CONTACTS
SUBJECTS
VA Lab Lipids Submit Labcorp Results to Prepare for Meeting on 14051
1503 -
1503 - ..
1504 - Summary/Objective
1505 -
150501 - Follow up ref SDS 58 0000. ref SDS 56 0000.
150502 -
150503 -
150504 -
150506 - ..
1506 -
1507 - Progress
150801 - ..
150802 - VA Notified Excellent Results on Lipids Need Follow Up Electrolytes
150803 -
150804 - Follow up ref SDS 58 IM9N, ref SDS 56 IM9N.
150805 -
150806 - Letter to VA medical team says...
150807 -
150808 - 1. Subject: Lipid Profile Improved
150809 - Date: 2014-05-15 21:19
150817 - ..
150818 - 2. Labcorp results last week on 140508, show LDL-P dropped to 851
150819 - and HDL increased to 67. [...shown in record consolidating
150820 - Labcorp test on 140508 with VA lab yesterday on 140514 0950.
150821 - ref SDS 58 IM9N...]. Previously, when labs showed major
150822 - improvement the next lab showed worsening conditions. [...see
150823 - Patient Lipid History, ref SDS 56 W25L...]. This report breaks
150824 - that cycle, showing continuing good results. ref SDS 56 U45J
150825 -
150826 - [On 140520 0732 letter to VA notifies Doctor Alba confirm
150827 - work plan to continue statin medication with Atorvastatin
150828 - 10 mg and Ezetimibe 10 mg despite rising peripheral
150829 - neuropathy because symptoms at this time are mild, and
150830 - lipid results are favorable. ref SDS 62 4U4F
150832 - ..
150833 - 3. Yesterday, after talking with you, I got results from ROI on VA
150834 - lab at the Medical Center, so no need for you to submit it.
150835 - While VA does not report LDL-P, since VA metrics on HDL and TG
150836 - align with Labcorp, ref SDS 56 5C7M, LDL-P 851 and pattern A
150837 - (large) LDL particle size 21.2 seem like good numbers to assess
150838 - lipid management and plan next steps.
150840 - ..
150841 - 4. Have to admit some confusion with format of new VA lab report
150842 - that presents multiple values (a and b). [...shown on 140514
150843 - 0950, ref SDS 58 5C7M...]. Some elements have no values.
150845 - ..
150846 - Later considered that VA may have run two tests on lipids to verify
150847 - exceptionally good numbers that "seemed too good to be true," added
150848 - explanation to the record on 140514 0950. ref SDS 58 864H
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150852 -
150853 -
1509 -
SUBJECTS
VA Lab Lipids Submit Labcorp Results to Prepare for Meeting on 14051
2903 -
290401 - ..
290402 - Potassium Elevated Doctor Egan Cites Electrical Problems for Heart
290403 -
290404 - Letter to VA continues...
290405 -
290406 - 5. Met with Doctor Egan in Cardiology at Martinez Clinic on
290407 - 140430. After the meeting, the doctor wrote a letter noting
290408 - again that potassium (K) was elevated in lab on 140203, and
290409 - cited risk of "electrical problems" for CAD patients (see line
290410 - 392120. ref SDS 54 UV5I
290412 - ..
290413 - 6. Notified Doctor Egan that follow up lab was scheduled in 2
290414 - weeks and that concerns on potassium and bilirubin would be
290415 - addressed in the meeting with you at the Medical Center on
290416 - 140519. [...referencing letter to Doctor Egan on 140430 0900.
290417 - ref SDS 54 YV5T...]
290419 - ..
290420 - 7. As you can see, on 140508, Labcorp reported potassium (K) high,
290421 - increased to 5.6. For some reason the lab at the VA yesterday
290422 - did not report potassium, nor glucose, sodium - actually most
290423 - of the electrolyte panel. ref SDS 56 ZG5O Both Labcorp and VA
290424 - report bilirubin still high. VA shows T Bili 2.2, nearly
290425 - double the range and up from 2.1 in lab 3 months ago. [...
