CONTACTS
SUBJECTS
CBC Lab WBC VA No Results
2003 -
2003 - ..
2004 - Summary/Objective
2005 -
200501 - Follow up ref SDS 59 0000. ref SDS 57 0000.
200502 -
200503 -
200504 -
200505 -
200506 -
200508 - ..
2006 -
2007 -
2008 - Background
2009 -
200901 - On 131016 1632 submit letter for agenda meeting to review lab results
200902 - scheduled 131017 1000. ref SDS 35 X45G
200904 - ..
200905 - On 140131 0815 ordered another lab - cbc, electrolytes, lipid with NMR
200906 - - from Labcor to get LDL-P. ref SDS 48 X45G
200908 - ..
200909 - On 140201 1159 had full lab with NMR lipid panel drawn at John Muir
200910 - Hospital on Treat, and by Labcorp. ref SDS 49 RP4N
200912 - ..
200913 - On 140203 1147 had partial lab drawn at VA in Martinez. ref SDS 50
200914 - KK9M
200916 - ..
200917 - On 140507 0857 ordered another full lab from Labcorp with NMR lipid
200918 - panel. ref SDS 56 OO5G
200920 - ..
200921 - On 140508 1133 lab blood daw at Labcorp with John Muir Medical Center
200922 - on Treat Blvd in Concord. ref SDS 57 445G
200924 - ..
200925 - On 140514 0950 VA partial lab at Medical Center in San Francisco.
200926 - ref SDS 59 X45G
200928 - ..
200929 - On 140515 2043 letter to VA submit Labcorp results blood draw on
200930 - 140508, showing LDL-P 851 and continuing improvement from prior lipid
200931 - labs on 140203, which improves prior patient history breaking cycle of
200932 - worsening labs after improvement. ref SDS 60 1V6M VA lipids lab for
200933 - HDL and TG (triglycerides) on 140514 aligns with Labcorp, indicating
200934 - LDL-P 851 and (large) LDL particle size 21.2 seem like good numbers to
200935 - assess lipid management and plan next steps. ref SDS 60 YM6G Notified
200936 - VA Medical Center in San Francisco that Doctor Egan in Cardiology at
200937 - VA in Martinez concerned about elevated Potassium. ref SDS 60 YM67
200938 - Lab results might be influenced by extended training exercise hiking
200939 - 22 miles the day before the lab and 11 miles the morning before blood
200940 - draw. ref SDS 60 YM79 On 140513, weight dropped to 163, lowest in 30
200941 - years. ref SDS 60 YM82 Ask about ordering follow up lab for
200942 - Electrolytes Chem profile in the morning before meeting with medical
200943 - team at 0800 on 140519, to check glucose, sodium and potassium, all
200944 - elevated in Labcorp lab on 140508, and since VA omitted Electrolyte
200945 - Chem Profile lab on 140514. ref SDS 60 YM9H Side effects taking
200946 - Ezetimibe - slight dizziness laying down; may have subsided past few
200947 - days, so issue seems de minimus. There may be increased urination,
200948 - ref SDS 60 YM98
200950 - ..
200951 - On 140515 2043 letter to VA reports visiting Radiology Department, who
200952 - reports support for coronary CTA. ref SDS 60 YM41 Present research on
200953 - patient physiology that cause regression of athersclerotic plaques,
200954 - which align with current patient conditions of high HDL rising from 30
200955 - in 2009 to now 67. ref SDS 60 YM4M
200956 -
200957 -
200958 -
200959 -
200960 -
200961 -
200963 - ..
200964 - On 140518 0920 letter to VA submits consolidated blood tests from
200965 - Labcorp on 140508 and the VA on 140514, to prepare for the meeting on
200966 - 140519. ref SDS 61 1V6M Advise that VA has not ordered follow up lab
200967 - to check Electrolytes (Chem Profile) requested by Doctor Egan to
200968 - assess previously elevated potassium (K) 5.6, that cause electrical
200969 - problems for the heart. ref SDS 61 DV4M Medication side effects of
200970 - dizziness have subsided. ref SDS 61 DV50 Dry mouth and urination have
200971 - increased. ref SDS 61 DV56 Peripheral neuropathy related to elevated
200972 - bilirubin has recurred. ref SDS 61 DV59
200974 - ..
