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 29, 2014 09:42 AM Thursday; Rod Welch

VA letter request Progress Notes and order coronary CTA.

1...Summary/Objective


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CONTACTS 

SUBJECTS
CBC Lab WBC VA No Results                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2003 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2003 -    ..
2004 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
2005 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
200501 - Follow up ref SDS 62 0000. ref SDS 59 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
200502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200503 - Notified Doctor Alba at VA Medical Center in San Francisco placed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200504 - order with Release of Information Department to submit Progress Notes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200505 - for meeting on 140519, so no need for Doctor Alba so submit them.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200506 - ref SDS 0 X45G  Recommend correcting errors in prior notes so they are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
200507 - carried forward in Progress Notes for meeting on 140519. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
200508 - QF6T  Recommend Progress Notes cite patient support to improve lipid                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200509 - labs past 6 months, ref SDS 0 QF67, referencing the lab report on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200510 - 140514 0950, ref SDS 59 W25L, which also presents extended exercise,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
200511 - weight loss, and diet changes. ref SDS 59 I17G  Asked about progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
200512 - getting approval for EPC lab. ref SDS 0 QG3U  Request VA order                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
200513 - coronary CT angiography with calcium score to evaluate regression of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200514 - athersclerosis, as a result of good labs from medication and extended                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200515 - exercise the past 6 months. ref SDS 0 QG38                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
200517 -             ..
200518 -            [On 140610 0903 request again completion of Progress Notes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
200519 -            for meeting on 140519, to review for corrections, and guide                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
200520 -            case management. ref SDS 64 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200522 -             ..
200523 -            [On 140610 0903 VA notifies Progress Notes were published a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
200524 -            week earlier and without notice to the customer so that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
200525 -            could continue toward timely completion. ref SDS 65 W84I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
200526 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200527 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200528 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200529 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200531 -  ..
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 140518 0920 letter to VA submits consolidated blood tests from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200930 - Labcorp on 140508 and the VA on 140514, to prepare for the meeting on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200931 - 140519. ref SDS 61 1V6M  Advise that VA has not ordered follow up lab                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
200932 - to check Electrolytes (Chem Profile) requested by Doctor Egan to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
200933 - assess previously elevated potassium (K) 5.6, that cause electrical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
200934 - problems for the heart. ref SDS 61 DV4M  Medication side effects of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
200935 - dizziness have subsided. ref SDS 61 DV50  Dry mouth and urination have                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
200936 - increased. ref SDS 61 DV56  Peripheral neuropathy related to elevated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
200937 - bilirubin has recurred. ref SDS 61 DV59                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
200939 -  ..
200940 - On 140518 0920 at 2244 received letter from Doctor Alba notifying not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200941 - to get blood draw at lab prior to meeting with medical team tomorrow                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200942 - morning. ref SDS 61 RW7O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
200944 -  ..
200945 - On 140520 0732 background and planning for getting supplemental labs                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200946 - on electrolyte (Chem Profile), and EPC. ref SDS 62 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
200948 -  ..
200949 - On 140520 0732 at 0743 letter requests VA order electrolyte (Chem                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200950 - Profile) lab order today. ref SDS 62 YW4H, and include lab for EPC.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
200951 - ref SDS 62 4U46  Doctor Sandhu notified that medical team in San                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
200952 - Francisco discusses increased urination indicates possible prostate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
200953 - issues. ref SDS 62 4U95  During meeting on 140519, decided that mild                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
200954 - symptoms peripheral neuropathy possibly due to statin treatment does                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200955 - not justify ending statin tratement, because treatments have been                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
200956 - effective managing lipids. ref SDS 62 4U4F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
200958 -  ..
200959 - On 140520 0732 at 0812 letter from VA advises Doctor Alba will order                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200960 - Chem Profile lab when she arrives at the hospital. ref SDS 62 4V5H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
200962 -  ..
200963 - On 140520 0732 at 1017 VA partial lab at Medical Center in San                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
200964 - Franciso for electrolyte (Chem) panel that was omitted on lab 140514.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200965 - ref SDS 62 KK9M  Glucose, sodium, potassium declined, with potassium                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
200966 - (K 5.2) still at high end of range for Labcorp and slightly above VA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200967 - range, ref SDS 62 ZG5O; bilirubin declined dramatically. ref SDS 62                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
200968 - 015M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200970 -  ..
200971 - On 140520 0732 at 1028 VA letter Doctor Alba requests clarification of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
200972 - scope for EPC lab. ref SDS 62 654J  Called to explain scope of EPC                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
200973 - lab, but encountered poor connection using cell phone. ref SDS 62 U63N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
200975 -  ..
200976 - On 140520 0732 at 1609 VA letter - Doctor Alba ordered EPC lab, she                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
200977 - advises EPC lab requires approval by lab staff of doctor's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
200978 - justification. ref SDS 62 AF5L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200980 -  ..
200981 - On 140520 0732 at 1617 letter to VA submits justification for doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200982 - to submit with order for EPC lab that saves lives, time, and money.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
200983 - ref SDS 62 JP8O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200985 -  ..
