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: May 14, 2014 09:50 AM Wednesday; Rod Welch

VA lab with lipid panel test cholesterol aligns with Labcorp results.

1...Summary/Objective
2...CBC WBC 9.5 Increased 50% After Several Years Stable
3...Blood Tests Evaluate Health 5 Years After CABG x4 Surgery
.............................CBC PANEL
4...Urinalysis Ketones Trace Abnormal Sp Gravity Above Range
.............................URINALYSIS PANEL
5...T Bili 2.2 Hyperbilirubinemia Worse Atorvastatin Ezetimibe
6...Potasium K 5.6 Elevated Increased Electrical Problems Heart
7...Bun/Creatinine Ratio Elevated Slightly
.............................ELECTROLYTES - CHEM PROFILE
8...Notes on Electrolytes Lab Hyperbilirubinemia Potassium Heart Problems
9...Hyperbilirubinemia Potassium Heart Problems Notes on Electrolytes Lab
10...Potassium Heart Problems Hyperbilirubinemia Notes on Electrolytes Lab
11...LDL-C 83 LDL-P 851 HDL 67 Hike 1000 Miles Weight Maintain 170
.............................LIPID PANEL
12...Lipid History Trend Analysis
13...Coronary CTA or IVUS Test Athereosclerosis Plaque 4 Years After CABG
14...Athereosclerosis Plaque 4 Years After CABG Coronary CTA or IVUS Test
15...Myopathy Muscle Pain Side Effects Simvistatin Decline
.............................CARDIAC ENZYMES
16...HGBA1c Diabetes Blood Test A1c
17...A1c Diabetes Blood Test HGBA1c
18...Diabetes HGBA1c A1c Blood Test
.............................Endocrine IV - HGBA1c - A1c
19...Cardiology Meeting on Radiology Test Regrission Atherosclerosis Plaque
20...Regrission Atherosclerosis Plaque Meeting Cardiology on Radiology Test
21...Atherosclerosis Plaque Regrission Meeting Cardiology on Radiology Test


..............
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CONTACTS 

SUBJECTS
CBC Lab WBC VA No Results                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2403 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2403 -    ..
2404 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
2405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
240501 - Follow up ref SDS 54 0000. ref SDS 47 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
240502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240503 - Lipids improved again with LDL-P 851 falling from 861, well below                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
240504 - 1000, the low end of the range.  VA and Labcorp align reporting HDL 67                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
240505 - increased from 61, and Triglycerides 59 fell from 68. ref SDS 0 U45J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
240506 - This indicates response to VA healthcare plan for regression of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240507 - artherosclerotic plaque through medication, diet and exercise.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
240508 - ref SDS 0 I17G  VA lab today omits CBC, so cannot cross check elevated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
240509 - WBC in Labcorp test last week. ref SDS 0 RP4N  Need further review of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
240510 - Urinalysis finding ketones Trace Abnormal, and Specific Gravity                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240511 - elevated. ref SDS 0 MT4L  Electrolytes (Chem Profile) need cross check                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
240512 - of elevated Glucose, Sodium, and Potassium. ref SDS 0 ZG5O  T Bili 2.2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
240513 - 80% above range may affect liver function, and align with recent new,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
240514 - mild episodes of peripheral neuropathy right foot. ref SDS 0 G34G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
240515 - Elevated Potassium 5.6 may risk "electrical problems with the heart."                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
240516 - ref SDS 0 TN3M  Elevated Chem labs (electrolytes) might be caused by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
240517 - dehydration from increased urination associated with taking statin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
240518 - medication, and compounded by extended hiking. ref SDS 0 KZ5O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
240519 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240520 -            [On 140515 2043 VA notified consolidated test results show                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
240521 -            progress lowering CVD risk with improved lipid management.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
240522 -            ref SDS 56 IM9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
240523 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240524 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240525 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240526 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240527 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240529 -  ..
2406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2408 - Background                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
240901 - On 131016 1632 submit letter for agenda meeting to review lab results                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
240902 - scheduled 131017 1000. ref SDS 36 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
240904 -  ..
240905 - On 140131 0815 ordered another lab - cbc, electrolytes, lipid with NMR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
240906 - - from Labcor to get LDL-P. ref SDS 45 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
240908 -  ..
240909 - On 140201 1159 had full lab with NMR lipid panel drawn at John Muir                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
240910 - Hospital on Treat, and by Labcorp. ref SDS 46 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
240912 -  ..
240913 - On 140203 1147 had partial lab drawn at VA in Martinez. ref SDS 47                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
240914 - KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
240916 -  ..
240917 - On 140507 0857 ordered another full lab from Labcorp with NMR lipid                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
240918 - panel. ref SDS 53 OO5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
240920 -  ..
240921 - On 140508 1133 lab blood daw at Labcorp with John Muir Medical Center                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
240922 - on Treat Blvd in Concord. ref SDS 54 445G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240924 -  ..
240925 - On 140514 0950 VA partial lab at Medical Center in San Francisco.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
240926 - ref SDS 0 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
240927 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240928 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240929 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240930 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240932 -  ..
2410 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2411 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2412 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2413 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241301 - Blood draw today at VA health care facility for meeting at VA with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
241302 - Doctor Alba on 140519, planned during prior meeting on 140213 0830.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
241303 - ref SDS 50 MQ5U  On 140204 1236 letter from VA says to get blood draw                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
241304 - at VA San Francisco Medical Center (SFMC) in order to included LDL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
241305 - direct, ref SDS 48 PT3M, responding to inquiry in letter to VA on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
241306 - 140128. ref SDS 44 TZ96  Letter to the VA on 140211 submitting agenda                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
241307 - for meeting on 140213, noted VA request for blood draw at Medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
241308 - Center in San Francisco, and presented plan to implement VA request                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
241309 - for next lab. ref SDS 49 HY6O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
241311 -  ..
241312 - Blood draw today is stored on CD pdf file stored in...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
241313 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
241314 -              F:\05\00003\SM\CC\AGMJ\20140514-101603\WELCH_0144_5 14 14.pdf                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
241315 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
241316 -              F:\05\00441\CG\GG\HMC\20140514-101603\WELCH_0144_5 14 14.pdf                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
241317 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
241318 -              F:\05\00441\SM\BGMC\20140514-101603\WELCH_0144_5 14 14.pdf                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
241320 -  ..
241321 - See directory structure for medical records on 140320 1125.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
241322 - ref SDS 51 4M5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
241324 -  ..
241325 - Blood draw today compliments test 6 days ago with Labcorp to perform                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
241326 - NMR lipid analysis, reported on 140508 1133. ref SDS 54 445G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
241328 -  ..
241329 - Blood draw today follows up previous VA partial lab on 140203 1147.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
241330 - ref SDS 47 ZG5O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
241332 -  ..
241333 - Last full VA lab was on 130529 0818. ref SDS 33 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
241335 -  ..