200975 - On 140518 0920 at 2244 received letter from Doctor Alba notifying not
200976 - to get blood draw at lab prior to meeting with medical team tomorrow
200977 - morning. ref SDS 61 RW7O
200979 - ..
200980 - On 140520 0813 VA partial lab at Medical Center in San Franciso to add
200981 - electrolyte (Chem) panel that was omitted on lab 140514. ref SDS 0
200982 - X45G
200984 - ..
200985 - On 140520 0732 at 0743 letter requests VA order electrolyte (Chem
200986 - Profile) lab order today. ref SDS 62 YW4H, and include lab for EPC.
200987 - ref SDS 62 4U46 Doctor Sandhu notified that medical team in San
200988 - Francisco discusses increased urination indicates possible prostate
200989 - issues. ref SDS 62 4U95 During meeting on 140519, decided that mild
200990 - symptoms peripheral neuropathy possibly due to statin treatment does
200991 - not justify ending statin tratement, because treatments have been
200992 - effective managing lipids. ref SDS 62 4U4F
200994 - ..
200995 - On 140520 0732 at 0812 letter from VA advises Doctor Alba will order
200996 - Chem Profile lab when she arrives at the hospital. ref SDS 62 4V5H
200998 - ..
200999 - On 140520 0732 at 1017 VA partial lab at Medical Center in San
201000 - Franciso for electrolyte (Chem) panel that was omitted on lab 140514.
201001 - ref SDS 62 KK9M Glucose, sodium, potassium declined, with potassium
201002 - (K 5.2) still at high end of range for Labcorp and slightly above VA
201003 - range, ref SDS 62 ZG5O; bilirubin declined dramatically. ref SDS 62
201004 - 015M
201006 - ..
201007 - On 140520 0732 at 1028 VA letter Doctor Alba requests clarification of
201008 - scope for EPC lab. ref SDS 62 654J Called to explain scope of EPC
201009 - lab, but encountered poor connection using cell phone. ref SDS 62 U63N
201011 - ..
201012 - On 140520 0732 at 1609 VA letter - Doctor Alba ordered EPC lab, she
201013 - advises EPC lab requires approval by lab staff of doctor's
201014 - justification. ref SDS 62 AF5L
201016 - ..
201017 - On 140520 0732 at 1617 letter to VA submits justification for doctor
201018 - to submit with order for EPC lab that saves lives, time, and money.
201019 - ref SDS 62 JP8O
201020 -
201021 -
201022 -
201023 -
201025 - ..
2011 -
2012 -
2013 - Progress
2014 -
201401 - VA Medical Center San Francisco Visit for Blood Draw Follow Up Lab
201402 -
201403 - Blood draw today at VA health care facility in San Francisco following
201404 - up meeting at VA with Doctor Alba yesterday, on 140519.
201406 - ..
201407 - Blood draw today is not stored on CD pdf file, it is only entered
201408 - below.
201410 - ..
201411 - Blood draw today compliments VA test that omitted Electrolytes on
201412 - 140514 0950. ref SDS 59 KK9M It further cross-checks Electrolyte
201413 - panel tested by Labcorp on 140508, shown in the record on 140514 0950.
201414 - ref SDS 59 KK9M
201416 - ..
201417 - VA partial lab on 140203 1147. ref SDS 50 ZG5O
201419 - ..
201420 - Last full VA lab was on 130529 0818. ref SDS 32 RP4N
201422 - ..
201423 - Prior full lab was on 121130 0846, ref SDS 25 RP4N, 120831 1400.
201424 - ref SDS 21 RP4N, following up 120509 1108, ref SDS 20 X45G; and before
201425 - that on 110727 1238, ref SDS 10 RP4N, and this was to prepare for
201426 - meeting in Primary Care a few weeks later on 110803 1400. ref SDS 11
201427 - U24I
201429 - ..
201430 - Partial lab to resolve skewed results from dehydration was on 121212
201431 - 0941. ref SDS 27 KK9M
201432 -
201434 - ..
2015 -
2016 -
2017 - 0743
2018 -
201801 - Request VA Confirm Lab Ordered Before Driving 60 Miles for Blood Draw
201802 -
201803 -
201804 - Sent letter to Doctor Alba saying...
