CONTACTS
SUBJECTS
CBC Lab WBC VA No Results
2403 -
2403 - ..
2404 - Summary/Objective
2405 -
240501 - Follow up ref SDS 57 0000. ref SDS 55 0000.
240502 -
240503 -
240504 -
240505 -
240506 -
240507 -
240509 - ..
2406 -
2407 -
2408 - Background
2409 -
240901 - On 131016 1632 submit letter for agenda meeting to review lab results
240902 - scheduled 131017 1000. ref SDS 37 X45G
240904 - ..
240905 - On 140131 0815 ordered another lab - cbc, electrolytes, lipid with NMR
240906 - - from Labcor to get LDL-P. ref SDS 46 X45G
240908 - ..
240909 - On 140201 1159 had full lab with NMR lipid panel drawn at John Muir
240910 - Hospital on Treat, and by Labcorp. ref SDS 47 RP4N
240912 - ..
240913 - On 140203 1147 had partial lab drawn at VA in Martinez. ref SDS 48
240914 - KK9M
240916 - ..
240917 - On 140507 0857 ordered another full lab from Labcorp with NMR lipid
240918 - panel. ref SDS 54 OO5G
240920 - ..
240921 - On 140508 1133 lab blood daw at Labcorp with John Muir Medical Center
240922 - on Treat Blvd in Concord. ref SDS 55 445G
240924 - ..
240925 - On 140514 0950 VA partial lab at Medical Center in San Francisco.
240926 - ref SDS 57 X45G
240928 - ..
240929 - On 140814 1530 VA partial lab at Clinic in Martinez.
240930 -
240931 -
240932 -
240933 -
240935 - ..
2410 -
2411 -
2412 - Progress
2413 -
241301 - Blood draw today at VA health care facility for meeting at VA with
241302 - Doctor Sandahu on 140815. Connie in Primary Care called and left
241303 - messages on Tuesday while I was out of town, for getting a blood draw
241304 - today.
241306 - ..
241307 - ROI VA Clinic Martinze unable to provide timely lab report, so Martha
241308 - printed the lab.
241310 - ..
241311 - See directory structure for medical records on 140320 1125.
241312 - ref SDS 52 4M5I
241313 -
241314 -
241316 - ..
241317 - CBC WBC 9.5 Increased 50% After Several Years Stable
241318 - Blood Tests Evaluate Health 5 Years After CABG x4 Surgery
241319 -
241320 - Follow up ref SDS 57 RP4N, ref SDS 55 RP4N.
241321 -
241322 - Prior VA CBC on 120509 1108. ref SDS 22 RP4N
241323 - Prior VA CBC on 120831 1524. ref SDS 23 RP4N
241324 - Prior VA CBC on 121130 1001. ref SDS 27 RP4N
241325 - Prior VA CBC on 130529 0818. ref SDS 34 RP4N
241326 - Prior Labcorp CBC on 140201 1159. ref SDS 47 RP4N
241327 - VA did not order CBC for lab on 140203 1147. ref SDS 48 YX8K
241328 - Prior Labcorp CBC on 140508 1149. ref SDS 55 RP4N
241330 - ..
241331 - CBC PANEL
241332 - ..