241336 - Prior full lab was on 121130 0846, ref SDS 26 RP4N, 120831 1400.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
241337 - ref SDS 22 RP4N, following up 120509 1108, ref SDS 21 X45G; and before                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
241338 - that on 110727 1238, ref SDS 11 RP4N, and this was to prepare for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
241339 - meeting in Primary Care a few weeks later on 110803 1400. ref SDS 12                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
241340 - U24I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
241342 -  ..
241343 - Partial lab to resolve skewed results from dehydration was on 121212                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
241344 - 0941. ref SDS 28 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
241346 -  ..
241347 - Went to 2nd floor for blood draw.  Used right arm, no problems.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
241348 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
241349 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
241351 -  ..
241352 - CBC WBC 9.5 Increased 50% After Several Years Stable                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
241353 - Blood Tests Evaluate Health 5 Years After CABG x4 Surgery                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
241354 - 
241355 - Follow up ref SDS 54 RP4N, ref SDS 47 RP4N.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
241356 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
241357 - Prior VA CBC on 120509 1108. ref SDS 21 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
241358 - Prior VA CBC on 120831 1524. ref SDS 22 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
241359 - Prior VA CBC on 121130 1001. ref SDS 26 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
241360 - Prior VA CBC on 130529 0818. ref SDS 33 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
241361 - Prior Labcorp CBC on 140201 1159. ref SDS 46 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
241362 - VA did not order CBC for lab on 140203 1147. ref SDS 47 YX8K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
241363 - Prior Labcorp CBC on 140508 1149. ref SDS 54 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
241365 -                              ..
241366 -                             CBC PANEL
241367 -         ..
241368 -        Dates......... 2014 05 14 1016    140508       140203        140201        130529                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
241369 -                               VA          Labcorp       VA            Labcorp        VA                          VA               Labcorp                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
241370 -        Blood                Results      Results      Results        Results       Results     Units            Range              Range                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
241371 -        WBC                                   9.5                         6.2           7.4     K/cmm        4.8   -   10.8     3.4   -   10.8                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241372 -        RBC                                   5.21                        5.13          5.09    M/cmm        4.7   -    6.1     4.14  -    5.80                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
241373 -        HGB                                  15.1                        15.2          15.0     g/dL        14     -   18      12.6   -   17.7                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241374 -        HCT                                  47.0                        44.2          46.2     %           42     -   52      37.5   -   51.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241375 -        MCV                                  90.0                        86.0          90.7     fL          80     -   99      79.0   -   97.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241376 -        MCH                                  29.0                        29.6          29.5     uug         27     -   34      26.6   -   33.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241377 -        MCHC                                 32.1                        34.4          32.5     gm/dL       32     -   35.2    31.5   -   35.7                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241378 -        RDW                                  13.8                        13.7          14.4     %           11.5   -   14.5    12.3   -   15.4                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241379 -        PLT                                 329                         303           279       K/cmm      130     -  400     155.0   -  379.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241380 -        MPV                                                                             8.8     fL           7     -   10.4                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
241381 -        NEUT %                               70                          69            69.9     %           40     -   80      40.0   -   74.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241382 -        LYMPH %                              20                          21      L     19.7     %           20     -   51      14.0   -   46.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241383 -        MONO %                                8                           8             7.8     %            2     -   13       4.0   -   12.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241384 -        EOS %                                 1                           1             1.9     %             .5   -    7       0.0   -    5.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241385 -        BASO %                                1                           1             0.7     %            0     -    2       0.0   -    3.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241386 -        NEUT #                                6.7                         4.3           5.2     K/cmm        1.5   -    7.9     1.4   -    7.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241387 -        LYMPH #                               1.9                         1.3           1.5     K/cmm        1.2   -    3.4     0.7   -    3.1                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241388 -        MONO #                                0.7                         0.5           0.6     K/cmm         .2   -    1.2     0.1   -    0.9                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241389 -        EOS #                                 0.1                         0.1           0.1     K/cmm         .1   -     .5     0.0   -    0.4                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241390 -        BASO #                                0.1                         0.1           0.1     K/cmm        0     -     .2     0.0   -    0.2                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241391 -        ESRmVES                                                                                 mm/hr        0     -   10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
241392 -        ESRxCYT                                                                                 mm/hr        2     -   10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
241393 -        RETIC %                                                                                 %             .66  -    2.85                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
241394 -        RETIC #                                                                                 k/uL        27.9   -  121.6                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
241395 -        Immature Granulocytes                 0.0                         0.0                   %                               0.0   -    2.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241396 -        Immature Grans (Abs)                  0.0                         0.0                   %                               0.0   -    0.1                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
241398 -         ..
241399 -        Comments:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
241400 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
241401 -             a.  Test not performed at VA today.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
241403 -  ..
241404 - VA does not report results for CBC, so cannot cross check Labcorp                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
241405 - finding WBC 9.5 increase 50% in blood test on 140508 1133. ref SDS 54                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
241406 - FK6I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
241408 -  ..
241409 - Increased exercise explained below, ref SDS 0 I17G, may have                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
241410 - stimulated bone marrow to produce more new blood that increased WBC                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
241411 - 50% in Labcorp blood test on 140508, per above, ref SDS 0 FK6I,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
241412 - explained by Doctor Johnson during a meeting at Kaiser on 030606.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
241413 - ref SDS 1 JP7G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
241414 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
241415 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
241416 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
241417 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
241418 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2415 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Urinalysis Lab VA No Results                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
3903 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
390401 -  ..
390402 - Urinalysis Ketones Trace Abnormal Sp Gravity Above Range                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
390403 - 
390404 - Follow up ref SDS 54 0X72, ref SDS 47 0X72.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
390405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
390406 - Prior Urinalysis test on 101207 0906. ref SDS 10 0X72                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
390407 - Prior Urinalysis test on 120509 1108. ref SDS 21 0X72                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
390408 - Prior Urinalysis test on 140201 1159. ref SDS 46 0X72                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
390409 - VA did not order urinalysis for lab on 140203 1147. ref SDS 47 0X72                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
390410 - Prior Labcorp CBC on 140508 1149. ref SDS 54 0X72                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
390412 -                              ..