201805 -
201806 - 1. Subject: Chem Lab Check Posassium
201807 - Date: 2014-05-20 07:54
201815 - ..
201816 - 2. Would like to come in today and get the chem lab, which you are
201817 - ordering to recheck labs for glucose, sodium at high end of
201818 - range, and potassium (K) 5.6 elevated above range, which
201819 - concerned Doctor Egan about presenting "electrical problems
201820 - with the heart," as noted in the letter to the medical team on
201821 - 140515. ref SDS 60 YM8M
201823 - ..
201824 - 3. Just want to make sure the order is at the lab, before driving
201825 - into the city today. Seemed like you may have said something
201826 - about doing it next week in order to ensure rehydration, which
201827 - you and Doctor Feingold indicated may have influenced the blood
201828 - test results because of hiking 22 miles the day before and
201829 - another 11 miles the morning of the lab on 140508, when blood
201830 - was drawn that yielded elevated electrolytes. I feel confident
201831 - have rehydrated at this time, so would like to get the lab done
201832 - today, if you concur.
201833 -
201834 -
2019 -
SUBJECTS
Default Null Subject Account for Blank Record
2103 -
210401 - ..
210402 - Ezetimibe Side Effects VA Clinic Martinez Notified
210403 -
210404 -
210405 - 4. As you suggested in the meeting yesterday, by copy giving
210406 - Doctor Sandhu a heads up on the theory that recent increased
210407 - frequency of urination may be an age related prostate issue,
210408 - rather than caused by rising side effects taking statins again.
210409 - As we discussed, when Doctor Egan ended Rosuvastatin on 121206,
210410 - frequent urination occurring after starting Rosuvastatin,
210411 - quickly subsided back to normal. Since at this time, the
210412 - problem is merely a nuisance, and since we are getting good
210413 - lipid labs, it was decided to continue over next 4 months the
210414 - current protocol of low dose Atorvastatin 10mg Ezetimibe 10mg,
210415 - hiking 1300 miles, weight loss, orange juice, etc, as set out
210416 - in the record of VA lab on 140514. ref SDS 59 I17G
210417 -
210418 -
2105 -
SUBJECTS
Default Null Subject Account for Blank Record
2203 -
220401 - ..
220402 - Peripheral Neuropathy Mild Side Effects Side Effects Do Not Justify Ending Atorvastatin
220403 -
220404 -
220405 - 5. Our discussion yesterday was helpful on peripheral neuropathy
220406 - in right foot while standing in line or walking slowly that
220407 - occurred previously taking Rosuvastatin, and then subsided on
220408 - ending treatment in December 2012. We decided that recent
220409 - return of very mild symptoms 5 months after starting low dose
220410 - statins would not justify ending treatment again at this time,
220411 - in order to maintain excellent lipid labs, shown on 140514
220412 - 0950. ref SDS 59 IM9N
220414 - ..
220415 - 6. Thanks to you and Doctor Feingold for a great meeting.
220416 -
220417 -
2205 -
SUBJECTS
Default Null Subject Account for Blank Record
2303 -
230401 - ..
230402 - EPC Add to Lab Assess Regression Athersclerotic Plaques Reduce Risk CAD
230403 -
230404 -
230405 - 7. Please let me know if the order for the lab has been issued.
230406 - Please include a lab for EPC to assess potential for regression
230407 - of atherosclerosis plaque. [...as requested previously in the
230408 - letter to the VA on 140515 2043. ref SDS 60 YM61...]. We are
230409 - all working hard for regression. Lipids are a good clue, and
230410 - EPCs are further evidence of response to treatment with
230411 - extended exercise.
230412 -
230413 - [...below on 140520 0732 at 1028 letter from Doctor Alba
230414 - requests clarification for adding EPC to lab order.
230415 - ref SDS 0 654J Called to explain scope of EPC lab, but
230416 - encountered poor connection using cell phone. ref SDS 0
230417 - U63N
230419 - ..
230420 - [...below on 140520 0732 at 1609 letter from Doctor Alba
230421 - advises EPC is not a typical scope for VA labs; she is
230422 - requesting approval for EPC lab in this case. ref SDS 0
230423 - AF5L
230425 - ..
