: Martinez OPC/CREC
490515 - 150 Muir Road Martinez, CA 94553 4668
490516 - Performing Lab: Martinez OPC/CREC
490517 - 150 Muir Road Martinez, CA 94553 4668
490519 - ..
490520 - Analysis....
490521 -
490522 - 1. LDL-P 861 with LDL-C 81 in Labcorp test on 140201 indicates
490523 - "concordance," with both elements low. Research indicates
490524 - healthiest cardiovascular condition occurs with lowest risk for
490525 - CVD, when lipids are "discordant," with LDL-P low and LDL-C
490526 - high, shown in the record on 131125 0005. ref SDS 40 FI3G
490528 - ..
490529 - What does "LDL-C high" mean? VA published goal for LDL-C <=
490530 - 160; Labcorp published goal LCL-C < 100. ref SDS 0 5C7M New
490531 - AHA guidelines show LDL-C < 190, reported on 131112 1422.
490532 - ref SDS 38 HT87
490534 - ..
490535 - NMR test lists LDL-P < 1600 for "borderline" CVD high risk, and
490536 - that below 1000, is "low," meaning low risk for CVD.
490537 - ref SDS 0 U45J Thus, LDL-P 861 in this test presents low risk
490538 - for CVD. Research on 131125, lists LDL-P < 700 may be a better
490539 - target to manage CVD risk. ref SDS 40 WY9H The same research
490540 - also cites LDL-P < 1000 for evaluating CVD risk, similar to NMR
490541 - test today. ref SDS 40 OQ9N
490543 - ..
490544 - When can patients be confident LDL-P < 700, 600, 200 - is low
490545 - enough to work on other aspects of daily life?
490547 - ..
490548 - 2. HDL 61 20% increase over 3 months, ref SDS 0 5C7M, enabled in
490549 - part by dropping Triglycerides 47 aligns with research
490550 - indicating these factors lower LDL-P and cause regression of
490551 - atherosclerosis plaque, reported on 131125 0005. ref SDS 40
490552 - 6S7F
490554 - ..
490555 - 3. LDL-C 68% reduction exceeds by 40% best results reported for
490556 - Atorvastatin 10 combined with Ezetimibe 10 yielding reductions
490557 - 50% in clinical trial reported by AHA, in 2002 study, shown in
490558 - the record on 131125 0005. ref SDS 40 1G7L
490560 - ..
490561 - 4. LDL-P 861 in Labcorp test on 140201 correlates with TG/HDL
490562 - ratio 68/61 = 1.11. Research indicates TG/HDL ratio correlates
490563 - to LDL-P vaulations produced by NMR testing, reported on 131125
490564 - 0005. ref SDS 40 666G
490566 - ..
490567 - 5. LDL-P 626 results from much lower TG/HDL ratio 47/58 = 0.81 in
490568 - VA test today, = 73% of Labcorp TG/HDL ratio; applying this
490569 - factor .73 x 861 = 626 - assuming straight line correlations
490570 - apply.
490572 - ..
490573 - 6. LDL-P 626 on Monday 140203, indicates strong cardiovascular
490574 - function, low risk for disease, per above analysis, ref SDS 0
490575 - RV5M, and may align with hiking 22 miles on Sunday 140202,
490576 - reported in case study on 120101 0900, ref SDS 14 GH4M, since
490577 - triglycerides are sensitive to exercise for several days.
490579 - ..
490580 - 7. Another NMR test in 2 or 3 months, possibly 2 or 3 more tests
490581 - are needed to determine reliable correlations between TG/HDL
490582 - ratios for calculating LDL-P and particle size from VA labs
490583 - that omit NMR testing, for this particular patient profile. At
490584 - that point the cost of NMR tests can be saved by doing the test
490585 - only once a year. As well, NMR testing may not be needed for
490586 - TG/HDL < 2, since this indicates small-size LDL pattern B.
490588 - ..
490589 - 8. Lipid favorable results - LDL-P 861, HDL 61, TG 68 - in NMR
490590 - test on 140201, and follow up test at VA on 140203, occurred
490591 - concurrent with...
