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 58 0000. ref SDS 54 0000.
600502 -
600503 -
600504 -
600505 -
600507 - ..
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 54 HY6O; report hiking 11 miles per day continued, weight hit
601103 - 165, ref SDS 54 TZ8U; ask where to get lab at VA Martinez, in San
601104 - Francisco, or at UCSF. ref SDS 54 TZ96 No side effects from
601105 - Atorvastatin and Ezetimibe. ref SDS 54 TZ99
601107 - ..
601108 - On 140131 0815 have not received instructions from VA on getting lab
601109 - to test LDL-P, so ordered test. ref SDS 55 OO5G lab blood draw at
601110 - Labcorp in Walnut Creek on Ygnacio Valley Road. ref SDS 55 NT6T
601112 - ..
601113 - On 140201 1159 obtained blood draw for Lipid NMR test at Labcor on
601114 - Health Testing Centers order # 27716, ref SDS 56 KQ4L, showing
601115 - "concordance" LDL-P 861, LDL-C 81, HDL 61, TG 68, LDL (pattern A) size
601116 - = large bouyant protective. ref SDS 56 IM9N
601118 - ..
601119 - On 140203 1147 since have not received instructions from VA, obtained
601120 - blood draw at VA in Martinez to cross check Labcorp blood test. 140203
601121 - 1147, ref SDS 57 KK9M, showing LDL-C 93, HDL 58, TG 47, ref SDS 57
601122 - IM9N, indicating "concordance" LDL-P 626, LDL (pattern A) size = large
601123 - bouyant protective. ref SDS 57 QV5G
601125 - ..
601126 - On 140204 1236 letter from VA today, notifies that Progress Notes for
601127 - meeting on 131219, have been posted and are available for customer to
601128 - receive from ROI department. ref SDS 58 HY6O Cause for 6-weeks delay
601129 - issuing Progress Notes not clear in the record. ref SDS 58 V44F VA
601130 - Progress Notes for meeting on 131219, are comprehensive and helpful.
601131 - ref SDS 58 MR3G Progress Notes have many minor grammatical errors
601132 - likely due to limited time, ref SDS 58 MZ5H, VA does not support NMR
601133 - lipid tests to determine LDL-P and discordance with LDL-C; patient can
601134 - obtain test from another lab. ref SDS 58 CE80 VA letter today
601135 - maintains discordance with low LDL-P and high LDL-C is "unhealthy" -
601136 - submits no evidence from medical literature supporting this
601137 - proposition, nor to address literature submitted to the VA stating
601138 - discordance is the healthiest condition for CVD patients. ref SDS 58
601139 - 6U4L VA concurs that lowering weight toward BMI standards aids
601140 - resolving hyperlipidemia. ref SDS 58 8N9H VA maintains lifestyle
601141 - through exercise and diet to control weight and hyperlipidemia require
601142 - support taking statin medications, e.g., Atorvastatin and Ezetimibe.
601143 - ref SDS 58 GT5F VA letter today says patient mis-reads literature on
601144 - discordance between LDL-P and LDL-C, and proposes discussions to
601145 - clarify this matter during meeting scheduled on 140213. ref SDS 58 HU5M
601146 - VA prefers patient get labs drawn at San Francisco VA Medical Center.
601147 - ref SDS 58 PT3M
601149 - ..
601150 - On 140211 0133 letter submits agenda to VA for meeting scheduled on
601151 - 140213. ref SDS 0 HY6O
601152 -
601153 -
601154 -
601155 -
601157 - ..
6012 -
6013 -
6014 - Progress
6015 -
601501 - LDL-P Add to Pending Lab Evaluate Discordant
601502 - Hyperlipidemia Patient Discordant Test Pending Lab LDL-P
601503 -
601504 - Follow up ref SDS 58 CE80, ref SDS 54 CE80.
601505 -
601506 - Letter to VA says...
601507 -
601508 - 1. Subject: Agenda Meeting 13 Feb; Lab LDL-P 861 LDL-C 81 Concordant
601509 - Date: 2014-02-11 02:59
601518 - ..
601519 - 3. Progress Notes on 131219 [...received from VA on 140204 1236.
601520 - ref SDS 58 HY6O...], stating LDL-P provides stronger
601521 - association with CVD risk, ref SDS 48 GO35, and your letter
601522 - saying patient can support the team with NMR lab [...reported
601523 - on 140204 1236. ref SDS 58 CE80...], was implemented on
601524 - February 1 using Labcorp. Your request on Feb 4th to have VA
601525 - lab at San Francisco [...reported on 140204 1236. ref SDS 58
601526 - PT3M...], was received the day after a lab was drawn at
601527 - Martinez. Will do VA labs in San Francisco for next cycle.