230426 - [...below on 140520 0732 at 1617 letter to VA submits
230427 - explanation for rationale and justification that warrants
230428 - testing EPC labs in this case, leading to coronary CTA that
230429 - can justify reducing line of care in order to reduce
230430 - adverse side effects, saving time and money. ref SDS 0 VQ48
230432 - ..
230433 - [On 140529 0942 letter to VA asks for results on request
230434 - for EPC lab. ref SDS 64 QG3U
230436 - ..
230437 - [On 140610 0903 letter to Doctor Alba asks about progress
230438 - on ordering EPC labs and coronary CTA to evaluate
230439 - regression of athersclerosis. ref SDS 66 LJ61
230440 -
230441 -
230448 -
230449 -
230450 -
230451 -
2305 -
SUBJECTS
Default Null Subject Account for Blank Record
2403 -
2404 - 0812
240501 - ..
240502 - VA Order Issue Follow Up Labs on Electrolytes Chem Profile
240503 -
240504 - Received letter from Doctor Alba saying...
240505 -
240506 - 1. Subject: Re: Chem Lab Check Posassium
240507 - Date: 2014-05-20 08:06
240513 -
240514 - Im not in the hospital right now, but the orders will be
240515 - placed around 8:45
240517 - ..
240518 - This responds to the letter sent earlier this morning, per above.
240519 - ref SDS 0 YW4H
240521 - ..
240526 -
240527 -
240529 - ..
2406 -
2407 -
2408 - 0828
2409 -
240901 - Drove to VA Medical Center in San Francisco.
240902 -
240904 - ..
2410 -
2411 -
2412 - 0948
2413 -
241301 - Arrived at VA.
241303 - ..
241304 - Went to 2nd floor for blood draw. Used right arm, no problems.
241305 -
241306 -
241307 -
2414 -
SUBJECTS
Lab Electrolytes Chem Profile Glucose 97 Sodium NA 144 Potasium K 5.
4103 -
4104 - 1017
410501 - ..
410502 - T Bili 1.2 Hyperbilirubinemia Declined Atorvastatin Ezetimibe
410503 - Potasium K 5.2 Elevated But Declined Electrical Problems Heart
410504 - Bun/Creatinine Ratio Elevated Slightly
410505 -
410506 - Follow up ref SDS 59 KK9M, ref SDS 57 KK9M.
410507 -
410508 - Prior CHEM PROFILE on 120509 1108. ref SDS 20 KK9M
410509 - Prior CHEM PROFILE on 120831 1524. ref SDS 21 KK9M
410510 - Prior CHEM PROFILE on 130228 1140. ref SDS 30 KK9M
410511 - Prior CHEM PROFILE on 130529 0818. ref SDS 32 KK9M
410512 - Prior CHEM PROFILE on 131015 0724. ref SDS 34 KK9M
410513 - Prior CHEM PROFILE Labcorp on 140201 1159. ref SDS 49 KK9M
410514 - Prior CHEM PROFILE on 140203 1147. ref SDS 50 KK9M
410515 - Prior CHEM PROFILE Labcorp on 140508 1149. ref SDS 57 KK9M
410517 - ..
410518 - ELECTROLYTES - CHEM PROFILE
410520 - ..
410521 - Dates..........2014 05 20 1020 140514 140508 140203 140201 131015 130529
410522 - VA VA Labcorp VA Labcorp VA VA VA Labcorp
410523 - PLASMA Results Results Results Results Results Results Results Units Range Range
410524 - GLUCOSE 98 97 103 98 108 H 120 mg/dL 65 - 115 65.0 - 99.0
410525 - GLUfast mg/dL Ref: <=99
410526 - NA (salt) 139 144 140 140 139 139 mmol/L 135 - 145 134.0 - 144.0
410527 - K (potasium) H 5.2 H 5.6 H 5.4 4.8 4.3 H 4.9 mmol/L 3.3 - 4.8 3.5 - 5.2
410528 - CL 102 105 103 102 105 105 mmol/L 98 - 106 97.0 - 108.0
410529 - CO2 29.0 30.0 37.0 30.0 mmol/L 23 - 33
410530 - AGAP 8.0 mmol/L 5 - 20
410531 - BUN 19 H 23 17 20 24 18 mg/dL 10 - 24 10.0 - 22.0
410532 - CREAT 0.80 0.97 0.82 0.81 0.83 0.83 mg/dL .6 - 1.3 0.76 - 1.27
410533 - eGFR INA 102 79 >60 91 >60 >60 mL/min Ref: >=60 >59
410534 - eGFR IA 92 106 mL/min >59
410535 - CALCIUM 8.9 9.5 9.3 9.4 9.2 9.2 mg/dL 8.5 - 10.5 8.6 - 10.2
410536 - CA CORR mg/dL 8.7 - 10.2
410537 - PO4 mg/dL 2.4 - 4.5
410538 - MG 85 mg/dL 1.8 - 2.5
410539 - ALK PHO 86 100 105 84 87 U/L 40 - 125 39.0 - 117.0
410540 - SGOT 27 U/L 5 - 35
410541 - SGPT 28 U/L 7 - 56
410542 - ..