390413 -                             URINALYSIS PANEL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
390414 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
390415 -        Dates..........2014 05 14 1016     140203         140201        120509                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
390416 -                               VA           Labcorp          VA           Labcorp        VA                          VA               Labcorp                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
390417 -                             Results       Results         Results       Results       Results     Units            Range              Range                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
390418 -        PH                                     5.5                           5.5           6.0                   5    -    9       5.0   -    7.5                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
390419 -        PROTEIN                                NEG                           NEG           NEG      mg/dL      NEG    -  TRACE     NEG   -   TRACE                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
390420 -        GLUCOSE                                NEG                           NEG           NEG      mg/dL      Ref: NEG            NEG                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
390421 -        KETONES                              Trace Abnormal                  NEG           NEG      mg/dL      Ref: NEG            NEG                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
390422 -        BILI                                   NEG                           NEG           NEG                 Ref: NEG            NEG                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
390423 -        BILIcnf                                                                                                Ref: NEG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
390424 -        BLOOD                                TRACE                         TRACE         TRACE                 Ref: NEG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
390425 -        NITRITE, URINE                         NEG                           NEG           NEG                 Ref: NEG            NEG                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
390426 -        UROBILI                                0.2                           0.2           0.2      EU/dL         .2  -    1       0.0    -   1.9                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
390427 -        LEU EST                                                                            NEG                 Ref: NEG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
390428 -        SP.GRAV                         H      1.036                         1.026         1.025                 1.003-    1.035   1.005 -    1.030                                                                                                                                                                                                                                                                                                                                                                                                                                                                
390429 -        COLOR                                YELLOW                        YELLOW        YELLOW                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
390430 -        APPEAR                               CLEAR                         CLEAR         CLEAR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
390431 -        WBC ESTERASE                           NEG                           NEG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
390432 -        OCCULT BLOOD                           NEG                           NEG                                                   NEG                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
390434 -         ..
390435 -        Comments:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
390436 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
390437 -             a.  Test not performed at VA today.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
390439 -  ..
390440 - VA does not report results for Urinalysis, so cannot cross check                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
390441 - Labcorp adverse findings in blood test on 140508 1133. ref SDS 54 FK6I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
390442 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
390443 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
390444 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
390445 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
390446 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
390447 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
390448 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
3905 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Lab Electrolytes Chem Profile Glucose 97 Sodium NA 144 Potasium K 5.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
5603 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
560401 -  ..
560402 - T Bili 2.2 Hyperbilirubinemia Worse Atorvastatin Ezetimibe                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
560403 - Potasium K 5.6 Elevated Increased Electrical Problems Heart                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560404 - Bun/Creatinine Ratio Elevated Slightly                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
560405 - 
560406 - Follow up ref SDS 54 KK9M, ref SDS 47 KK9M.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
560407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560408 - Prior CHEM PROFILE on 120509 1108. ref SDS 21 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
560409 - Prior CHEM PROFILE on 120831 1524. ref SDS 22 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
560410 - Prior CHEM PROFILE on 130228 1140. ref SDS 31 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
560411 - Prior CHEM PROFILE on 130529 0818. ref SDS 33 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
560412 - Prior CHEM PROFILE on 131015 0724. ref SDS 35 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
560413 - Prior CHEM PROFILE Labcorp on 140201 1159. ref SDS 46 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
560414 - Prior CHEM PROFILE on 140203 1147. ref SDS 47 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
560415 - Prior CHEM PROFILE Labcorp on 140508 1149. ref SDS 54 KK9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
560417 -                              ..
560418 -                             ELECTROLYTES - CHEM PROFILE                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
560420 -         ..
560421 -        Dates..........2014 05 14 1016     140508         140203        140201       131015       130529                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
560422 -                               VA           Labcorp         VA           Labcorp        VA           VA                          VA               Labcorp                                                                                                                                                                                                                                                                                                                                                                                                                                                          
560423 -        PLASMA               Results       Results        Results       Results       Results      Results     Units            Range              Range                                                                                                                                                                                                                                                                                                                                                                                                                                                           
560424 -        GLUCOSE                               97            103            98           108     H    120       mg/dL       74     -  118      65.0   -   99.0                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560425 -        GLUfast                                                                                                mg/dL       Ref: <=99
560426 -        NA (salt)                            144            140           140           139          139       mmol/L     136     -  144     134.0   -  144.0                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560427 -        K (potasium)                     H     5.6      H     5.4           4.8           4.3   H      4.9     mmol/L       3.4   -    4.8     3.5   -    5.2                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560428 -        CL                                   105            103           102           105          105       mmol/L      98     -  106      97.0   -  108.0                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560429 -        CO2                                                  30.0                        37.0         30.0     mmol/L      23     -   33                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
560430 -        BUN/Creati Ratio                 H    23             17            20            24           18       mg/dL        8     -   26      10.0   -   22.0                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560431 -        CREAT                                  0.97           0.82          0.81          0.83         0.83    mg/dL         .5   -    1.1     0.76  -    1.27                                                                                                                                                                                                                                                                                                                                                                                                                                                     
560432 -        eGFR INA                              79            >60            91           >60          >60       mL/min      Ref: >=60                   >59                                                                                                                                                                                                                                                                                                                                                                                                                                          
560433 -        eGFR IA                               92                          106                                  mL/min                                  >59                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560434 -        CALCIUM                                9.5            9.3           9.4           9.2          9.2     mg/dL        8.7   -   10.2     8.6   -   10.2                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560435 -        CA CORR                                                                                                mg/dL        8.7   -   10.2                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
560436 -        PO4                                                                                                    mg/dL        2.4   -    4.5                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
560437 -        MG                                                   85                                                mg/dL        1.8   -    2.5                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
560438 -        ALK PHO                              100                          105            84           87       IntUnits/L  37     -  107      39.0   -  117.0
560439 -  ..
560440 -        T. BIL             H   2.2       H     1.3      H     2.1     H     1.6    H      1.7   H      1.3     mg/dL         .1   -    1.2     0.0   -    1.2                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560441 -        D. BILI                0.2             0.32           0.3           0.34        < 0.1                  mg/dL         .1   -     .5     0.00  -    0.40
560442 -        Bilirubin, Indir                       0.98                         1.26   H                           mg/dL                           0.10  -    0.80                                                                                                                                                                                                                                                                                                                                                                                                                                                     
560443 -        AST                                   26             23            21            20           22       IntUnits/L   8     -   42       0.0   -   40.0                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560444 -        ALT                                   17             21            19            17           19       IntUnits/L   5     -   55       0.0   -   44.0                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560445 -        ALBUMIN                4.6             4.6            4.1           4.4           3.9          4.0     g/dL         3.3   -    5.2     3.6   -    4.8                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560446 -        PROTEIN                7.5             6.6            6.7           6.5           7.1          7.2     g/dL         6.0   -    8.5     6.0   -    8.5                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560447 -        Globulin, Total                        2.0                          2.1                                g/dL                            1.4   -    4.5                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560448 -        A/G Ratio                              2.3                          2.1                                                                1.1   -    2.5                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560449 -        LDH                                  200.0                        180.0                                IntUnits/L  90     -  208       0.0   -  225.0                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560450 -        GGT                                   11.0                          9.0                                IU/L                            0.0   -   65.0                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560451 -        Iron, Serum                          100.0                        114.0                                ug/dL                          40.0   -  155.0                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560452 -        AMYLASE                                                                                                Units/L     28     -  100                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
560453 -        LIPASE                                                                                                 Units/L      7     -   58                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
560454 -        NH3                                                                                                    mcmol/L     15     -   56                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
560455 -        URIC AC                                5.6                                                             mg/dL        4.8   -    8.7     3.7   -    8.6                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560456 -        Cholesterol, Total                   164.0                        162.0                                mg/dL                         100.0   -  199.0                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560457 -        Triglycerides                         55.0                         64.0                                mg/dL                           0.0   -  149.0                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560458 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560460 -             ..