290426 - shown on 140508 1133. ref SDS 56 015M...]. This might be an
290427 - issue of liver function in relation to medication, though we
290428 - are currently low dose with Atorvastatin 10mg and Ezetimibe
290429 - 10mg.
290430 -
290431 - [On 140518 2120 follow up letter reports that since VA has
290432 - not issued notice to do Electrolyte (Chem Profile) lab to
290433 - check glucose, sodium and potassium, customer will not
290434 - report lab for blood draw prior to meeting with VA at
290435 - Medical Center in San Francisco on 140519 0830. ref SDS 59
290436 - DV4M
290437 -
2905 -
SUBJECTS
Default Null Subject Account for Blank Record
3003 -
300401 - ..
300402 - Lab Results Influenced Extended Exercise Hiking 22 Miles then 11 Miles
300403 -
300404 -
300405 - 8. As well, lab results might be influenced by exercise, e.g.,
300406 - dehydration, from hiking 22 miles the day before both labs, and
300407 - 11 miles the morning before both labs.
300408 -
300409 -
3005 -
SUBJECTS
Default Null Subject Account for Blank Record
3103 -
310401 - ..
310402 - Weight 163 Lowest in 30 Years Resolve Metabolic Syndrome
310403 -
310404 -
310405 - 9. On 140513, weight dropped to 163, lowest in 30 years, after
310406 - hiking another 1000 miles since prior labs in February, see
310407 - case study (see line 105212. [...shown on 120101 0900,
310408 - ref SDS 15 ZU5G
310410 - ..
310411 - This level of endurance exercise that aids weight control, also
310412 - lowers triglycerides, cited in research on 131125. ref SDS 43 U44L
310414 - ..
310415 - The record hiking 1000 miles during the past cycle is shown in the
310416 - study at line 105312 for the record on 120101 0900, ref SDS 15 6Q5G,
310417 - and is cited to reconcile improved labs in the record on 140514 0950.
310418 - ref SDS 58 I17G
310420 - ..
310421 - This implements the doctor's prescription for regression of
310422 - atherosclerosis by managing cholesterol with weight loss to 165 or
310423 - even 160 through physical activity hiking 11 miles per day, presented
310424 - during the meeting at the VA Medical Center in San Francisco on 131219
310425 - 0930, ref SDS 44 A56N,
310426 -
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310428 -
310429 -
310430 -
3105 -
SUBJECTS
Default Null Subject Account for Blank Record
3203 -
320401 - ..
320402 - VA Order Electrolyte Chem Lab Order Check After Re-hydration
320403 -
320404 -
320405 - 10. A year or so ago during a meeting on 121206, Doctor Egan
320406 - noticed elevated glucose, sodium and potassium. Rosuvastatin
320407 - causing increased urination was ended, and the doctor ordered
320408 - retest a few days later. We paused hiking to further reduce
320409 - dehydration. As you can see, the 2nd lab showed the numbers
320410 - all fell back within range, reported on 121212 (see line 0408.
320411 - ref SDS 27 X45G
320413 - ..
320414 - 11. Please let me know if you want another electrolyte panel to
320415 - double check these issues. We could do the blood draw next
320416 - Monday at 0700 (assuming lab is open at that time). Results
320417 - should be posted for review during our meeting at 0800.
320418 -
320419 - [On 140518 2120 follow up letter reports that since VA has
320420 - not issued notice to do Electrolyte (Chem Profile) lab to
320421 - check glucose, sodium and potassium, customer will not
320422 - report lab for blood draw prior to meeting with VA at
320423 - Medical Center in San Francisco on 140519 0830. ref SDS 59
320424 - DV4M
320426 - ..
320427 - [On 140518 0920 at 2242 Doctor Alba notifies customer to
320428 - defer follow up chem profile (electrolyte) labs to verify
320429 - glucose, sodium and potassium elevated in Labcorp Lab on
320430 - 140508, responding to Doctor Egan's request based on
320431 - potential for potassium to cause heart problems.
320432 - ref SDS 59 NY4F
320434 - ..