410543 - T. BIL 1.2 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
410544 - D. BILI 0.2 0.2 0.32 0.3 0.34 < 0.1 mg/dL .1 - .5 0.00 - 0.40
410545 - Bilirubin, Indir 0.98 1.26 H mg/dL 0.10 - 0.80
410546 - AST 23 26 23 21 20 22 IntUnits/L 8 - 42 0.0 - 40.0
410547 - ALT 21 17 21 19 17 19 IntUnits/L 5 - 55 0.0 - 44.0
410548 - ALBUMIN 3.9 4.6 4.6 4.1 4.4 3.9 4.0 gm/dL 3.3 - 5.2 3.6 - 4.8
410549 - PROTEIN 6.5 7.5 6.6 6.7 6.5 7.1 7.2 g/dL 6.0 - 8.5 6.0 - 8.5
410550 - Globulin, Total 2.0 2.1 g/dL 1.4 - 4.5
410551 - A/G Ratio 2.3 2.1 1.1 - 2.5
410552 - LDH 200.0 180.0 IntUnits/L 90 - 208 0.0 - 225.0
410553 - GGT 11.0 9.0 IU/L 0.0 - 65.0
410554 - Iron, Serum 100.0 114.0 ug/dL 40.0 - 155.0
410555 - AMYLASE Units/L 28 - 100
410556 - LIPASE Units/L 7 - 58
410557 - NH3 mcmol/L 15 - 56
410558 - URIC AC 5.6 mg/dL 4.8 - 8.7 3.7 - 8.6
410559 - Cholesterol, Total 164.0 162.0 mg/dL 100.0 - 199.0
410560 - Triglycerides 55.0 64.0 mg/dL 0.0 - 149.0
410561 -
410562 - [On 140522 1052 Electrolyte panel Chem Profile labs
410563 - submitted to Doctor Egan. ref SDS 63 3N4S
410565 - ..
410566 - a. SLIGHTLY Hemolyzed specimen /HN
410568 - ..
410569 - b. Ordering Provider: Diana Alba
410570 - Report Released..: May 20, 2014@11:21
410571 - Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]
410572 - 4150 CLEMENT STREET
410573 - SAN FRANCISCO, CA 94121-1545
410574 - Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]
410575 -
410576 -
410577 -
410579 - ..
410580 - Notes on Electrolytes Lab Hyperbilirubinemia Potassium Heart Problems
410581 - Hyperbilirubinemia Potassium Heart Problems Notes on Electrolytes Lab
410582 - Potassium Heart Problems Hyperbilirubinemia Notes on Electrolytes Lab
410583 -
410584 - Follow up ref SDS 59 G34G, ref SDS 57 G34G.
410585 -
410586 - 1. T Bilirubin 1.2................. ref SDS 0 015M
410587 -
410588 - Bilirubin 1.2 in lab today, fell within range at high end, a
410589 - week after being elevated nearly 100% in VA lab on 140514,
410590 - ref SDS 59 015M, and 2 weeks after elevated in Labcorp test
410591 - results, as shown above. ref SDS 0 015M This seems strong
410592 - improvement resolving side effects after ending Rosuvastatin 17
410593 - months ago on 121206 0900, ref SDS 26 OS5L, - with continuing
410594 - side effects of poor liver function that may align with new,
410595 - recent mild episodes peripheral neuropathy in right foot,
410596 - reported on 140510, shown in case study on 120101 0900.