560461 -        a.  SLIGHTLY ICTERIC SPECIMEN /HN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
560463 -             ..
560464 -        b.  Ordering Provider: Diana Alba                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
560465 -            Report Released..: May 14, 2014@11:29                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
560466 -            Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
560467 -                               4150 CLEMENT STREET                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
560468 -                               SAN FRANCISCO, CA 94121-1545                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
560469 -            Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
560470 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560471 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560472 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560474 -  ..
560475 - Notes on Electrolytes Lab Hyperbilirubinemia Potassium Heart Problems                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
560476 - Hyperbilirubinemia Potassium Heart Problems Notes on Electrolytes Lab                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
560477 - Potassium Heart Problems Hyperbilirubinemia Notes on Electrolytes Lab                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
560478 - 
560479 - Follow up ref SDS 54 G34G, ref SDS 47 G34G.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
560480 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560481 -    1.  T Bilirubin 2.2................. ref SDS 0 015M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
560482 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560483 -        Bilirubin 2.2 in lab today, elevated 80% above range after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
560484 -        ending Rosuvastatin 17 months ago on 121206 0900, ref SDS 27                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
560485 -        OS5L, - with continuing side effects of poor liver function                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
560486 -        that may align with new, recent mild episodes peripheral                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560487 -        neuropathy in right foot, reported on 140510, shown in case                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
560488 -        study on 120101 0900. ref SDS 16 TV6I  Until then there had                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
560489 -        been no symptoms for past 9 months, since 130614, reported in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
560490 -        case study on 120101 0900. ref SDS 16 TSUY  Prior to 130614,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
560491 -        there were no episodes for several months reported on 130402,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
560492 -        ref SDS 16 RURT, until episode occurred on 130210. ref SDS 16                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
560493 -        PV8I  Major peripheral neuopathy both feet on 130107.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560494 -        ref SDS 16 8H5F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560495 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560496 -            [On 140520 0732 follow up lab at VA shows T Bili 1.2,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
560497 -            falling dramatically to within range, ref SDS 59 G34G, from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560498 -            being elevated at 2.2 recorded in test today on 140514, per                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
560499 -            above. ref SDS 0 015M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
560501 -         ..
560502 -        Background on Rosuvastatin causing elevated T Bilirubin with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
560503 -        associated severe side effects is reported on 121206 0900,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
560504 -        ref SDS 27 NI9L, and further explained in the record on 121130                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
560505 -        0846. ref SDS 26 ER4K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
560507 -         ..
560508 -        On 131017 1000 Doctor Egan explained patient history of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
560509 -        intermittant and mild peripheral neuropathy that correlates                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
560510 -        with persistent elevated T Bilirubin in lab on 131015,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
560511 -        ref SDS 35 015M, and further reported with vitals, diet and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
560512 -        exercise since prior meeting at VA on 130603, see case study on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
560513 -        120101 0900, ref SDS 16 X14N, suggests intervention is not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
560514 -        required at this time to improve recovery from side effects                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
560515 -        taking Rosuvastatin. ref SDS 37 LV5J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
560517 -         ..
560518 -        On 131017 1000 VA medical chart Progress Notes assessment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
560519 -        report doctor concerned about chronic hyperbilirubinemia.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
560520 -        ref SDS 37 PSXT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560522 -         ..
560523 -    2.  Potasium K 5.6 Elevated above range......... ref SDS 54 ZG5O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
560524 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560525 -        Labcorp blood test last week on 140508 reported potassium 5.6                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
560526 -        increased from 4.8 on prior Labcorp lab and 5.4 on VA lab from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
560527 -        3 months ago, shown on 140203 1147. ref SDS 47 ZG5O  VA lab did                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560528 -        not report results for Potassium today. ref SDS 0 ZG5O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
560530 -         ..
560531 -        Doctor Egan, referring cardiology physician at Martinez VA,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
560532 -        noted in a recent letter that meeting at VA Medical Center in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
560533 -        San Francisco on 140213 0830, ref SDS 50 GT7G, did not address                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
560534 -        elevated potassium in labs performed by Labcorp and VA, shown                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
560535 -        on 140203 1147. ref SDS 47 ZG5O  Doctor Egan again notifies                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
560536 -        that this condition of elevated potassium represents exposure                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
560537 -        to "electrical problems" with the heart, reported on 140430.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
560538 -        ref SDS 52 UV5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560539 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560540 -            [On 140515 2043 letter submits agenda for meeting on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
560541 -            140519, and notifies VA Medical Center in San Francisco                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
560542 -            that glucose, sodium and potassium are elevated above                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
560543 -            expected levels in Labcorp Lab on 140508, and reminds that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
560544 -            Doctor Egan issued request for re-lab because elevated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
560545 -            potassium presents electrical problems for the heart, which                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
560546 -            is at risk in this case based on CABG +4 on 091022.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
560547 -            ref SDS 56 YM75                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
560549 -         ..
560550 -        Doctor Egan was concerned last year about potasium (K) rising                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
560551 -        above range for good health.  He explained potasium effects                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
560552 -        electrical signals to the heart, and so has significance for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
560553 -        CVD, reported during meeting at VA on 121206 0900. ref SDS 27                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
560554 -        6K56                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
560556 -         ..
560557 -        At that time on 121206, the doctor cited medication conflicts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
560558 -        as possibly causing elevated potasium. ref SDS 27 FI7L  Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
560559 -        Egan further considered dehydration (urination) caused by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
560560 -        Rosuvastatin may have skewed lab results for electrolytes on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
560561 -        121130, and so ordered re-test. ref SDS 27 6K4J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560563 -         ..
560564 -        On 121212 0941 re-test lab reported Glucose 111, sodium 139,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
560565 -        and potasium (K) 4.6, all within range, ref SDS 28 KK9M,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
560566 -        correcting errors noted by Doctor Egan during meeting at VA on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
560567 -        121206 0900. ref SDS 27 6K4J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
560569 -         ..
560570 -        At this time, dehydration from increased urination, possibly                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
560571 -        caused by statin medication, and combined with hiking 22 miles                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
560572 -        yesterday, and another 11 miles this moring before the blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
560573 -        draw, reported in case study on 120101 0900, ref SDS 16 4G5I,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
560574 -        might reconcile elevated potasium (K 5.6).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
560576 -         ..
560577 -    3.  Glucose 97...................... ref SDS 0 ZG5O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
560578 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560579 -        Glucose near upper range 99 of Labcorp blood test last week on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
560580 -        140508, presents risk diabetes, see above. ref SDS 0 ZG5O  Like                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
560581 -        potassium, ref SDS 0 KZ5O, glucose may be elevated by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
560582 -        dehydration taking statin medication, and by hiking 22 miles                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
560583 -        yesterday and 11 miles this morning before the lab, reported in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
560584 -        case study on 120101 0900. ref SDS 15 4G5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
560585 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560586 -            [...below on 140514 0950 VA lab today for HGBA1c 5.6 within                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
560587 -            range 4 - 6, seems to indicate no evident exposure for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
560588 -            diabetes. ref SDS 0 H66G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
560589 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560590 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560591 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560592 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560593 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560594 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560595 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560596 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560597 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
560598 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
5606 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
VA Lab Lipid Cholesterol 164 with Medication Hiking 1000 Miles Weigh                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
7603 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
760401 -  ..