490592 -
490593 - a. Hiking 933 miles since prior lab on 131015, reported in
490594 - case study 120101 0900, ref SDS 14 LO5O, and recommended in
490595 - research on 131125 0005. ref SDS 40 QP9F including regular
490596 - aerobic exercise to lower triglycerides, ref SDS 40 JV5O,
490597 - and raise HDL, ref SDS 40 P261 and ref SDS 40 U44L, and
490598 - also raise EPC, which together cause regression of
490599 - atherosclerosis to reduce CVD risk. ref SDS 40 8X4N
490600 -
490601 - [On 140213 0830 VA work plan in Progress Notes for
490602 - meeting on 140213 prescribes continuing exercise and
490603 - dietary regimen. ref SDS 51 E34O
490605 - ..
490606 - [On 140629 1921 follow up letter to VA on 140520,
490607 - ordering coronary CTA with calcium score, ref SDS 55
490608 - VQ48, to assess reducing level of care hiking 11
490609 - miles per day in order to reduce side effects,
490610 - ref SDS 56 UZ64; further request referral to Podiatry
490611 - for consultation to relieve metatarsalgia side
490612 - effects of prescribed care. ref SDS 56 U14H
490614 - ..
490615 - b. Weight loss - hit 165 on 140121, shown in case study on
490616 - 120101 0900. ref SDS 14 A39H Did this twice more on
490617 - 140129, and weight 164 next day on 140130. ref SDS 14 RS6K
490618 - This is continuing challenge bouncing around from over 200
490619 - in 2011, but has varied significantly.
490621 - ..
490622 - c. Low-carbohydrate diet lowers triglycerides (TG 68 in
490623 - Labcorp test, and 47 in VA lab, per above, ref SDS 0 5C7M),
490624 - which together with higher HDL (TG/HDL ratio < 2) combine
490625 - to lower LDL-P, cited in research on 131125 0005.
490626 - ref SDS 40 QP9F
490628 - ..
490629 - d. Chia seeds added to diet on 131125, reported in case study
490630 - on 120101 0900, ref SDS 14 746M, and recommended by Karen
490631 - at VA on 131121 0930. ref SDS 39 NQ37
490633 - ..
490634 - e. Orange juice added to diet on 131125, based on study
490635 - indicating HDL increase 21%, ref SDS 40 R48K, as reported
490636 - to VA in letter on 140114 0845. ref SDS 44 218O
490638 - ..
490639 - f. Atorvastatin 40 mg added on 131121, reported in case study
490640 - on 120101 0900. ref SDS 14 RN3F
490642 - ..
490643 - g. Atorvastatin 10 mg reduced 131230, and added Ezetimibe 10
490644 - mg reported in case study, ref SDS 14 6A6H
490646 - ..
490647 - Research cites studies that report Atorvastatin 10 mg +
490648 - Ezetimibe 10 mg achieves LDL < 70, and favorably changes
490649 - triglycerides and HDL, reported on 131125 0005. ref SDS 40
490650 - CO45 While low LDL < 70 conflicts with goal of
490651 - "discordance" that lowers health risk for arterialsclorosis
490652 - and CVD when LDL-P low and LDL-C high, shown in research on
490653 - 131125 0005, ref SDS 40 FI3G, even "concordant" results
490654 - today are good news.
490656 - ..
490657 - Since prior lab on 131015, until lab at VA today on 140203,
490658 - case study shows on 120101, ref SDS 14 E47L, patient has
490659 - taken...
490660 -
490661 - 1. Atorvastatin............... 1850 mg
490662 - 2. Ezetimibe.................. 340 mg
490663 -
490665 - ..
490666 - Follow up prior lipid history on 121130 0846. ref SDS 24 W25L.
490667 - ..