410597 - ref SDS 15 TV6I Until then there had been no symptoms for past
410598 - 9 months, since 130614, reported in case study on 120101 0900.
410599 - ref SDS 15 TSUY Prior to 130614, there were no episodes for
410600 - several months reported on 130402, ref SDS 15 RURT, until
410601 - episode occurred on 130210. ref SDS 15 PV8I Major peripheral
410602 - neuopathy both feet on 130107. ref SDS 15 8H5F
410604 - ..
410605 - Background on Rosuvastatin causing elevated T Bilirubin with
410606 - associated severe side effects is reported on 121206 0900,
410607 - ref SDS 26 NI9L, and further explained in the record on 121130
410608 - 0846. ref SDS 25 ER4K
410610 - ..
410611 - On 131017 1000 Doctor Egan explained patient history of
410612 - intermittant and mild peripheral neuropathy that correlates
410613 - with persistent elevated T Bilirubin in lab on 131015,
410614 - ref SDS 34 015M, and further reported with vitals, diet and
410615 - exercise since prior meeting at VA on 130603, see case study on
410616 - 120101 0900, ref SDS 15 X14N, suggests intervention is not
410617 - required at this time to improve recovery from side effects
410618 - taking Rosuvastatin. ref SDS 37 LV5J
410620 - ..
410621 - On 131017 1000 VA medical chart Progress Notes assessment
410622 - report doctor concerned about chronic hyperbilirubinemia.
410623 - ref SDS 37 PSXT
410625 - ..
410626 - 2. Potasium K 5.2 Elevated above range......... ref SDS 0 ZG5O
410627 -
410628 - Labcorp blood test on 140508 reported potassium 5.6 increased
410629 - from 4.8 on prior Labcorp lab and 5.4 on VA lab from 3 months
410630 - ago, shown on 140203 1147. ref SDS 50 ZG5O VA lab today,
410631 - reporting Potassium (K) 5.2 substantially improves these prior
410632 - results, but remains slightly elevated. ref SDS 0 ZG5O
410633 -
410634 - [On 140522 1052 Electrolyte panel Chem Profile labs
410635 - submitted to Doctor Egan. ref SDS 63 3N4S
410637 - ..
410638 - In the meeting yesterday on 140519, Doctor Alba recommended
410639 - waiting until next week to fully rehydrate after hiking 22
410640 - miles on 140513, and 11 miles the morning of the lab on 140514.
410641 - If that advice had been implemented to pause hiking before
410642 - follow up lab, then potassium may have further fallen within
410643 - prescribed range, as shown by glucose and sodium. ref SDS 0
410644 - ZG5O
410646 - ..
410647 - Doctor Egan, referring cardiology physician at Martinez VA,
410648 - noted in a recent letter that meeting at VA Medical Center in
410649 - San Francisco on 140213 0830, ref SDS 53 GT7G, did not address
410650 - elevated potassium in labs performed by Labcorp and VA, shown
410651 - on 140203 1147. ref SDS 50 ZG5O Doctor Egan again notifies
410652 - that this condition of elevated potassium represents exposure
410653 - to "electrical problems" with the heart, reported on 140430.
410654 - ref SDS 55 UV5I
410656 - ..
410657 - Doctor Egan was concerned last year about potasium (K) rising
410658 - above range for good health. He explained potasium effects
410659 - electrical signals to the heart, and so has significance for
410660 - CVD, reported during meeting at VA on 121206 0900. ref SDS 26
410661 - 6K56
410662 -
410663 - [...below on 140520 0732 letter to VA cites improved
410664 - Potassium in follow up lab today. ref SDS 0 VQ54
410666 - ..
410667 - [On 140522 1052 Electrolyte panel Chem Profile labs
410668 - submitted to Doctor Egan. ref SDS 63 3N4S
410670 - ..
410671 - 3. Glucose 98...................... ref SDS 0 ZG5O
410672 -
410673 - Glucose fell to midrange 65 - 115, resolves concern that
410674 - dehydration increased glucose to nearly above range of Labcorp
410675 - blood test last week on 140508, presenting false positive for
410676 - risk diabetes, see above. ref SDS 0 ZG5O
410677 -
410678 -
410679 -
420510 - To: "Rod Welch"
420512 - ..