760402 - LDL-C 83 LDL-P 851 HDL 67 Hike 1000 Miles Weight Maintain 170                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
760403 - 
760404 - Follow up ref SDS 54 IM9N, ref SDS 47 IM9N.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
760405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760406 - Excellent VA results today align with Labcorp blood test using NMR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760407 - technology reported last week on 140508 1133. ref SDS 54 5C7M  This                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
760408 - reflects increased hiking and weight control past 3.5 months, reported                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760409 - in case study on 120101 0900, ref SDS 16 PYXR, and supported with low                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
760410 - carb diet (including orange juice) and low dose medication, reported                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760411 - on 140513, in the same study. ref SDS 16 ZU5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760412 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760413 -            [On 140515 2043 VA notified consolidated test results show                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
760414 -            progress lowering CVD risk with improved lipid management.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760415 -            ref SDS 56 IM9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
760417 -             ..
760418 -            [On 140520 0732 letter to VA notifies Doctor Alba confirm                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760419 -            work plan to continue statin medication with Atorvastatin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760420 -            10 mg and Ezetimibe 10 mg despite rising peripheral                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
760421 -            neuropathy because symptoms at this time are mild, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760422 -            lipid results are favorable. ref SDS 58 4U4F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
760424 -  ..
760425 - Prior LIPID PANEL 120509 1108. ref SDS 21 IM9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760426 - Prior LIPID PANEL 120831 1525. ref SDS 22 IM9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760427 - Prior LIPID PANEL 130228 1140. ref SDS 31 IM9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760428 - Prior LIPID PANEL 130529 0818. ref SDS 33 IM9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760429 - Prior LIPID PANEL 131015 0724, ref SDS 35 IM9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760430 - Prior LIPID PANEL Labcorp, 140201 1159, ref SDS 46 IM9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
760431 - Prior LIPID PANEL, 140203 1147, ref SDS 47 IM9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760432 - Prior CHEM PROFILE Labcorp on 140508 1149. ref SDS 54 IM9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
760434 -                              ..
760435 -                             LIPID PANEL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760437 -         ..
760438 -        Dates..........2014 05 14 1016     140508        140203        140201       131015       130529                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760439 -                               VA           Labcorp        VA           Labcorp        VA           VA                          VA               Labcorp                                                                                                                                                                                                                                                                                                                                                                                                                                                           
760440 -        NMR LipoProfile      Results       Results       Results       Results       Results      Results     Units            Range              Range                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760441 -        LDL Particle Number                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
760442 -        LDL-P                                851.0                       861.0                                nmol/L                                < 1000
760443 -                                                                                                                              <ow                   < 1000
760444 -                                                                                                                              Moderate        1000  - 1299                                                                                                                                                                                                                                                                                                                                                                                                                                                         
760445 -                                                                                                                              Borderline High 1300  - 1599                                                                                                                                                                                                                                                                                                                                                                                                                                                         
760446 -                                                                                                                              High            1600  - 2000                                                                                                                                                                                                                                                                                                                                                                                                                                                         
760447 -                                                                                                                              Very High             > 2000                                                                                                                                                                                                                                                                                                                                                                                                                                                      
760449 -         ..
760450 -        Lipids                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
760451 -        CHOL     (a)           164           162           160           156          321      H    307       mg/dL       100     -  240             < 200
760452 -                 (b)           169                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760453 -        TRIGLYC  (a)            58            59            47            68          109            85       mg/dL        10     -  190             < 150
760454 -                 (b)            59                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760455 -        HDL-C    (a)            66            67            58            61           50            50       mg/dL       Ref: >=35                  >= 40                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760456 -                 (b)            67                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760457 -        LDL-C    (a)            87            83            93            81          249      H    240       mg/dL       Ref: <=131                 < 100
760458 -                 (b)            90                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760459 - **     LDL Dir                 93                                                                            mg/dL         0     -  130                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
760460 -        TRIG NF                                                                                               mg/dL       Ref: <=150
760462 -         ..
760463 -        TG/HDL ratio  (a)....    0.88          0.88          0.81          1.11                                                                      < 2.0
760464 -                      (b)....    0.88                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760466 -         ..
760467 -        Comments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760468 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760469 -        a.  Format and scope VA lab report changed by adding multiple                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760470 -            (a and b) values for several elements; changed ranges.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760471 -            HDL target lowered from 40 to 35.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
760472 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760473 -            A and B values not clear in the record.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760475 -  ..
760476 - These multiple values for each blood element may indicate the VA did a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760477 - second test to verify initial exceptionally good results that "seem                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760478 - too good to be true" - particularly HDL 67 increasing 34% in 6 months                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760479 - since October 2013.  In this case, VA results align (i.e., are nearly                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760480 - identical) with Labcorp test a few days earlier. ref SDS 0 5C7M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760481 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760482 -            [On 140515 2043 notified VA lab reporting multiple values                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760483 -            is a new format. ref SDS 56 YM6T                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760485 -  ..
760486 - VA Lipid Panel report continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760487 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760488 -        b.  SLIGHTLY Hemolyzed specimen /HN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
760489 -            Evaluation for HDL:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
760490 -            HDL <35 is associated with increased risk of CAD.
760491 -            Evaluation for LDL CHO:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760492 -            Desired LDL: <130 mg/dL; evaluate in light of CHD risk factors.
760494 -             ..
760495 - **     c.  Evaluation for DLDL:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760496 -            DLDL ref.range: <100 mg/dL = Optimal; 100-129 mg/dL = Near
760497 -            Optimal; 130-159 mg/dL = Borderline High; >/=160 mg/dL =                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760498 -            High.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
760500 -             ..
760501 -            Ordering Provider: Diana Alba                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760502 -            Report Released..: May 14, 2014@11:30                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
760503 -            Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760504 -                               4150 CLEMENT STREET                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760505 -                               SAN FRANCISCO, CA 94121-1545                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
760506 -            Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760507 -                               4150 CLEMENT STREET                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760508 -                               SAN FRANCISCO, CA 94121-1545                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
760510 -             ..
760511 -        c.  SLIGHTLY ICTERIC SPECIMEN /HN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760512 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760513 -            Ordering Provider: Diana Alba                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760514 -            Report Released..: May 14, 2014@11:30                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
760515 -            Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760516 -                               4150 CLEMENT STREET                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760517 -                               SAN FRANCISCO, CA 94121-1545                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
760518 -            Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760519 -                               4150 CLEMENT STREET                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760520 -                               SAN FRANCISCO, CA 94121-1545                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
760521 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760523 -  ..
