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
A20416 -
A20417 -
A20418 -
A20419 -
A20420 -
A20421 -
A20422 -
A20423 -
A20424 -
A20425 -
A20426 -
A20427 -
A20428 -