420912 -
420913 -
420914 -
4210 -
SUBJECTS
Default Null Subject Account for Blank Record
4303 -
4304 - 1609
430501 - ..
430502 - EPC Test Requires Approval of Doctor Order by VA Lab
430503 -
430504 -
430505 - Received letter from Doctor Alba saying...
430506 -
430507 - 1. Subject: RE: Chem Lab Check Posassium
430508 - Date: 2014-05-20 10:53
430514 -
430515 - EPC is not something that we do regularly at the VA. It has be
430516 - approved by the lab medicine service, since we need to justify
430517 - it. Im in clinic right now, but when im done, I?ll be happy to
430518 - page them to see if they can take a look. Approvals take a
430519 - while, because they need to review the chart before they decide
430520 - to approve it or not. We do not use EPC to assess potential
430521 - for regression of atherosclerosis plaque, so I doubt they will
430522 - approve it. But I'll pass along you request. Aprovals usually
430523 - take 24-48 hrs.
430525 - ..
430526 - The doctor responds to the letter this morning on adding EPC to labs
430527 - for blood draw this morning, reported above. ref SDS 0 4U46
430528 -
430529 - [...below on 140520 0732 at 1617 letter to VA submits
430530 - explanation for rationale and justification that warrants
430531 - testing EPC labs in this case, leading to coronary CTA that
430532 - can justify reducing line of care in order to reduce
430533 - adverse side effects, saving time and money. ref SDS 0 VQ48
430535 - ..
430536 - [On 140529 0942 letter to VA asks for results on request
430537 - for EPC lab. ref SDS 64 QG3U
430539 - ..
430540 - [On 140610 0903 letter to Doctor Alba asks about progress
430541 - on ordering EPC labs and coronary CTA to evaluate
430542 - regression of athersclerosis. ref SDS 66 LJ61
430543 -
430546 - Clinical Fellow, Endocrinology, Diabetes and Metabolism
430547 - University of California San Francisco
430548 -
430549 -
430550 -
430551 -
430552 -
4306 -
SUBJECTS
Default Null Subject Account for Blank Record
4403 -
4404 - 1617
440501 - ..
440502 - Lab Results Electrolyte Panel Chem Profile Submitted to VA
440503 -
440504 - Sent letter to the VA saying...
440505 -
440506 - 1. Subject: Re: Chem Lab Check Posassium
440507 - Date: 2014-05-20 16:27
440514 - ..
440515 - 2. Back home, so can communicate again. Have not been able to get
440516 - the hang of using cell phones for correspondence.
440517 -
440518 -
440519 -
4406 -
SUBJECTS
Default Null Subject Account for Blank Record
4503 -
450401 - ..
450402 - Justification Coronary CTA EPC Lab Regression Artersclerosis Save Lives Time Money
450403 - Coronary CTA Justification EPC Lab Regression Artersclerosis Save Lives Time Money
450404 - Justification EPC Lab Coronary CTA Regression Artersclerosis Save Lives Time Money
450405 - EPC Lab Coronary CTA Justification Regression Artersclerosis Save Lives Time Money
450406 -
450407 -
450408 - 3. Justification to submit on EPC [...and coronary CTA...] goes
450409 - along following lines...
450410 -
450411 - [On 140610 0903 letter to Doctor Alba asks about progress
450412 - on ordering EPC labs and coronary CTA to evaluate
450413 - regression of athersclerosis. ref SDS 66 LJ61
450415 - ..
450416 - This extended justification aids Doctor Alba's efforts to obtain
450417 - approval for the VA to test EPC in the labs today, cited in her letter
450418 - earlier today, above, ref SDS 0 AF5L, which responded to request in
450419 - the letter early this morning, per above. ref SDS 0 4U46
450421 - ..
450422 - Letter to VA continues...
450423 -
450424 - 4. Patient did a lot of running in 20s and 30s. He switched to
450425 - tennis in 40s and 50s, causing weight to go from 165 to 205.