760524 - Analysis....                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
760525 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760526 -    1.  LDL-P 851, ref SDS 54 U45J, represents lower CVD risk and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760527 -        improving lipid management.  LDL-C 83 increased 2 points from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760528 -        prior lab on 140201.  It remains low concordant with LDL-P, but                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760529 -        moving toward discordance.  Research indicates healthiest                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
760530 -        cardiovascular condition occurs with lowest risk for CVD, when                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760531 -        lipids are discordant, with LDL-P low and LDL-C high, shown in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760532 -        the record on 131125 0005. ref SDS 41 FI3G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
760534 -         ..
760535 -        VA published goal LDL-C <= 131; Labcorp published goal LCL-C <
760536 -        100. ref SDS 0 5C7M  New AHA guidelines show LDL-C < 190,
760537 -        reported on 131112 1422. ref SDS 39 HT87                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760539 -         ..
760540 -        VA lowering goal to HDL > 35 from > 40 seems conflicting with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
760541 -        patient history of CABG +4 on 091022 0700. ref SDS 3 PQWU                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760542 -        Since HDL 30 was found at that time (see Lipid history below,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760543 -        ref SDS 0 W25L, setting the bar at HDL 35 has little tolerance                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760544 -        for genetic variation to avoid and repair endothelium lesions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760545 -        causing atheriosclerotic plaque.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
760547 -         ..
760548 -        NMR test lists LDL-P < 1600 for "borderline" CVD high risk, and
760549 -        that below 1000, is "low," risk for CVD. ref SDS 47 U45J  Thus,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
760550 -        LDL-P 851 presents low risk for CVD.  Research on 131125, lists                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760551 -        LDL-P < 700 may be a better target to manage CVD risk.
760552 -        ref SDS 41 WY9H  The same research also cites LDL-P < 1000 for
760553 -        evaluating CVD risk, similar to NMR test today. ref SDS 41 OQ9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
760555 -         ..
760556 -        When can patients be confident LDL-P < 700, 600, 200 - is low
760557 -        enough to work on other aspects of daily life?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760559 -         ..
760560 -        EPC and CTA with calcium score standard of care to test for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760561 -        regression of atheroclerosis, reported in research on 131125                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760562 -        0005. ref SDS 41 RA7K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760564 -         ..
760565 -    2.  LDL-P 851 in Labcorp test today on 140508, correlates with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760566 -        TG/HDL ratio 59/67 = 0.88. ref SDS 54 5C7M  Research indicates                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
760567 -        TG/HDL ratio correlates to LDL-P vaulations produced by NMR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760568 -        testing, reported on 131125 0005. ref SDS 41 666G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
760570 -         ..
760571 -    3.  Resting heart rate getting up in the morings has fallen below                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760572 -        50.  Blood pressure varies - averages about 115 65.  After                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760573 -        hikes about 105 55.  Systalic on occassion falls below 100.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760574 -        Dystalic has fallen below 50 - e.g., see Monday 140428 reported                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760575 -        in case study on 120101 0900. ref SDS 16 CB6N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
760577 -         ..
760578 -    4.  LDL-P 851 and HDL 67 and Triglycerides 59 on 140508, indicate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760579 -        low risk for CVD, per above analysis, ref SDS 54 RV5M, and may                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
760580 -        align with hiking 22 miles yesterday on 140507, and 11 miles                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760581 -        this morning at 0400 (see again case study - ref SDS 16 4G5I),                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
760582 -        before doing the blood draw later this morning at 1149.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
760583 -        ref SDS 54 U45J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
760585 -         ..
760586 -    5.  Lipid favorable results in NMR test on 140508, and follow up                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760587 -        test at VA on 140514, particularly increase HDL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760588 -        occurred concurrent with...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760589 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760590 -               [On 140520 0732 letter notifies Doctor Alba at VA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760591 -               getting good labs through prescribed care integrating                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760592 -               diet, exercise, and medications. ref SDS 57 4U46                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760594 -             ..
760595 -        a.  Hiking 955 miles since prior lab on 140203, reported in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760596 -            case study 120101 0900, ref SDS 16 P36G, and recommended in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
760597 -            research on 131125 0005. ref SDS 41 QP9F including regular                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
760598 -            aerobic exercise to lower triglycerides, ref SDS 41 U44L,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
760599 -            and raise HDL, ref SDS 41 SH50, and raise EPC production                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
760600 -            toward regression of atherosclerosis plaque. ref SDS 41                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760601 -            6O9M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760602 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760603 -               [On 140529 0942 letter asks VA to present record of care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
760604 -               that includes extended training exercise that yielded                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760605 -               significantly improved lipid labs. ref SDS 60 QF67                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760607 -             ..
760608 -        b.  Weight - hit 163 yesterday on 140513, shown in case study                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760609 -            on 120101 0900. ref SDS 16 ZU5G  This is lowest is about 30                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
760610 -            years.  On 140420 was able to hold 165 for 3 days.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
760611 -            ref SDS 16 TO6O  This is continuing challenge bouncing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
760612 -            around from over 200 in 2011, but varied significantly.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760613 -            Daily weight remains generally between 170 - 175.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
760615 -             ..
760616 -        c.  Low-carbohydrate diet lowers triglycerides (TG 59 in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760617 -            Labcorp and VA tests, per above, ref SDS 0 5C7M), which                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760618 -            together with higher HDL 67 (TG/HDL ratio .88 < 2,
760619 -            ref SDS 0 5X5G, combine to lower LDL-P, cited in research                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760620 -            on 131125 0005. ref SDS 41 QP9F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
760622 -             ..
760623 -        d.  Chia seeds added to diet on 131125, reported in case study                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760624 -            on 120101 0900, ref SDS 16 746M, and recommended by Karen                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
760625 -            at VA on 131121 0930. ref SDS 40 NQ37                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760627 -             ..
760628 -        e.  Orange juice 1 gallon (3786 ML) per week (541 ML/day) added                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760629 -            to diet on 131125, based on study indicating HDL increased                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760630 -            21% over 4 weeks with 750 ml per day (i.e., 1.4 gal per                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760631 -            week), ref SDS 41 R48K, as reported to VA in letter on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
760632 -            140114 0845. ref SDS 43 218O  Some research also indicates                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
760633 -            grape juice increases HDL; however, no studies have                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
760634 -            quantified this effect.  Patient consumes combination of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760635 -            lemon juice, orange juice, and grape juice in large                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
760636 -            quantities to hydrate after hiking 11 miles per day.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760638 -             ..
760639 -            HDL 50 increased to HDL 67 = 34% rise in 6 months from Dec                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760640 -            2013 - May 2014, shown in patient history below.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
760641 -            ref SDS 0 W25L  This is approximately 7% for each 4 week                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760642 -            period, which may reflect taking 541 ML of orange juice                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760643 -            rather than 750 ML per day found effective in research                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760644 -            study shown in the record on 131125 0005. ref SDS 41 K34L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
760645 -            Raising HDL consistently 7% over 4 weeks for 6 months                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
760646 -            taking only 541 ML in this case, presents improved results                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760647 -            compared to study results finding 500 ML of orange juice                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760648 -            for 4 weeks had no effect on HDL levels.  Improved results                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760649 -            in this case may indicate that orange juice at 540 ML/day                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760650 -            combined with hiking 11 miles per day, explained above (see                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760651 -            para a), ref SDS 0 I17G, provides a direct path to improve                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760652 -            lipid profiles toward avoiding and regressing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760653 -            atherosclerosis plaque.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760655 -             ..