200986 - On 140522 1052 letter to Doctor Egan at Martinez submits results of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
200987 - labs on Electrolyte Chem Profile showing Potassium, which Doctor Egan                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200988 - requested. ref SDS 63 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
200990 -  ..
200991 - On 140529 0942 letter to Doctor Alba at VA Medical Center in San                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
200992 - Francisco adise placed order with Release of Information Department to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
200993 - submit Progress Notes for meeting on 140519, so no need for Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
200994 - Alba so submit. ref SDS 0 X45G  Recommend correcting errors in prior                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200995 - notes so they are carried forward in Progress Notes for meeting on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
200996 - 140519. ref SDS 0 QF6T  Recommend Progress Notes cite patient support                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200997 - to improve lipid labs past 6 months, ref SDS 0 QF67, referencing the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
200998 - lab report on 140514 0950, ref SDS 59 W25L, which also presents                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
200999 - extended exercise, weight loss, and diet changes. ref SDS 59 I17G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
201000 - Asked about progress getting approval for EPC lab. ref SDS 0 QG3U                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
201001 - Request VA order coronary CT angiography with calcium score to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
201002 - evaluate regression of athersclerosis, as a result of good labs from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201003 - medication and extended exercise the past 6 months. ref SDS 0 QG38                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
201004 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201005 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201007 -  ..
2011 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2012 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2013 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2014 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
201401 - Sent letter to Doctor Alba saying...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201402 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201403 -    1.  Subject:  Progress Notes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201404 -        Date:  2014-05-29 10:15                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
201411 -         ..
201412 -    2.  Stopped at the Medical Center on the way back from Santa Cruz                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201413 -        yesterday.  Great drive on Highway 1 up the Coast.  Went to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
201414 -        Release of Information and ordered your progress notes for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
201415 -        meeting on 140519, so no need for you to submit directly.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
201416 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201417 -            [On 140610 0903 request again completion of Progress Notes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
201418 -            for meeting on 140519, to review for corrections, and guide                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
201419 -            case management. ref SDS 64 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
201421 -         ..
201422 -    3.  Hope there is time to correct errors in patient history to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
201423 -        avoid propagating prior errors in the current notes.  It's a 2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
201424 -        minute read. [...following up review on 140213 0830.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
201425 -        ref SDS 53 WF5J and ref SDS 53 E66J and ref SDS 53 NM6M and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201426 -        ref SDS 53 5I7H...]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
201428 -         ..
201429 -    4.  Additionally, hoping you can mention in the current notes that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
201430 -        lab results reflect in part patient support listed in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
201431 -        record on 140514 (see line 760562. ref SDS 59 I17G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201433 -         ..
201434 -    5.  No rush on completing notes, but please send me notice when                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
201435 -        they are posted, so I can follow up with ROI.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201436 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201437 -            [On 140610 0903 request again completion of Progress Notes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
201438 -            for meeting on 140519, to review for corrections, and guide                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
201439 -            case management. ref SDS 64 X45G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
201441 -             ..
201442 -            [On 140610 0903 VA notifies Progress Notes were published a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
201443 -            week earlier and without notice to the customer so that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
201444 -            could continue toward timely completion. ref SDS 65 W84I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
201446 -         ..
201447 -    6.  Have not heard on EPC lab issue, so guess the team could not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
201448 -        get this done.  Did you get any feedback on your submission?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
201449 -        ...[cited in correspondence on 140520 0732. 140520 0732,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201450 -        ref SDS 62 4U46 and ref SDS 62 AF5L, and referencing prior                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
201451 -        request on 140515 2043, ref SDS 60 YM61, citing research on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
201452 -        131125 0005. ref SDS 42 6O9M...]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
201454 -         ..
201455 -    7.  Having heard Doctor Feingold's explanation [...during meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201456 -        at VA on 140519...] that coronary CT angiography is difficult                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201457 -        for CABG patients [...due to anatomy changes during                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
201458 -        surgery...], would like to proceed with this to verify                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
201459 -        regression of atherosclerosis plaque, and for reasons set out                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
201460 -        in the letter to you on 140520, [...reported on 140520 0732.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
201461 -        ref SDS 62 VQ48...].                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
201463 -         ..
201464 -    8.  Will think of you when I get to the top of Half Dome.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
201465 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201468 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201469 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201470 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201471 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201472 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201473 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201474 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201475 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201476 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201477 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
201478 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2015 -