450426 - Customer had HDL 30 in August 2009. In about 2004, he had
450427 - begun hiking 3 - 5 miles 4 - 5 times per week, i.e., about 20
450428 - miles per week, but this was insufficient to resolve mounting
450429 - atherosclerosis. He therefore required CABG +4 surgery on Oct
450430 - 22, 2009, due to severe plaque buildup. Following surgery, he
450431 - began a regimen of extended exercise for weight loss and
450432 - regression of atherosclerosis plaque. This has been gradually
450433 - increased year to year to achieve favorable lipids. He is
450434 - currently hiking about 80 miles per week, increase of 400%.
450435 - HDL 67 on most recent lab indicates response to treatment.
450436 - Patient requests lab for Endothelial Progenitor Cells (EPC) to
450437 - assess rapid regression of atherosclerosis, toward ordering
450438 - coronary CTA to determine if sufficient regression has occurred
450439 - that justifies reducing treatment hiking 300 miles per month.
450440 - If regression has occurred with EPC labs elevated like HDL, it
450441 - might be possible to hike only 150 miles per month, freeing
450442 - time for other work, and reducing side effects of sore feet,
450443 - sore back, neck, hips, hamstrings, shins, calfs, etc. The
450444 - medical team met with the patient yesterday on May 19, and
450445 - explained trade-offs between reducing treatment and suffering
450446 - side effects of increased urination, peripheral neuropathy,
450447 - dizziness, etc from taking statins. While an absolute
450448 - correlation has not been established with current medication,
450449 - patient's experience with prior statins showed side effects
450450 - ended, when medication was ended. However, it was recommended
450451 - that benefits of continuing treatment to prevent advance or
450452 - cause regression of plaque, outweigh advantages of avoiding
450453 - "minor" side effects. If EPC lab is favorable, this would
450454 - indicate along with already established favorable HDL 67 lab
450455 - results that regression of atherosclerotic plaques may be
450456 - occurring for this patient, leading to ordering coronary CTA
450457 - based on expectation that results can justify reducing line of
450458 - care along with side effects that are inconvenient and possibly
450459 - unnecessary for the patient to continue suffering.
450460 - Additionally, this would save time and money, and demonstrate
450461 - excellent care by the VA.
450463 - ..
450464 - [On 140629 1921 follow up letter to VA on 140520, ordering
450465 - coronary CTA with calcium score, ref SDS 62 VQ48, to assess
450466 - reducing level of care hiking 11 miles per day in order to
450467 - reduce side effects, ref SDS 68 UZ64; further request
450468 - referral to Podiatry for consultation to relieve
450469 - metatarsalgia side effects of prescribed care. ref SDS 68
450470 - U14H
450471 -
450472 -
450473 -
4505 -
SUBJECTS
Default Null Subject Account for Blank Record
4603 -
460401 - ..
460402 - Dehydration Resolved Electrolyte Panel Shows Labs within Range
460403 -
460404 -
460405 - 5. The lab this morning showed better numbers for glucosamine,
460406 - sodium, and potassium, [...reported above, ref SDS 0 KK9M...],
460407 - as occurred previously in December 2012, under similar
460408 - circumstances. Potassium 5.2 remains slightly elevated. [...
460409 - see analyis of lab above, ref SDS 0 TN3M...]. If we had waited
460410 - another day or so, as you suggested yesterday, might have
460411 - fallen within range as well.
460412 -
460413 - [On 140522 1052 Electrolyte panel Chem Profile labs
460414 - submitted to Doctor Egan. ref SDS 63 3N4S
460415 -
460416 -
460417 -
4605 -
SUBJECTS
Default Null Subject Account for Blank Record
4703 -
470401 - ..
470402 - Commend VA Effective Collaborating Doctor/Patient Partnership
470403 -
470404 -
470405 - 6. Sorry, we had so much trouble this morning coordinating with
470406 - the cell phone. [...referencing calls earlier today, above,
470407 - ref SDS 0 U63N...]. Very grateful for your timely, thorough
470408 - support, indicating good care through doctor/patient
470409 - partnership.
470411 - ..
470412 - 7. You have been a terrific partner - will miss working with you
470413 - when your rotation ends at the VA.
470414 -
470420 -
470421 -
470422 -
470423 -
470424 -
470425 -
470426 -
470427 -
470428 -
470429 -
470430 -
470431 -
470432 -
4705 -