241333 - Dates......... 2014 08 14 1528 140514 140508 140203 140201 130529
241334 - VA VA Labcorp VA Labcorp VA VA Labcorp
241335 - Blood Results Results Results Results Results Results Units Range Range
241336 - WBC 12.8 H 9.5 6.2 7.4 K/cmm 4.8 - 10.8 3.4 - 10.8
241337 - RBC 5.44 5.21 5.13 5.09 M/cmm 4.7 - 6.1 4.14 - 5.80
241338 - HGB 16.2 15.1 15.2 15.0 g/dL 14 - 18 12.6 - 17.7
241339 - HCT 48.3 47.0 44.2 46.2 % 42 - 52 37.5 - 51.0
241340 - MCV 88.7 90.0 86.0 90.7 fL 80 - 99 79.0 - 97.0
241341 - MCH 29.8 29.0 29.6 29.5 uug 27 - 34 26.6 - 33.0
241342 - MCHC 33.6 32.1 34.4 32.5 gm/dL 32 - 35.2 31.5 - 35.7
241343 - RDW 13.9 13.8 13.7 14.4 % 11.5 - 14.5 12.3 - 15.4
241344 - PLT 295.0 329 303 279 K/cmm 130 - 400 155.0 - 379.0
241345 - MPV 8.3 8.8 fL 7 - 10.4
241346 - NEUT % 78.1 70 69 69.9 % 40 - 80 40.0 - 74.0
241347 - LYMPH % 13.6 L 20 21 L 19.7 % 20 - 51 14.0 - 46.0
241348 - MONO % 7.6 8 8 7.8 % 2 - 13 4.0 - 12.0
241349 - EOS % 0.4 L 1 1 1.9 % .5 - 7 0.0 - 5.0
241350 - BASO % 0.3 1 1 0.7 % 0 - 2 0.0 - 3.0
241351 - NEUT # 10.0 H 6.7 4.3 5.2 K/cmm 1.5 - 7.9 1.4 - 7.0
241352 - LYMPH # 1.7 1.9 1.3 1.5 K/cmm 1.2 - 3.4 0.7 - 3.1
241353 - MONO # 1.0 0.7 0.5 0.6 K/cmm .2 - 1.2 0.1 - 0.9
241354 - EOS # 0.1 0.1 0.1 0.1 K/cmm .1 - .5 0.0 - 0.4
241355 - BASO # 0.0 0.1 0.1 0.1 K/cmm 0 - .2 0.0 - 0.2
241356 - ESRmVES mm/hr 0 - 10
241357 - ESRxCYT mm/hr 2 - 10
241358 - RETIC % % .66 - 2.85
241359 - RETIC # k/uL 27.9 - 121.6
241360 - Immature Granulocytes 0.0 0.0 % 0.0 - 2.0
241361 - Immature Grans (Abs) 0.0 0.0 % 0.0 - 0.1
241363 - ..
241364 - Comments:
241365 -
241366 - a. Reporting Lab
241367 - Martinez CBOC
241368 - 150 Muir Road
241369 - Martinez, CA 94553 4668
241370 -
241372 - ..
241373 - Recent infection on left big toe may have elevated WBC, noted in
241374 - letter to Primary Care later today on 140814 2227, ref SDS 63 K055,
241375 - side effect from treatment for regression of atherosclerosis.
241377 - ..
241378 - Increased exercise explained below, ref SDS 0 I17G, may have
241379 - stimulated bone marrow to produce more new blood that increased WBC
241380 - 30% in VA blood test on 140814, per above, ref SDS 0 FK6I,
241381 - explained by Doctor Johnson during a meeting at Kaiser on 030606.
241382 - ref SDS 1 JP7G
241383 -
241384 -
241385 -
241386 -
241387 -
2414 -
SUBJECTS
Urinalysis Lab VA No Results
3903 -
390401 - ..
390402 - Urinalysis Ketones Trace Abnormal Sp Gravity Above Range
390403 -
390404 - Follow up ref SDS 57 0X72, ref SDS 55 0X72.
390405 -
390406 - Prior Urinalysis test on 101207 0906. ref SDS 11 0X72
390407 - Prior Urinalysis test on 120509 1108. ref SDS 22 0X72
390408 - Prior Urinalysis test on 140201 1159. ref SDS 47 0X72
390409 - VA did not order urinalysis for lab on 140203 1147. ref SDS 48 0X72
390410 - Prior Labcorp CBC on 140508 1149. ref SDS 55 0X72
390411 - Prior Urinalysis test on 140814 1530. ref SDS 0 0X72
390413 - ..
390414 - URINALYSIS PANEL
390415 - ..