320435 - [On 140520 0732 letter to Doctor Alba asking if order has
320436 - been filed for supplemental lab testing Electrolyte panel
320437 - (Chem Profile), as planned in the meeting on 140519, and
320438 - requested by Doctor Egan, so that blood draw can be done at
320439 - VA Medical Center in San Francisco. ref SDS 62 4U87
320441 - ..
320442 - 12. Alternatively, a full electrolyte (Chem) profile might be done
320443 - using the blood draw yesterday, to cross check Labcorp, and get
320444 - the numbers in the VA system? Notice VA lab reports blood
320445 - "SLIGHTLY ICTERIC SPECIMEN /HN" and for lipids "SLIGHTLY
320446 - Hemolyzed specimen /HN".
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320448 -
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SUBJECTS
Default Null Subject Account for Blank Record
4403 -
440401 - ..
440402 - Medication Side Effects Atorvastatin Ezetimibe
440403 - Dizziness Increase Urination Peripheral Neuropathy
440404 -
440405 -
440406 - 13. Only evident side effects from Ezetimibe is slight dizziness in
440407 - past month when laying down and turning my head left or right.
440408 - Don't recall this occurring past few days, so issue seems de
440409 - minimus. There may also be increased urination the past month
440410 - or so, but this is hard to track. Seem to be getting up a lot
440411 - during the night, as occurred with Rosuvastatin, but could be
440412 - imagination - not sure yet.
440414 - ..
440415 - Side effects Atorvastatin listed on 130603 0930. ref SDS 33 PC6O
440417 - ..
440418 - Side effects of Ezetimibe are listed on 131125 0005. ref SDS 43 YA7F
440419 -
440420 - [On 140518 2120 letter to VA notify Doctor Alba that side
440421 - effects of statin medications - dizziness has subsided;
440422 - urination and peripheral neuropathy have increased.
440423 - ref SDS 59 DV5S
440424 -
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440427 -
4405 -
SUBJECTS
Default Null Subject Account for Blank Record
4503 -
450401 - ..
450402 - Coronary CTA Assess Regression Atherosclerosis 5-years Post CABG +4
450403 -
450404 -
450405 - 14. While on site yesterday, visited Radiology Department. The VA
450406 - Medical Center supports coronary CTA studies to assess
450407 - regression of plaque toward evaluating CVD risk and course of
450408 - care. This provides a baseline condition in light of rising
450409 - cholesterol the past year, prior to recent dramatic decline.
450410 - Research indicates plaque can regress quickly with restoration
450411 - of endothelial function (see study on 131125 (see line OE0402.
450412 - ref SDS 43 R44O
450413 -
450414 - [On 140519 0800 during meeting at VA discussed coronary CTA
450415 - with calcium score that tests response to treatment hiking
450416 - 300+ miles per day that creates pharmaphysiological
450417 - conditions of elevated HDL and EPCs which cause rapid
450418 - regression of atherosclerosis to lower CVD risk.
450419 - ref SDS 61 X59G
450421 - ..
450422 - 15. The "Conclusion" says in part...
450423 -
450424 - "...it is recognized that established plaques can rapidly
450425 - stabilize and regress in animals and humans." ref SDS 43 RA7K
450426 -
450427 - [On 140626 1652 letter notifies VA of case studies showing
450428 - failure to perform timely testing causes negative patient
450429 - outcomes. ref SDS 64 MY51 VA reference to patient having
450430 - vessel plaques 5 years ago, begs the question of testing to
450431 - determine currently how much plaque, and level of care
450432 - required, if any, to treat current condition. ref SDS 64
450433 - MZ33 Evidence shows CTA common procedure to evaluate
450434 - current condition post CABG surgery. ref SDS 64 MZ54
450436 - ..
450437 - 16. HDL 67 increased from 30 in 2009, when CABG was performed, may
450438 - be due in part to reliance on orange juice, along with
450439 - increased hiking, following study finding 21% increase in HDL,
450440 - reported on 131125 (see line NV0403. ref SDS 43 K34L
450441 -
450442 - [On 140519 0800 Progress Notes for meeting at VA report
450443 - customer increased intake of orange juice; fails to mention
450444 - correlation with rise in HDL, nor correlation with study.