490668 - Small LDL LP-IR
490669 - Collection DT CHOL TRIGL HDL LDL-C LDL-P HDL-P LDL-P SIZE SCORE
490670 - 02/03/2014 09:52 160 47 58 93 ......................................... ref SDS 0 BE6O
490671 - 02/01/2014 12:31 156 68 61 81 861 31.4 < 90 21.3 < 25 ..... ref SDS 47 BE6O
490672 - 10/15/2013 08:25 321 H 109 50 249 H ......................................... ref SDS 32 BE6O
490673 - 05/29/2013 08:18 307 H 85 50 240 H ......................................... ref SDS 28 BE6O
490674 - 02/28/2013 08:39 310 H 73 47 248 H ......................................... ref SDS 28 BE6O
490675 - 11/30/2012 10:01 173 53 57 105 ......................................... ref SDS 24 BE6O
490676 - 08/31/2012 15:25 176 94 47 110 ......................................... ref SDS 20 U89N
490677 - 05/09/2012 11:24 155 76 49 94 ......................................... ref SDS 19 U89N
490678 - 02/09/2012 11:18 285 82 41 228 H ......................................... ref SDS 15 2A4G
490679 - 11/17/2011 14:27 260 84 43 200 H ......................................... ref SDS 13 2A4G
490680 - 07/27/2011 12:58 163 81 45 102 ......................................... ref SDS 9 E19L
490681 - 12/07/2010 09:17 151 41 47 96 ......................................... ref SDS 8 E19L
490682 - 07/21/2010 08:54 261 H 87 35 L 209 H ......................................... ref SDS 4 E19L
490683 - 06/10/2010 10:33 217 H 83 36 L 164 H ......................................... ref SDS 3 QV4F
490684 - * 12/14/2009 11:10 241 H 136 44 170 H ......................................... 100928 0706, ref SDS 5 VW6J
490685 - 08/13/2009 15:09 233 H 118 30 L 179 H ......................................... 100610 1046, ref SDS 3 U45G
490686 - 06/16/2006 10:59 238 H 68 32 L 192 H ......................................... 091002 0900, ref SDS 1 LJ5H
490687 -
490688 - * Lab at VA San Francisco Medical Center reported on 100928 0706.
490689 - ref SDS 5 VW6J
490691 - ..
490692 - Research on cholesterol reported on 091002 0900. ref SDS 1 2F8K
490694 - ..
490695 - On 131125 0005 research found ezetimibe (zetia) mg added to
490696 - Atorvastatin 20 mg yielded after 6 weeks significantly greater changes
490697 - to lipids than taking Atorvastatin in higher doses, e.g., 20 or 40 mg.
490698 - ref SDS 40 CO56
490700 - ..
490701 - On 131125 0005 research found discordance LDL-P low and LDL-C high
490702 - lipid panel HDL 65 TG 77 healthy patient profile with LDL 246.
490703 - ref SDS 42 MN98 Discordance with LDL-P low and LDL-C high is lowest
490704 - risk for CVD, arterialsclorosis. 131125 0005, ref SDS 40 FI3G
490706 - ..
490707 - On 131125 0005 research further found CT tests can evaluate level of
490708 - plaque build up resulting from elevated cholesterol. ref SDS 41 N73K
490710 - ..
490711 - Follow up testing can take several directions...
490712 -
490713 -
490714 - 1. Continue current regimine 3 months and perform NMR test to
490715 - determine correlation between LDL-P count and size with TG/HDL
490716 - ratio. Repeat once or twice more, per analysis above.
490717 - ref SDS 0 QV6L
490719 - ..
490720 - Patient history shows prior favorable lipid results after
490721 - initial 6 months of statin drugs, and then LDL rises (see
490722 - above, ref SDS 0 W25L, This could have indicated discordance,
490723 - which shows improving cardiovascular health and lower CVD risk.
490724 - Without NMR testing, the record is unclear.
490726 - ..
490727 - 2. Trial end Ezetimibe 10 mg and continue Atorvastatin and perform
490728 - NMR in 3 months to see if favorable lipid results remain with
490729 - less medical expense.
490731 - ..
490732 - 3. Trial end Atorvastatin 10 mg and Ezetimibe 10 mg and perform
490733 - NMR in 3 months to obtain baseline NMR results without
490734 - medication.
490736 - ..
490737 - 4. Trial current medication and reduce exercise 50% from 1000
490738 - miles to 500 miles over 3 months, i.e., about 6 miles per day,
490739 - and perform NMR test to control lipids correlation between
490740 - LDL-P count and size with TG/HDL ratio. Repeat once or twice
490741 - more, per analysis above. ref SDS 0 QV6L
490742 -
490743 -
490744 -
490745 -
490746 -
490747 -
4908 -
SUBJECTS
VA Lab Cardiac Enzymnes Creatine Kinase CK 149 Range 36 340 Measures
5503 -
550401 - ..
550402 - Rosuvastatin Switch from Simvastatin Myopathy Side Effects Decline
550403 - Simvistatin Side Effects Myopathy Muscle Pain Decline Switch to Rosuvastatin
550404 - Myopathy Muscle Pain Side Effects Simvistatin Decline Switch to Rosuvastatin
550405 -
550406 - Follow up ref SDS 47 D26G, ref SDS 32 D26G.