390416 - Dates.......... 2014 08 14 1528 140514 140203 140201 120509
390417 - VA VA Labcorp VA Labcorp VA VA Labcorp
390418 - Results Results Results Results Results Results Units Range Range
390419 - PH 6.0 5.5 5.5 6.0 5 - 9 5.0 - 7.5
390420 - PROTEIN NEG NEG NEG NEG mg/dL NEG - TRACE NEG - TRACE
390421 - GLUCOSE NEG NEG NEG NEG mg/dL Ref: NEG NEG
390422 - KETONES 15 Trace Abnormal NEG NEG mg/dL Ref: NEG NEG
390423 - BILI NEG NEG NEG NEG Ref: NEG NEG
390424 - BILIcnf Ref: NEG
390425 - BLOOD TRACE TRACE TRACE TRACE Ref: NEG
390426 - NITRITE, URINE NEG NEG NEG NEG Ref: NEG NEG
390427 - UROBILI 0.2 0.2 0.2 0.2 EU/dL .2 - 1 0.0 - 1.9
390428 - LEU EST NEG NEG Ref: NEG
390429 - SP.GRAV >=1.030 H 1.036 1.026 1.025 1.003- 1.035 1.005 - 1.030
390430 - COLOR YELLOW YELLOW YELLOW YELLOW
390431 - APPEAR CLEAR CLEAR CLEAR CLEAR
390432 - WBC ESTERASE NEG NEG
390433 - OCCULT BLOOD NEG NEG NEG
390434 - HAYALINE CASTS NORM(0-1) per lpf 0 - 1
390435 - GRANULAR CASTS None per lpf Ref: None
390436 - CELLULAR CASTS None per lpf Ref: None
390437 - RBC/HPF NORM(0-3) per lpf 0 - 3
390438 - BACTERIA NORM(0-1) per lpf 0 - 1
390439 - EPITHELIAL CELLS NORM(0-1) per lpf 0 - 1
390440 - RENAL EPITHELIAL CELLS None per lpf Ref: None
390441 - CALCIUM OXILATE CRYST NORM(0-1) per lpf 0 - 1
390442 - URIC ACID CRYSTALS NORM(0-1) per lpf 0 - 1
390443 - TRIPLE PHOSPHATE CRYST NORM(0-1) per lpf 0 - 1
390444 - AMORPHOUS SEDIMENT None per lpf Ref: None
390445 - MUCOUS None per lpf Ref: None
390446 - TRICHOMONAS None per lpf Ref: None
390447 - YEAST None per lpf Ref: None
390448 - CULTURE REFLEXED No
390449 - TR EPTH None per lpf Ref: None
390451 - ..
390452 - Comments:
390453 -
390454 - a. Reporting Lab
390455 - Martinez CBOC
390456 - 150 Muir Road
390457 - Martinez, CA 94553 4668
390458 -
390460 - ..
390461 - Ketnones 15 review by VA, follow up prior lab showning Ketones trace
390462 - abnormal, reported on 140514 0950. ref SDS 57 MT4L
390463 -
390464 -
390465 -
390466 -
390467 -
390468 -
390469 -
390470 -
3905 -
SUBJECTS
Lab Electrolytes Chem Profile Glucose 97 Sodium NA 144 Potasium K 5.
5603 -
560401 - ..
560402 - T Bili 2.2 Hyperbilirubinemia Worse Atorvastatin Ezetimibe
560403 - Potasium K 5.6 Elevated Increased Electrical Problems Heart
560404 - Bun/Creatinine Ratio Elevated Slightly
560405 -
560406 - Follow up ref SDS 57 KK9M, ref SDS 55 KK9M.
560407 -
560408 - Prior CHEM PROFILE on 120509 1108. ref SDS 22 KK9M
560409 - Prior CHEM PROFILE on 120831 1524. ref SDS 23 KK9M
560410 - Prior CHEM PROFILE on 130228 1140. ref SDS 32 KK9M
560411 - Prior CHEM PROFILE on 130529 0818. ref SDS 34 KK9M
560412 - Prior CHEM PROFILE on 131015 0724. ref SDS 36 KK9M
560413 - Prior CHEM PROFILE Labcorp on 140201 1159. ref SDS 47 KK9M
560414 - Prior CHEM PROFILE on 140203 1147. ref SDS 48 KK9M
560415 - Prior CHEM PROFILE Labcorp on 140508 1149. ref SDS 55 KK9M
560416 - Prior CHEM PROFILE on 140520 0732. ref SDS 59 KK9M
560417 - Prior CHEM PROFILE on 140814 1530. ref SDS 0 KK9M
560418 -
560420 - ..
560421 - ELECTROLYTES - CHEM PROFILE
560423 - ..