601528 -
601529 - [On 140514 0950 blood draw for lab to support meeting with
601530 - Doctor Alba on 140519, was performed at VA Medical Center
601531 - in San Francisco in order to include LDL Direct.
601532 - ref SDS 63 X45G
601534 - ..
601535 - 4. Consolidated patient history shows strong alignment between NMR
601536 - test on 140201, and VA lipid panel 2 days later on 140203 (see
601537 - line 490402. ref SDS 57 IM9N
601539 - ..
601540 - 5. Low LDL-P 861 appears concordant with low LDL-C 81 in Labcorp
601541 - NMR report on 140201. TG 47 and HDL 58 in VA lab [...2 days
601542 - later on 140203 1147, ref SDS 57 5C7M...], aligns with Labcorp
601543 - results. Labcorp further shows LDL size 21.3 is "pattern A",
601544 - indicating large, buoyant LDL particles that "protect" against
601545 - CVD. While research indicates discordance with LDL-P low and
601546 - LDL-C high is the healthiest cardiovascular condition [...shown
601547 - on 131125 0005, ref SDS 44 FI3G, and submitted to the VA in a
601548 - letter on 140116 0814, ref SDS 53 H29T; and previously cited in
601549 - a prior letter on 140114 0845, ref SDS 50 2140...], I feel both
601550 - very healthy and very grateful for your outstanding care, and
601551 - the entire VA team.
601553 - ..
601554 - 6. Analysis indicates results improving prior lab on 131015, were
601555 - achieved taking Atorvastatin 40 mg - 4 weeks [...beginning on
601556 - 131121, shown in case study on 120101 0900, ref SDS 12
601557 - RN3F...], then Atorvastatin 10 mg and Ezetimibe 10 mg [...
601558 - beginning on 131230, also in case study, ref SDS 12 6A6H...],
601559 - making total for 8 weeks Atorvastatin 1850 mg, Ezetimibe 340
601560 - mg; as well, hiking 933 miles, weight loss to 165, low-carb
601561 - diet, chia seeds, orange juice, as further set out in the
601562 - record for the lab at the VA on 140203 (see Analysis para 6
601563 - line 490552. ref SDS 57 I17G
601564 -
601565 - [On 140213 0830 VA work plan in Progress Notes for meeting
601566 - on 140213 prescribes continuing exercise and dietary
601567 - regimen that yielded favorable labs and weight loss.
601568 - ref SDS 59 E34O
601570 - ..
601571 - 7. Look forward to meeting on Thursday, 140213 0830, to discuss
601572 - follow up test opportunities, e.g., develop coefficient to
601573 - convert TG/HDL ratio in VA labs into reliable LDL-P
601574 - calculation, reduce medication and hold other variables, or
601575 - maintain medication and adjust other variables, as further
601576 - shown in the record for the lab on 140203. ref SDS 57 IL7N
601578 - ..
601579 - 8. Notice VA lab shows potasium (K 5.4) is elevated again, and T
601580 - Bilirubin 2.1 further increased again, while Labcorp shows
601581 - these are stable. ref SDS 57 ZG5O
601582 -
601583 - [On 140430 0900 letter from Doctor Egan, Cardiology
601584 - Physician at Martinez Clinic, notes medical team did not
601585 - address elevated potassium in labs, and again notifies that
601586 - this condition represents exposure to "electrical problems"
601587 - with the heart. ref SDS 60 UV5I
601589 - ..
601590 - [On 140505 0936 Doctor Egan notified that medical team at
601591 - VA Medical Center in San Francisco was advised of concerns
601592 - on elevated potassium (K) and Total Bilirubin, ref SDS 61
601593 - YV4L, shown in labs reported in the record on 140203 1147.
601594 - ref SDS 57 ZG5O
601596 - ..
601597 - [On 140508 1133 follow up lab by Labcorp shows potassium
601598 - (K) 5.6 elevated above range. ref SDS 62 ZG5O
601600 - ..
601601 - [On 140508 1133 follow up lab by Labcorp shows Total
601602 - Bilirubin 1.3 elevated, but improved only slightly above
601603 - range. ref SDS 62 015M
601605 - ..
601606 - 9. Again, congratulations to the VA on excellent health care.
601607 -
601614 - ..
601615 - 12. PS. Please call if you have difficulty accessing and
601616 - navigating the record.
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