550407 -
550408 - Prior Cardiac Enzymes Profile on 120209 1118. ref SDS 15 D26G
550409 - Prior Cardiac Enzymes Profile on 120509 1108. ref SDS 19 D26G
550410 - Prior Cardiac Enzymes, 131015 0724, ref SDS 32 D26G
550412 - ..
550413 - This test not performed by Labcorp with blood draw on 140201...
550414 -
550415 - CARDIAC ENZYMES
550416 -
550417 - DATE 2014 02 03 0952 131015 120509
550418 - VA VA VA
550419 - PLASMA Results Results Results Units Range
550420 - CK 149 110 152 IntUnits/L 36 - 340
550421 - TRPONIN ng/ml 0 - 0.07
550422 - CK-MB ng/ml 0.6 - 3.5
550423 - MYOGLOB ng/ml 20 - 82
550425 - ..
550426 - a. TEST PERFORMED BY VAMC SACRAMENTO, 10535 HOSPITAL WAY,
550427 - MATHER CA.
550429 - ..
550430 - Research on 111013 explains Creatine Kinase CK, relates to muscle
550431 - disorders caused by cholesterol medications with statins. 111013 1404,
550432 - ref SDS 12 J54K
550434 - ..
550435 - CK lab may align with reduced side effects of muscle pain in left
550436 - shoulder.
550437 -
550438 -
550439 -
550440 -
550441 -
550442 -
5505 -
SUBJECTS
HGBA1C 5.5 Range 4.1-6.2 Diabetes Negative Laboratory Blood Test Cro
8403 -
840401 - ..
840402 - HGBA1c Diabetes Blood Test
840403 - Diabetes Blood Test HGBA1c
840404 -
840405 - Follow up ref SDS 47 9F4O, ref SDS 32 9F4O.
840406 -
840407 - Prior HGBA1c Profile on 100721 0800. ref SDS 4 IL4N
840408 - Prior HGBA1c Profile on 101207 0906. ref SDS 8 IL4N
840409 - Prior HGBA1c Profile on 131015 0724. ref SDS 32 9F4O
840411 - ..
840412 - This test not performed by Labcorp with blood draw on 140201...
840413 -
840414 - HGBA1c
840415 -
840416 - HGBA1c.........2014 02 03 0952 131015 101207
840417 - VA VA VA
840418 - BLOOD Results Results Results Units Range
840419 - HGBA1c 5.5 5.5 5.7 % 4.1 - 6
840420 - eAG 111 111 mg/dL 74.0 - 118
840422 - ..
840423 - Comments:
840424 -
840425 - b. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.
840426 -
840427 - eAG = Calculated Estimated Average Daily Glucose and may be
840428 - easier for patients to understand than an A1c result.
840429 - Calculation: 28.7 x HGBA1c - 46.7
840431 - ..
840432 - Ordering Provider: Harkesh S. Sandhu MD
840433 - Report Released: Oct 15, 2013 @ 1309
840435 - ..
840436 - Reporting Lab: MARTINEZ OPC/CREC
840437 - 150 MUIR ROAD MARTINEZ, CA 94553-4668
840439 - ..
840440 - Performing Lab: MARTINEZ OPC/CREC
840441 - 150 MUIR ROAD MARTINEZ, CA 94553-4668
840442 -
840444 - ..
840445 - This test for diabetes was ordered by Doctor Abrams during a meeting
840446 - at the San Francisco VA Medical Center on 130227 0930. ref SDS 27 8T5L
840447 - However, it is not reported for the lab performed the next day on
840448 - 130228 1140, ref SDS 28 RP4N, nor in the follow up lab 3 months later
840449 - on 130529 0818. ref SDS 30 RP4N
840451 - ..
840452 - HGGA1c was performed previously on 101207 0906, ref SDS 8 IL4N, and 5
840453 - months earlier on 100721 0800. ref SDS 4 IL4N
840455 - ..
840456 - VA lab today shows no evidence of diabetes. Aligns with Labcorp test
840457 - on 2 days earlier showing LP-IR Score < 25.0, indicating very low risk
840458 - of diabetes, reported on 140201 1159. ref SDS 47 WR9H
840459 -
840460 -
840461 -
840462 -
840463 -
840464 -
840465 -
840466 -
8405 -