560424 - Dates..........2014 08 14 1528 140520 140514 140508 140203 140201 131015 130529
560425 - VA VA VA Labcorp VA Labcorp VA VA VA Labcorp
560426 - PLASMA Results Results Results Results Results Results Results Results Units Range Range
560427 - GLUCOSE 98 98 97 103 98 108 H 120 mg/dL 74 - 118 65.0 - 99.0
560428 - GLUfast mg/dL Ref: <=99
560429 - NA (salt) 144 139 144 140 140 139 139 mmol/L 136 - 144 134.0 - 144.0
560430 - K (potasium) 4.3 H 5.2 H 5.6 H 5.4 4.8 4.3 H 4.9 mmol/L 3.4 - 4.8 3.5 - 5.2
560431 - CL H 108 102 105 103 102 105 105 mmol/L 98 - 106 97.0 - 108.0
560432 - CO2 29 29.0 30.0 37.0 30.0 mmol/L 23 - 33
560433 - AGAP 8.0 mmol/L 5 - 20
560434 - BUN/Creati Ratio 19 H 23 17 20 24 18 mg/dL 8 - 26 10.0 - 22.0
560435 - CREAT 1.03 0.80 0.97 0.82 0.81 0.83 0.83 mg/dL .5 - 1.1 0.76 - 1.27
560436 - eGFR INA >60 102 79 >60 91 >60 >60 mL/min Ref: >=60 >59
560437 - eGFR IA 92 106 mL/min >59
560438 - CALCIUM 9.1 8.9 9.5 9.3 9.4 9.2 9.2 mg/dL 8.7 - 10.2 8.6 - 10.2
560439 - CA CORR mg/dL 8.7 - 10.2
560440 - PO4 mg/dL 2.4 - 4.5
560441 - MG 85 mg/dL 1.8 - 2.5
560442 - ALK PHO 85 86 100 105 84 87 U/L 40 - 125 39.0 - 117.0
560443 - SGOT 27 U/L 5 - 35
560444 - SGPT 28 U/L 7 - 56
560446 - ..
560447 - T. BIL H 2.5 1.2 H 2.2 H 1.3 H 2.1 H 1.6 H 1.7 H 1.3 mg/dL .1 - 1.2 0.0 - 1.2
560448 - D. BILI 0.3 0.2 0.2 0.32 0.3 0.34 < 0.1 mg/dL .1 - .5 0.00 - 0.40
560449 - Bilirubin, Indir 0.98 1.26 H mg/dL 0.10 - 0.80
560450 - AST (SGOT) 25 23 26 23 21 20 22 IntUnits/L 8 - 42 0.0 - 40.0
560451 - ALT (SGPT) 21 21 17 21 19 17 19 IntUnits/L 5 - 55 0.0 - 44.0
560452 - ALBUMIN 4.3 3.9 4.6 4.6 4.1 4.4 3.9 4.0 g/dL 3.3 - 5.2 3.6 - 4.8
560453 - PROTEIN 7.2 6.5 7.5 6.6 6.7 6.5 7.1 7.2 g/dL 6.0 - 8.5 6.0 - 8.5
560454 - Globulin, Total 2.0 2.1 g/dL 1.4 - 4.5
560455 - A/G Ratio 2.3 2.1 1.1 - 2.5
560456 - LDH 200.0 180.0 IntUnits/L 90 - 208 0.0 - 225.0
560457 - GGT 11.0 9.0 IU/L 0.0 - 65.0
560458 - Iron, Serum 100.0 114.0 ug/dL 40.0 - 155.0
560459 - AMYLASE Units/L 28 - 100
560460 - LIPASE Units/L 7 - 58
560461 - NH3 mcmol/L 15 - 56
560462 - URIC AC 5.6 mg/dL 4.8 - 8.7 3.7 - 8.6
560463 - Cholesterol, Total 164.0 162.0 mg/dL 100.0 - 199.0
560464 - Triglycerides 55.0 64.0 mg/dL 0.0 - 149.0
560465 -
560467 - ..
560468 - Comments:
560469 -
560470 - a. Reporting Lab
560471 - Martinez CBOC
560472 - 150 Muir Road
560473 - Martinez, CA 94553 4668
560475 - ..
560476 - b. Creatinine
560477 -
560478 - Eval: Effective 7/2/08, new standardized method for
560479 - creatinine in place.
560481 - ..
560482 - Eval: Note reference range change. Previous range
560483 - 0.5 - 1.2 mg/dL.
560484 -
560485 - c. eGFR
560486 -
560487 - Eval: eGFR Units = mL/min/1.73 square meters
560489 - ..
560490 - d. Alkaline Phosphatase
560491 -
560492 - Eval: The normal range is for an adult population
560493 - less than 50 years old. Alk Phos increases with age
560494 - over 50 to about 60% higher values by ages greater
560495 - than 75 years old.
560496 -
560497 -
560499 - ..