760656 -        f.  Atorvastatin 10 mg with Ezetimibe 10 begun on 131230,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
760657 -            reported in case study on 120101. ref SDS 16 6A6H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760659 -             ..
760660 -            Research studies report Atorvastatin 10 mg + Ezetimibe 10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760661 -            mg achieves LDL < 70, and favorably changes triglycerides
760662 -            and HDL by 5%, reported on 131125 0005. ref SDS 41 CO45                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760663 -            While low LDL < 70 conflicts with goal of "discordance"
760664 -            that lowers health risk for arterialsclorosis and CVD when                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760665 -            LDL-P low and LDL-C high, shown in research on 131125 0005,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760666 -            ref SDS 41 FI3G, even "concordant" results today are good                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
760667 -            news.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
760669 -             ..
760670 -            Since prior lab on 140201, until lab at VA today on 140508,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760671 -            case study shows on 120101, ref SDS 16 E47L, patient has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
760672 -            taken...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760673 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760674 -            1.  Atorvastatin............... 900 mg                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760675 -            2.  Ezetimibe.................. 900 mg                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760676 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760678 -  ..
760679 - Lipid History Trend Analysis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
760680 - 
760681 - Follow up ref SDS 54 W25L, ref SDS 26 W25L.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
760682 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760683 -                                                                         Small   LDL   LP-IR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
760684 -        Collection DT        CHOL    TRIGL   HDL   LDL-C   LDL-P  HDL-P  LDL-P  SIZE   SCORE  LDL-D                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760685 -        05/14/2014 10:16     164       58    67      87   .................................... 93.. ref SDS 0 5C7M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760686 -        05/08/2014 11:49     162       59    67      83     851    38.1  < 90   21.2    < 25  ..... ref SDS 54 BE6O
760687 -        02/03/2014 12:28     160 H     47    58      93   ......................................... ref SDS 47 BE6O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760688 -        02/01/2014 12:31     156       68    61      81     861    31.4  < 90   21.3    < 25  ..... ref SDS 46 BE6O
760689 -        10/15/2013 08:25     321 H    109    50     249 H ......................................... ref SDS 35 BE6O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760690 -        05/29/2013 08:18     307 H     85    50     240 H ......................................... ref SDS 31 BE6O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760691 -        02/28/2013 08:39     310 H     73    47     248 H ......................................... ref SDS 31 BE6O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760692 -        11/30/2012 10:01     173       53    57     105   ......................................... ref SDS 26 BE6O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760693 -        08/31/2012 15:25     176       94    47     110   ......................................... ref SDS 22 U89N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760694 -        05/09/2012 11:24     158       76    49      94   ......................................... ref SDS 21 U89N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760695 -        02/09/2012 11:18     285       82    41     228 H ......................................... ref SDS 17 2A4G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760696 -        11/17/2011 14:27     260       84    43     200 H ......................................... ref SDS 15 2A4G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760697 -        07/27/2011 12:58     163       81    45     102   ......................................... ref SDS 11 E19L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760698 -        12/07/2010 09:17     151       41    47      96   ......................................... ref SDS 10 E19L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
760699 -        07/21/2010 08:54     261 H     87    35 L   209 H ......................................... ref SDS 6 E19L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
760700 -        06/10/2010 10:33     217 H     83    36 L   164 H ......................................... ref SDS 5 QV4F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
760701 -      * 12/14/2009 11:10     241 H    136    44     170 H ......................................... 100928 0706, ref SDS 7 VW6J                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760702 -        08/13/2009 15:09     233 H    118    30 L   179 H ......................................... 100610 1046, ref SDS 5 U45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760703 -        06/16/2006 10:59     238 H     68    32 L   192 H ......................................... 091002 0900, ref SDS 2 LJ5H                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760704 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760705 -      * Lab at VA San Francisco Medical Center reported on 100928 0706.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760706 -        ref SDS 7 VW6J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
760708 -  ..
760709 - Research on cholesterol reported on 091002 0900. ref SDS 2 2F8K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760711 -  ..
760712 - On 131125 0005 research found ezetimibe (zetia) mg added to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
760713 - Atorvastatin 20 mg yielded after 6 weeks significantly greater changes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760714 - to lipids than taking Atorvastatin in higher doses, e.g., 20 or 40 mg.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760715 - ref SDS 41 CO56                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760717 -  ..
760718 - On 131125 0005 research found discordance LDL-P low and LDL-C high                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760719 - lipid panel HDL 65 TG 77 healthy patient profile with LDL 246.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
760720 - ref SDS 41 MN98  Discordance with LDL-P low and LDL-C high is lowest                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
760721 - risk for CVD, arterialsclorosis. ref SDS 41 FI3G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760722 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760723 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760725 -  ..
760726 - Coronary CTA or IVUS Test Athereosclerosis Plaque 4 Years After CABG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760727 - Athereosclerosis Plaque 4 Years After CABG Coronary CTA or IVUS Test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760728 - 
760729 - On 131125 0005 research further found radiology imaging tests can                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
760730 - evaluate level of plaque build up resulting from elevated cholesterol.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760731 - ref SDS 41 N73K  Radiology imaging technologies are Coronary CT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760732 - angiography - CTA - and Intravascular ultrasound - IVUS. ref SDS 41                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
760733 - KZ8O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760735 -  ..
760736 - Lipid history and particularly the past 6 months with HDL > 60 and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760737 - Triglycerides < 100, ref SDS 54 W25L, indicates patient may have change
760738 - body chemestry sufficient to cause rapid regression of atherosclerosis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760739 - plaque, cited in research on 131125 0005. ref SDS 41 RA7K  Research                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
760740 - indicates that favorable lipid profile, weight loss, and production of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
760741 - EPC in the bone marrow, all stimulated by exercise, drives regression                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
760742 - of plaque. ref SDS 41 XY7L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
760744 -  ..
760745 - The next step monitoring results of medical, diet, and exercise                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760746 - interventions the past 4 years, since CABG +4 on 091022 0700,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
760747 - ref SDS 3 PQWU, is to perform radiology imaging study with coronary CT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
760748 - angiography or IVUS to assess regression of atherosclerosis plaque,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760749 - which previously required major surgery to fix.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760751 -  ..
760752 - This step is supported by patient history using CT radiology imaging                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
760753 - to assess regression of esophageal bubble after 4 years of medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760754 - interventions, reported favorable by Doctor Stewart, Chief General                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
760755 - Surgery at VA on 130122 1330. ref SDS 29 03H6                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
760756 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760757 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760758 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760759 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760760 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
760761 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
7608 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
VA Lab Cardiac Enzymnes Creatine Kinase CK also CPK Creatine Phospho                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
8403 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
840401 -  ..
