CONTACTS
SUBJECTS
VA Prescribe Atorvastin 10 MG Trial 4 Weeks Evaluate Side Effects In
3903 -
3903 - ..
3904 - Summary/Objective
3905 -
390501 - Follow up ref SDS 73 0000. ref SDS 64 0000.
390502 -
390503 -
390504 -
390505 -
390507 - ..
3906 -
3907 -
3908 - Background
3909 -
3910 -
391001 - Lab on 131015, showing LDL-C cholesterol remained high, 131015 0724,
391002 - ref SDS 38 BE6O, conflict with increased exercise and weight loss,
391003 - discussed in the letter to the medical team yesterday on 131016 1632.
391004 - ref SDS 39 IW57
391006 - ..
391007 - On 131017 1000 VA medical chart Progress Notes assessment report
391008 - patient status CAD stable, asymptomatic. hyperlipidemia not
391009 - controlled. ref SDS 40 T24N
391011 - ..
391012 - On 131017 1000 Doctor Egan proposed referring patient for clinical
391013 - trial to reduce cholesterol with new "targeted" drugs. ref SDS 40 179N
391015 - ..
391016 - On 131017 1000 VA medical chart Progress Notes assessment report
391017 - patient status hyperlipidemia not controlled, ref SDS 40 PSXT; Doctor
391018 - Egan makes referral to SF VA Medical Center for consult on
391019 - participation clinical trials, ref SDS 40 EU9F, with experimental
391020 - agents such as AMG 145 and REGN 727 to resolve multiple statin
391021 - intolerances. ref SDS 40 CN4H
391023 - ..
391024 - On 131103 received letter from VA SF Medical Center scheduling meeting
391025 - on 131121 1000, to consider clinical trial for lowering cholesteral.
391026 - ref SDS 41 YT4N
391028 - ..
391029 - On 131112 New York Times published several articles reporting that the
391030 - day before on 131113, American Heart Association published new
391031 - guidelines for treating CAD patients that expand use of statin
391032 - medication regardless of cholesterol levels, ref SDS 42 0001, and
391033 - further raise the LDL 70 to LDL 190, as a target for cardiovascular
391034 - risk. ref SDS 42 CW6H
391036 - ..
391037 - On 131114 New York Times published several articles reporting that the
391038 - day before on 131113, American Heart Association published new
391039 - guidelines for treating CAD patients. ref SDS 43 SH6G
391041 - ..
391042 - On 131121 0930 meeting with Doctor Alba at San Francisco Medical
391043 - Center - prescribed Atorvastatin 20 mg 4-week trial and evaluate
391044 - adding Zetia 10 mg, schedule follow up on 131219 0930. ref SDS 44 6H6K
391046 - ..
391047 - On 131121 1604 in another record later in the day, VA prescription RX
391048 - # 5674471 for Atorvastatin 20 mg was ordered. ref SDS 45 GH5M
391050 - ..
391051 - On 131125 0005 letter from Karen reports VA work plan to take statin
391052 - drug low dose Atvorstatin 10 mg for 4 weeks, then add ezetimibe
391053 - (Zetia) 10 mg in clinical trial for lowering cholesterol. ref SDS 47
391054 - V154
391056 - ..
391057 - On 131125 0005 research seems to indicate this clincial trial of low
391058 - dose Atorvasatatin 10 mg with Zeitia 10 mg has lowered cholesterol LDL
391059 - < 70, ref SDS 46 CO45; aligns with VA work plan, shown in VA Progress
391060 - Notes on 131121 0930. ref SDS 44 S26O
391062 - ..
391063 - On 131205 1448 received new prescription for Atvorstatin 20 mg,
391064 - ordered by Doctor Alba today for 4-week trial to assess side effects
391065 - for adding 2nd drug, Zetia 10 mg to lower LDL 249. ref SDS 48 GH5M
391067 - ..
391068 - On 131216 0028 letter to Doctor Alba submit agenda for meeting at VA
391069 - SFMC on 131219. ref SDS 50 HY6O
391071 - ..
391072 - On 131219 0930 meeting Doctor Alba at San Francisco VA Medical Center
391073 - ordered Ezetimibe 10 mg prescription for adding to Atorvastatin, and
391074 - ordered blood test to evaluate changes in lipid profile. 131219 0930,
391075 - ref SDS 51 NJ6G
391077 - ..
391078 - On 131230 1450, received Ezetimibe in US mail, ref SDS 52 5N3O,
391079 - ordered by Doctor Alba on 131219, 131219 0930, ref SDS 51 6H6K; begin
391080 - trial to manage cholesterol with Atorvastatin 10 mg and Ezetimibe 10
391081 - mg, planned during meeting at VA on 131121 0930. ref SDS 44 6H6K
391083 - ..
391084 - On 140114 0845 letter to Diana request Progress Notes meeting 131219,
391085 - ref SDS 53 HY6O, and ask about expanding scope pending lab to include
391086 - LDL-P. ref SDS 53 2140
391088 - ..