560500 - Notes on Electrolytes Lab Hyperbilirubinemia Potassium Heart Problems
560501 - Hyperbilirubinemia Potassium Heart Problems Notes on Electrolytes Lab
560502 - Potassium Heart Problems Hyperbilirubinemia Notes on Electrolytes Lab
560503 -
560504 - Follow up ref SDS 57 G34G, ref SDS 55 G34G.
560505 -
560506 - 1. T Bilirubin 2.5................. ref SDS 0 015M
560508 - ..
560509 - Collection DT T Bili Range Source
560510 - 05/08/2014 15:28 2.5 H...0.3 - 1.2.. ref SDS 0 WJ5H
560511 - 20/05/2014 10:20 1.2 ....0.3 - 1.2.. ref SDS 59 015M
560512 - 08/05/2014 11:49 1.3 H...0.0 - 1.2.. ref SDS 55 015M
560513 - 03/02/2014 09:52 2.1 H...0.3 - 1.2.. ref SDS 48 015M
560514 - 01/02/2014 12:28 1.6 H...0.0 - 1.2.. ref SDS 47 015M
560515 - 15/10/2013 08:25 1.7 H...0.3 - 1.2.. ref SDS 36 015M
560516 - 29/05/2013 08:18 1.3 H...0.3 - 1.2.. ref SDS 34 1Y9G
560517 - 28/02/2013 08:36 1.3 H...0.3 - 1.2.. ref SDS 32 6S4F
560518 - 31/08/2012 15:24 2.3 H...0.3 - 1.2.. ref SDS 23 NV9M
560519 - 09/05/2012 11:24 2.5 H...0.3 - 1.2.. ref SDS 22 O46K
560520 - 09/02/2012 11:18 1.8 H...0.3 - 1.2.. ref SDS 18 KK9M
560521 - 17/11/2011 14:27 1.3 H.............. ref SDS 16 KK9M
560522 - 13/10/2011 14:35 1.3 H.............. ref SDS 15 GM65
560523 - 27/07/2011 12:58 2.0 H.............. ref SDS 12 GM65
560524 - 07/12/2010 09:17 1.0 ............... ref SDS 11 GM65
560525 - 21/07/2010 08:54 1.3 H.............. ref SDS 7 GM65
560526 - 13/08/2009 15:09 1.7 H.............. ref SDS 2 VG8R
560527 - 11/02/2009 0.9 ............... ref DRP 1 LG4L
560528 - 12/14/2009 1.3 H ............. ref DRP 1 DE4O
560530 - ..
560531 - On 131017 1000 VA medical chart Progress Notes assessment
560532 - reports Doctor Egan diagnosed chronic hyperbilirubinemia.
560533 - ref SDS 38 PSXT
560535 - ..
560536 - Bilirubin 2.5 in lab today, elevated 110% above range shows
560537 - dramatic increase from 1.2 in lab at VA San Francisco Medical
560538 - Center on 140520. ref SDS 59 015M This is highest result for T
560539 - Bili in patient history, may demonstrate chronic side effects
560540 - statin medications causing poor liver function, as reviewed
560541 - previously on prior lab on 140514 0950. ref SDS 57 G34G Side
560542 - effects of peripheral neuropathy in right foot have ebbed and
560543 - flowed, reported on 140510, shown in case study on 120101 0900.
560544 - ref SDS 17 TV6I
560545 -
560546 - [On 140819 0800 during meeting with Doctor Sandhu in
560547 - Primary Care VA Clinic in Martinez, there was no review of
560548 - chronic hyperbilirubinemia, with T Bilirubin 2.5 rising
560549 - 110% above range, ref SDS 64 9K7I, shown in lab ordered by
560550 - the doctor on 140814. ref SDS 0 015M
560552 - ..
560553 - Background on Rosuvastatin causing elevated T Bilirubin with
560554 - associated severe side effects is reported on 121206 0900,
560555 - ref SDS 28 NI9L, and further explained in the record on 121130
560556 - 0846. ref SDS 27 ER4K
560558 - ..
560559 - On 131017 1000 Doctor Egan explained patient history of
560560 - intermittant and mild peripheral neuropathy that correlates
560561 - with persistent elevated T Bilirubin in lab on 131015,
560562 - ref SDS 36 015M, and further reported with vitals, diet and
560563 - exercise since prior meeting at VA on 130603, see case study on
560564 - 120101 0900, ref SDS 17 X14N, suggests intervention is not
560565 - required at this time to improve recovery from side effects
560566 - taking Rosuvastatin. ref SDS 38 LV5J
560568 - ..