840402 - Myopathy Muscle Pain Side Effects Simvistatin Decline                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
840403 - 
840404 - Follow up ref SDS 54 D26G, ref SDS 47 D26G.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
840405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
840406 - Prior Cardiac Enzymes Profile on 120209 1118. ref SDS 17 D26G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
840407 - Prior Cardiac Enzymes Profile on 120509 1108. ref SDS 21 D26G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
840408 - Prior Cardiac Enzymes, 131015 0724, ref SDS 35 D26G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
840409 - Prior Cardiac Enzymes Profile VA on 140203 1147. ref SDS 47 NX6G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
840411 -  ..
840412 - This test not performed by Labcorp with blood draw on 140508...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
840413 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
840414 -                             CARDIAC ENZYMES                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
840415 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
840416 -        Dates          2014 05 14 1016    140508       140203        131015        120509                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
840417 -                               VA          Labcorp        VA            VA            VA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
840418 -        PLASMA               Results      Results       Results       Results       Results    Units            Range                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
840419 -        CPK (CK)               192                        149           110           152        U/L       30     -  235                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
840420 -        TRPONIN                                                                                ng/ml        0     -    0.07                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
840421 -        CK-MB                                                                                  ng/ml        0.6   -    3.5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
840422 -        MYOGLOB                                                                                ng/ml       20     -   82                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
840424 -             ..
840425 -        a.  CPK/CK test not performed by Labcorp                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
840427 -             ..
840428 -        b.  SLIGHTLY ICTERIC SPECIMEN /HN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
840430 -             ..
840431 -        c.  Ordering Provider: Diana Alba                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
840432 -            Report Released..: May 14, 2014@11:29                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
840433 -            Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
840434 -                               4150 CLEMENT STREET                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
840435 -                               SAN FRANCISCO, CA 94121-1545                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
840436 -            Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
840438 -  ..
840439 - CKP and CK are the same thing - creatine phosphokinase (CPK) also                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
840440 - called creatine kinase (CK).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
840441 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
840442 -              http://www.scai.org/SecondsCount/Resources/Detail.aspx?cid=ed385473-d4e8-491e-9ce0-a7c984fe6f8e#.U3b_BfldWi8                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
840444 -  ..
840445 - Research on 111013 explains Creatine Kinase CK, relates to muscle                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
840446 - disorders caused by cholesterol medications with statins. 111013 1404,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
840447 - ref SDS 14 J54K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
840449 -  ..
840450 - CK lab may align with reduced side effects of muscle pain in left                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
840451 - shoulder.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
840452 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
840453 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
840454 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
840455 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
840456 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
840457 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
8405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
HGBA1C 5.4 Range 4.0-6.0 Diabetes Negative Laboratory Blood Test Cro                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
A103 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
A10401 -  ..
A10402 - HGBA1c Diabetes Blood Test A1c                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
A10403 - A1c Diabetes Blood Test HGBA1c                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
A10404 - Diabetes HGBA1c A1c Blood Test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
A10405 - 
A10406 - Follow up ref SDS 54 9F4O, ref SDS 47 9F4O.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
A10407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
A10408 - Prior HGBA1c Profile on 100721 0800. ref SDS 6 IL4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
A10409 - Prior HGBA1c Profile on 101207 0906. ref SDS 10 IL4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
A10410 - Prior HGBA1c Profile on 131015 0724. ref SDS 35 9F4O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
A10411 - Prior HGBA1c Profile on 140203 1147. ref SDS 47 9F4O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
A10413 -  ..
A10414 - This test not performed by Labcorp with blood draw on 140508...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
A10416 -                              ..
A10417 -                             Endocrine IV - HGBA1c - A1c                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
A10418 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
A10419 -        Dates..........2014 05 14 1016    140508       140203        131015        101207                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
A10420 -                               VA          Labcorp        VA            VA            VA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
A10421 -        BLOOD                Results      Results       Results       Results       Results     Units            Range                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
A10422 -        HGBA1c                   5.4                        5.5           5.5          5.7      %            4.0   -    6.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
A10423 -        eAG                                               111           111                     mg/dL       74.0   -  118                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
A10425 -         ..
A10426 -        Comments:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
A10427 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
A10428 -        a.  Labcorp did not perform HGBA1c lab                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
A10429 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
A10430 -        b.  Ordering Provider: Diana Alba                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
A10431 -            Report Released..: May 14, 2014@11:29                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
A10432 -            Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
A10433 -                               4150 CLEMENT STREET                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
A10434 -                               SAN FRANCISCO, CA 94121-1545                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
A10435 -            Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
A10437 -  ..
A10438 - This test for diabetes was ordered by Doctor Abrams during a meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
A10439 - at the San Francisco VA Medical Center on 130227 0930. ref SDS 30 8T5L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
A10440 - However, it is not reported for the lab performed the next day on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
A10441 - 130228 1140, ref SDS 31 RP4N, nor in the follow up lab 3 months later                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
A10442 - on 130529 0818. ref SDS 33 RP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
A10444 -  ..
A10445 - HGBA1c was performed previously on 101207 0906, ref SDS 10 IL4N, and 5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
A10446 - months earlier on 100721 0800. ref SDS 6 IL4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
A10448 -  ..
A10449 - Labcorp test showing LP-IR Score < 25.0, indicating very low risk of
A10450 - diabetes, reported on 140508. ref SDS 54 TU6L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
A10452 -  ..
A10453 - Glucose 97 near upper range 79 99, Labcorp electrolyte panel last week                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
A10454 - on 140508, per above, ref SDS 0 ZG5O, indicates potential diabetes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
A10455 - risk, but may be elevated by dehydration from statin medication and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
A10456 - hiking 22 miles the day before the lab and 11 miles the morning before                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
A10457 - getting the blood draw, reported on 140508 1133. ref SDS 54 QW6K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
A10458 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
A10459 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
A10460 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
A105 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Default Null Subject Account for Blank Record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
A203 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
A20401 -  ..
A20402 - Cardiology Meeting on Radiology Test Regrission Atherosclerosis Plaque                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
A20403 - Regrission Atherosclerosis Plaque Meeting Cardiology on Radiology Test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
A20404 - Atherosclerosis Plaque Regrission Meeting Cardiology on Radiology Test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
A20405 - 
A20406 - After getting the blood draw, went across the street and met with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
A20407 - Karen in the Cardiology Cath Lab Scheduling and Administration                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
A20408 - Department.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
A20410 -  ..
A20411 - Karen was pleased to hear that lipid profile has improved dramatically                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
A20412 - since CABG +4 in 2009, shown by history above. ref SDS 0 W25L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
A20413 - Explained implementing her suggestion on chia seeds, when we met on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
A20414 - 131121 0930, ref SDS 40 NQ37, cited in analysis on improving lipid                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
A20415 - profile, above. ref SDS 0 419M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
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