391089 - On 140115 1842 letter Diana will look for Progress Notes meeting
391090 - 131219, ref SDS 54 HY6O; investigating prospects for ordering lab test
391091 - LDL-P, ref SDS 54 CE80; VA claims patient cholesterol and LDL are above
391092 - target. ref SDS 54 CE91 VA further claims testing LDL-P not effective
391093 - in this case because LDL-C is not optimal. ref SDS 54 FF4H
391095 - ..
391096 - On 140116 0814 letter thanks Doctor Alba for investigting to find
391097 - Progress Notes for meeting at VA on 131219. ref SDS 55 HY6O Cite
391098 - research indicating patient with discordant LDL-C high and LDL-P low,
391099 - shown in patient lab on 131015, constitutes least risk for
391100 - arterialsclorosis disorder, CVD, mycardial infarction. ref SDS 55 735Y
391102 - ..
391103 - On 140128 1327 letter asks again about Progress Notes meeting 131219,
391104 - ref SDS 56 HY6O; report hiking 11 miles per day continued, weight hit
391105 - 165, ref SDS 56 TZ8U; ask where to get lab at VA Martinez, in San
391106 - Francisco, or at UCSF. ref SDS 56 TZ96 No side effects from
391107 - Atorvastatin and Ezetimibe. ref SDS 56 TZ99
391109 - ..
391110 - On 140131 0815 have not received instructions from VA on getting lab
391111 - to test LDL-P, so ordered test. ref SDS 57 OO5G lab blood draw at
391112 - Labcorp in Walnut Creek on Ygnacio Valley Road. ref SDS 57 NT6T
391114 - ..
391115 - On 140201 1159 obtained blood draw for Lipid NMR test at Labcor on
391116 - Health Testing Centers order # 27716, ref SDS 58 KQ4L, showing
391117 - "concordance" LDL-P 861, LDL-C 81, HDL 61, TG 68, LDL (pattern A) size
391118 - = large bouyant protective. ref SDS 58 IM9N
391120 - ..
391121 - On 140203 1147 since have not received instructions from VA, obtained
391122 - blood draw at VA in Martinez to cross check Labcorp blood test. 140203
391123 - 1147, ref SDS 59 KK9M, showing LDL-C 93, HDL 58, TG 47, ref SDS 59
391124 - IM9N, indicating "concordance" LDL-P 626, LDL (pattern A) size = large
391125 - bouyant protective. ref SDS 59 QV5G
391127 - ..
391128 - On 140204 1236 letter from VA today, notifies that Progress Notes for
391129 - meeting on 131219, have been posted and are available for customer to
391130 - receive from ROI department. ref SDS 61 HY6O Cause for 6-weeks delay
391131 - issuing Progress Notes not clear in the record. ref SDS 61 V44F VA
391132 - Progress Notes for meeting on 131219, are comprehensive and helpful.
391133 - ref SDS 61 MR3G Progress Notes have many minor grammatical errors
391134 - likely due to limited time, ref SDS 61 MZ5H, VA does not support NMR
391135 - lipid tests to determine LDL-P and discordance with LDL-C; patient can
391136 - obtain test from another lab. ref SDS 61 CE80 VA letter today
391137 - maintains discordance with low LDL-P and high LDL-C is "unhealthy" -
391138 - submits no evidence from medical literature supporting this
391139 - proposition, nor to address literature submitted to the VA stating
391140 - discordance is the healthiest condition for CVD patients. ref SDS 61
391141 - 6U4L VA concurs that lowering weight toward BMI standards aids
391142 - resolving hyperlipidemia. ref SDS 61 8N9H VA maintains lifestyle
391143 - through exercise and diet to control weight and hyperlipidemia require
391144 - support taking statin medications, e.g., Atorvastatin and Ezetimibe.
391145 - ref SDS 61 GT5F VA letter today says patient mis-reads literature on
391146 - discordance between LDL-P and LDL-C, and proposes discussions to
391147 - clarify this matter during meeting scheduled on 140213. ref SDS 61 HU5M
391148 - VA prefers patient get labs drawn at San Francisco VA Medical Center.
391149 - ref SDS 61 PT3M
391151 - ..
391152 - On 140213 0830 meeting VA San Francisco, ref SDS 64 195I, report good
391153 - progress lowering risks of recurrant CVD based on concordant low LDL-P
391154 - 861 with low LDL-C 81. shown by lab NMR lipid panal. ref SDS 64 TB6J
391155 - Medical team excellent results collaborating doctor/patient
391156 - partnership. ref SDS 64 1L7M Atorvastatin 40 mg started 131121, and
391157 - then changed to Atorvastatin 10 mg with Ezetimibe 10 mg started
391158 - 131230. ref SDS 64 IE7F No side effects taking medication past 6
391159 - weeks. ref SDS 64 333L Objectives and ramifications of discordance
391160 - between LDL-P and LDL-C discussed. ref SDS 64 WM8J Regression of
391161 - atherosclerosis plaque can be assessed with CT and IVUS modalities to
391162 - evaluate recovery from prior acute condition that required surgery in
391163 - 2009. ref SDS 64 JZ4O Will continue medication, diet, exercise and
391164 - weight loss protocols, and test lipid panal again in 3 months on
391165 - 140519 0800. ref SDS 64 8X5O Did not discuss today elevated potasium
391166 - and bilirubin. ref SDS 64 GT7G
391168 - ..