560569 - 2. Potasium K 4.3 within range................. ref SDS 0 ZG5O
560570 -
560571 - Until the lab today, potassium (k) has been persistently
560572 - elevated above range for 6 months through several labs,
560573 - reported on 140514 0950. ref SDS 57 TN3M
560575 - ..
560576 - Doctor Egan, referring cardiology physician at Martinez VA,
560577 - noted in a recent letter that meeting at VA Medical Center in
560578 - San Francisco on 140213 0830, ref SDS 51 GT7G, did not address
560579 - elevated potassium in labs performed by Labcorp and VA, shown
560580 - on 140203 1147. ref SDS 48 ZG5O Doctor Egan again notifies
560581 - that this condition of elevated potassium represents exposure
560582 - to "electrical problems" with the heart, reported on 140430.
560583 - ref SDS 53 UV5I
560585 - ..
560586 - Doctor Egan was concerned last year about potasium (K) rising
560587 - above range for good health. He explained potasium effects
560588 - electrical signals to the heart, and so has significance for
560589 - CVD, reported during meeting at VA on 121206 0900. ref SDS 28
560590 - 6K56
560592 - ..
560593 - At that time on 121206, the doctor cited medication conflicts
560594 - as possibly causing elevated potasium. ref SDS 28 FI7L Doctor
560595 - Egan further considered dehydration (urination) caused by
560596 - Rosuvastatin may have skewed lab results for electrolytes on
560597 - 121130, and so ordered re-test. ref SDS 28 6K4J
560599 - ..
560600 - On 121212 0941 re-test lab reported Glucose 111, sodium 139,
560601 - and potasium (K) 4.6, all within range, ref SDS 29 KK9M,
560602 - correcting errors noted by Doctor Egan during meeting at VA on
560603 - 121206 0900. ref SDS 28 6K4J
560605 - ..
560606 - Dramatic decline in hiking the past 6 weeks, shown in case
560607 - study on 120101 0900, ref SDS 17 7718, and reported on the
560608 - agenda for meeting with Doctor Sandhu in Primary Care, which
560609 - was submitted later today in another record on 140814 2227.
560610 - ref SDS 63 K098, may correlate with potassium falling back
560611 - within range.
560612 -
560614 - ..
560615 - 3. Glucose 98...................... ref SDS 0 ZG5O
560616 -
560617 - On 140514 0950 VA lab for HGBA1c 5.6 within range 4 - 6, seems
560618 - to indicate no evident exposure for diabetes. ref SDS 57 H66G
560620 - ..
560621 - 4. Cloride 108..................... ref SDS 0 WJ5H
560622 -
560623 - There is no record on cause and implications of elevated CL.
560624 -
560625 -
560626 -
560627 -
560628 -
560629 -
560630 -
560631 -
5607 -
SUBJECTS
VA Lab Lipid Cholesterol 164 with Medication Hiking 1000 Miles Weigh
7603 -
760401 - ..
760402 - LDL-C 83 LDL-P 851 HDL 67 Hike 1000 Miles Weight Maintain 170
760403 -
760404 - Follow up ref SDS 57 IM9N, ref SDS 55 IM9N.
760405 -
760406 - Poor VA lab results today align with decline Labcorp blood test using
760407 - NMR technology reported last week on 140508 1133. ref SDS 55 5C7M
760408 - This reflects increased hiking and weight control past 3.5 months,
760409 - reported in case study on 120101 0900, ref SDS 17 PYXR, and supported
760410 - with low carb diet (including orange juice) and low dose medication,
760411 - reported on 140513, in the same study. ref SDS 17 ZU5G
760413 - ..
760414 - Prior LIPID PANEL 120509 1108. ref SDS 22 IM9N
760415 - Prior LIPID PANEL 120831 1525. ref SDS 23 IM9N
760416 - Prior LIPID PANEL 130228 1140. ref SDS 32 IM9N
760417 - Prior LIPID PANEL 130529 0818. ref SDS 34 IM9N
760418 - Prior LIPID PANEL 131015 0724, ref SDS 36 IM9N
760419 - Prior LIPID PANEL Labcorp, 140201 1159, ref SDS 47 IM9N
760420 - Prior LIPID PANEL, 140203 1147, ref SDS 48 IM9N
760421 - Prior CHEM PROFILE Labcorp on 140508 1149. ref SDS 55 IM9N
760422 - Prior LIPID PANEL, 140814 1530, ref SDS 0 IM9N
760424 - ..