450445 - ref SDS 60 PB4I
450446 -
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450448 -
4505 -
SUBJECTS
Default Null Subject Account for Blank Record
4603 -
460401 - ..
460402 - HDL 20 Increase with Orange Juice Aligns Patient History
460403 - Orange Juice Study Aligns Patient History HDL 67 Increase 20%
460404 -
460405 -
460406 - 17. Added orange juice at that time following 131125, about a
460407 - gallon per week. Note 20% increase in HDL between lab on
460408 - 131015 and 140201, and another 10% from 140201 to 140508. [...
460409 - shown in record of VA lab on 140514 0950. ref SDS 58 W25L...].
460410 - This record aligns well with findings in the study.
460411 -
460412 - [On 140519 0800 Progress Notes for meeting at VA report
460413 - customer increased intake of orange juice; fails to mention
460414 - correlation with rise in HDL, nor correlation with study.
460415 - ref SDS 60 PB4I
460416 -
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4605 -
SUBJECTS
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4703 -
470401 - ..
470402 - EPC Add to Labs Assess Potential Regression Atherosclerosis
470403 -
470404 -
470405 - 18. If we redo some of the labs on Monday, might consider adding
470406 - EPC which further indicates potential for regression of plaque,
470407 - along with rising HDL and weight loss. Since, like HDL, EPC
470408 - labs and weight loss respond to exercise [...reported in
470409 - research on 131125 0005, ref SDS 43 6O9M...], we should get
470410 - good numbers that support coronary CTA or IVUS.
470411 -
470412 - [On 140520 0732 letter to VA notifies Doctor Alba about
470413 - adding EPC to follow up lab ordered to test Electrolyte
470414 - panel (Chem Profile). ref SDS 63 4U46
470416 - ..
470417 - [On 140520 0732 at 1028 letter from Doctor Alba requests
470418 - clarification for adding EPC to lab order. ref SDS 63 654J
470419 - Called to explain scope of EPC lab, but encountered poor
470420 - connection using cell phone. ref SDS 63 U63N
470422 - ..
470423 - [On 140520 0732 at 1617 letter to VA submits explanation
470424 - for rationale and justification that warrants testing EPC
470425 - labs in this case, leading to coronary CTA showing
470426 - favorable regression of athersclerotic plaques that can
470427 - justify reducing line of care in order to reduce adverse
470428 - side effects, saving time and money. ref SDS 63 VQ48
470430 - ..
470431 - [On 140703 1938 Doctor Alba reports EPC issue discussed
470432 - among team at VA in detail; determined no justification to
470433 - evaluate EPC toward coronary CTA to assess regression of
470434 - atherosclerosis, ref SDS 65 H167, which VA maintains
470435 - requires treatment, shown in Progress Notes on 140519 0800,
470436 - ref SDS 60 OW76, based solely on history of atherosclerosis
470437 - requiring CABG x4 surgery on 091022, 5 years ago, as
470438 - presented in VA Progress Notes on 140519 0800, ref SDS 60
470439 - OW49, and without knowledge of actual current condition
470440 - resulting from intervening events, e.g., 120% rise from HDL
470441 - 30 to HDL 67, shown in labs on 140514 0950. ref SDS 58 W25L
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4705 -
SUBJECTS
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4803 -
480401 - ..
480402 - VA Commend Good Care Shown by Excellent Results
480403 -
480404 -
480405 - 19. In sum, recent labs show excellent care at the VA achieving
480406 - favorable results lowering CVD risk for continuing cycles. As
480407 - noted initially, in past years, whenever HDL increased and
480408 - Triglycerides dropped, on the next test the numbers got worse,
480409 - see patient Lipid History Trend Analysis on 140508 (line
480410 - 610726. ref SDS 58 W25L Thanks to skill and persistence of the
480411 - VA medical team, this time the numbers improved.
480413 - ..
480414 - 20. Have a good weekend - see you Monday.
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