391169 - On 140226 1243 letter to VA submits this record of meeting on 140213,
391170 - ref SDS 65 HY6O, and notifies cold/flu symptoms began a week ago,
391171 - similar to side effects for Atorvastatin and Ezebimibe. ref SDS 65
391172 - JR8H Request consideration order CT test evaluate regression of
391173 - athersclorosis plaque. ref SDS 65 JR99
391175 - ..
391176 - On 140303 1644 letter requests submission of Progress Notes for
391177 - meeting on 140213. ref SDS 67 E792
391179 - ..
391180 - On 140310 0939 received Progress Notes from VA for meeting on 140213.
391181 - ref SDS 71 VP9O
391183 - ..
391184 - On 140312 1720 submitted comments on Progress Notes, requesting
391185 - document identification, ref SDS 72 5N3O, notify of grammitical errors
391186 - in Progress Notes, ref SDS 72 IL83, advise Progress Notes mistake
391187 - citing LDL-P as focus of VA medical efforts, but likely intended to
391188 - present VA policy that advocates lowering LDL-C, ref SDS 72 IL87,
391189 - confirm VA notice that LDL-P has stronger association with CVD risk,
391190 - ref SDS 72 IL4R, request VA report HDL and TG improved in lab due to
391191 - customer intervention hiking, diet and weight loss, ref SDS 72 IL50,
391192 - which present opportunity for regression of atherosclerosis systemic
391193 - plaque, ref SDS 72 PSXX, clarify customer goals to assess medication
391194 - for maintaining lipid profile that reduces CVD risk, and consider
391195 - reducing reliance on medication in the future. ref SDS 72 IL61
391197 - ..
391198 - On 140430 0900 met with Doctor Egan at VA Clinic in Martinez,
391199 - ref SDS 73 HY6O; the doctor sent a letter after the meeting reporting
391200 - risk of heart problems caused by elevated potassium (K), ref SDS 73
391201 - UV5I, shown in labs reported on 140203 1147. ref SDS 59 ZG5O
391202 -
391203 -
391204 -
391206 - ..
3913 -
3914 -
3915 - Progress
3916 -
391601 - Potassium Elevated Exposure Electrical Problems Heart Function
391602 -
391603 - Follow up ref SDS 73 UV5I.
391604 -
391605 - Sent letter to Doctor Egan saying...
391606 -
391607 -
391608 - 1. Subject: Meeting Apr 30, Elevated Potassium Bilirubin Prior Lab
391609 - Date: 2014-05-05 10:04
391617 - ..
391618 - 2. Thanks very much for your letter on 140430, shown below.
391619 - ref SDS 73 4U3H Glad you received the agenda for our meeting.
391620 - I sent it at 0400, so it would get to you in time to prepare
391621 - for meeting at 0900.
391623 - ..
391624 - 3. As you can see, the team in San Francisco was notified that
391625 - both potassium and bilirubin were elevated in the last lab on
391626 - 140203. ref SDS 59 G34G
391628 - ..
391629 - 4. Your concerns were submitted with links to relevant Progress
391630 - Notes. The agenda for meeting on 140213, expressly cites
391631 - elevated potassium and T Bili [...in the letter to VA on 140211
391632 - 0133. ref SDS 62 TV5F...] in VA lab on 140203, and further
391633 - notes they are stable in Labcorp lab 2 days earlier on 140201,
391634 - all as shown in the record. ref SDS 59 ZG5O
391636 - ..
391637 - 5. Note that I hiked 22 miles the day before the VA lab on 140203,
391638 - so this may have affected results.
391640 - ..
391641 - 6. Next Monday, on 140512, will do another Labcorp blood draw to
391642 - get NMR results for LDL-P, HDL, TG, along with electrolytes
391643 - (Chem profile). On Wednesday, 140514, will get a blood draw at
391644 - VA in San Francisco, as requested by Doctor Alba. This will
391645 - cross check lipids and electrolytes. If potassium and
391646 - bilirubin continue elevated, will again present this in the
391647 - agenda for meeting on 140519, and cite your letter on 140430,
391648 - shown below.
391650 - ..
391651 - 7. Have increased hiking - 93 miles 2 weeks ago, and 82 miles last
391652 - week. If this week goes well, should have weight back to 165
391653 - again, in time for favorable labs next week.
391655 - ..
391656 - 8. Thanks again for excellent care.
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