760425 - LIPID PANEL
760427 - ..
760428 - Dates..........2014 08 14 1528 140514 140508 140203 140201 131015 130529
760429 - VA VA Labcorp VA Labcorp VA VA VA Labcorp
760430 - NMR LipoProfile Results Results Results Results Results Results Results Units Range Range
760431 - LDL Particle Number
760432 - LDL-P 851.0 861.0 nmol/L < 1000
760433 - Low < 1000
760434 - Moderate 1000 - 1299
760435 - Borderline High 1300 - 1599
760436 - High 1600 - 2000
760437 - Very High > 2000
760439 - ..
760440 - Lipids
760441 - CHOL (a) 161 164 162 160 156 321 H 307 mg/dL 100 - 240 < 200
760442 - (b) 169
760443 - TRIGLYC (a) 72 58 59 47 68 109 85 mg/dL 10 - 190 < 150
760444 - (b) 59
760445 - HDL-C (a) 55 66 67 58 61 50 50 mg/dL Ref: >=35 >= 40
760446 - (b) 67
760447 - LDL-C (a) 92 87 83 93 81 249 H 240 mg/dL Ref: <=131 < 160
760448 - (b) 90
760449 - ** LDL Dir 93 mg/dL 0 - 130
760450 - TRIG NF mg/dL Ref: <=150
760452 - ..
760453 - TG/HDL ratio (a).... 1.31 0.88 0.88 0.81 1.11 < 2.0
760454 - (b).... 0.88
760456 - ..
760457 - Comments
760458 -
760459 - a. Reporting Lab
760460 - Martinez CBOC
760461 - 150 Muir Road
760462 - Martinez, CA 94553 4668
760464 - ..
760465 - b. VA Intretation Risk Factors
760466 -
760467 - Risk Catagory LDL Goal
760468 - CHD and CHD risk equivalents <100 mg/dL
760469 - Multiple (2+) risk factors <130 mg/dL
760470 - 0-1 risk factor <160 mg/dL
760472 - ..
760473 - c. HDL Chol.
760474 -
760475 - Greater than/equal to 60 mg/dL counts as a "negative"
760476 - risk factor; its presence removes 1 risk factor from
760477 - the total count.
760479 - ..
760480 - d. Cholesterol and LDL standards source....
760481 -
760482 - Adult Treatment Panel III (ATP III) JAMA 5/16/ Vol.
760483 - 285 $19.
760485 - ..
760486 - Analysis....
760487 -
760488 - 1. LDL-P 851, ref SDS 55 U45J, represents lower CVD risk and
760489 - improving lipid management. LDL-C 83 increased 2 points from
760490 - prior lab on 140201. It remains low concordant with LDL-P, but
760491 - moving toward discordance. Research indicates healthiest
760492 - cardiovascular condition occurs with lowest risk for CVD, when
760493 - lipids are discordant, with LDL-P low and LDL-C high, shown in
760494 - the record on 131125 0005. ref SDS 42 FI3G
760496 - ..
760497 - VA published goal LDL-C <= 131; Labcorp published goal LCL-C <
760498 - 100. ref SDS 57 5C7M New AHA guidelines show LDL-C < 190,
760499 - reported on 131112 1422. ref SDS 40 HT87
760501 - ..
760502 - VA lowering goal to HDL > 35 from > 40 seems conflicting with
760503 - patient history of CABG +4 on 091022 0700. ref SDS 4 PQWU
760504 - Since HDL 30 was found at that time (see Lipid history below,
760505 - ref SDS 57 W25L, setting the bar at HDL 35 has little tolerance
760506 - for genetic variation to avoid and repair endothelium lesions
760507 - causing atheriosclerotic plaque.
760509 - ..
760510 - NMR test lists LDL-P < 1600 for "borderline" CVD high risk, and
760511 - that below 1000, is "low," risk for CVD. ref SDS 48 U45J Thus,
760512 - LDL-P 851 presents low risk for CVD. Research on 131125, lists
760513 - LDL-P < 700 may be a better target to manage CVD risk.
760514 - ref SDS 42 WY9H The same research also cites LDL-P < 1000 for
760515 - evaluating CVD risk, similar to NMR test today. ref SDS 42 OQ9N
760517 - ..
760518 - When can patients be confident LDL-P < 700, 600, 200 - is low
760519 - enough to work on other aspects of daily life?
760521 - ..
760522 - 2. LDL-P 851 in Labcorp test today on 140508, correlates with
760523 - TG/HDL ratio 59/67 = 0.88. ref SDS 55 5C7M Research indicates
760524 - TG/HDL ratio correlates to LDL-P vaulations produced by NMR
760525 - testing, reported on 131125 0005. ref SDS 42 666G
760527 - ..
760528 - 3. Resting heart rate getting up in the morings has fallen below
760529 - 50. Blood pressure varies - averages about 115 65. After
760530 - hikes about 105 55. Systalic on occassion falls below 100.
760531 - Dystalic has fallen below 50 - e.g., see Monday 140428 reported
760532 - in case study on 120101 0900. ref SDS 17 CB6N
760534 - ..
760535 - 4. LDL-P 851 and HDL 67 and Triglycerides 59 on 140508, indicate
760536 - low risk for CVD, per above analysis, ref SDS 55 RV5M, and may
760537 - align with hiking 22 miles yesterday on 140507, and 11 miles
760538 - this morning at 0400 (see again case study - ref SDS 17 4G5I),
760539 - before doing the blood draw later this morning at 1149.
760540 - ref SDS 55 U45J
760542 - ..
760543 - 5. Lipid favorable results in NMR test on 140508, and follow up
760544 - test at VA on 140514, particularly increase HDL
760545 - occurred concurrent with...
760546 -
760547 - [On 140520 0732 letter notifies Doctor Alba at VA
760548 - getting good labs through prescribed care integrating
760549 - diet, exercise, and medications. ref SDS 59 4U46
760551 - ..
760552 - a. Hiking 955 miles since prior lab on 140203, reported in
760553 - case study 120101 0900, ref SDS 17 P36G, and recommended in
760554 - research on 131125 0005. ref SDS 42 QP9F including regular
760555 - aerobic exercise to lower triglycerides, ref SDS 42 U44L,
760556 - and raise HDL, ref SDS 42 SH50, and raise EPC production
760557 - toward regression of atherosclerosis plaque. ref SDS 42
760558 - 6O9M
760559 -
760560 - [On 140529 0942 letter asks VA to present record of care
760561 - that includes extended training exercise that yielded
760562 - significantly improved lipid labs. ref SDS 62 QF67
760564 - ..
760565 - b. Weight - hit 163 yesterday on 140513, shown in case study
760566 - on 120101 0900. ref SDS 17 ZU5G This is lowest is about 30
760567 - years. On 140420 was able to hold 165 for 3 days.
760568 - ref SDS 17 TO6O This is continuing challenge bouncing
760569 - around from over 200 in 2011, but varied significantly.
760570 - Daily weight remains generally between 170 - 175.
760572 - ..
760573 - c. Low-carbohydrate diet lowers triglycerides (TG 59 in
760574 - Labcorp and VA tests, per above, ref SDS 57 5C7M), which
760575 - together with higher HDL 67 (TG/HDL ratio .88 < 2,
760576 - ref SDS 57 5X5G, combine to lower LDL-P, cited in research
760577 - on 131125 0005. ref SDS 42 QP9F
760579 - ..
760580 - d. Chia seeds added to diet on 131125, reported in case study
760581 - on 120101 0900, ref SDS 17 746M, and recommended by Karen
760582 - at VA on 131121 0930. ref SDS 41 NQ37
760584 - ..
760585 - e. Orange juice 1 gallon (3786 ML) per week (541 ML/day) added
760586 - to diet on 131125, based on study indicating HDL increased
760587 - 21% over 4 weeks with 750 ml per day (i.e., 1.4 gal per
760588 - week), ref SDS 42 R48K, as reported to VA in letter on
760589 - 140114 0845. ref SDS 44 218O Some research also indicates
760590 - grape juice increases HDL; however, no studies have
760591 - quantified this effect. Patient consumes combination of
760592 - lemon juice, orange juice, and grape juice in large
760593 - quantities to hydrate after hiking 11 miles per day.
760595 - ..
760596 - HDL 50 increased to HDL 67 = 34% over 6 months from Dec
760597 - 2013 - May 2014, shown in patient history below.
760598 - ref SDS 57 W25L This is approximately 7% for each 4 week
760599 - period, which may reflect taking 541 ML of orange juice
760600 - rather than 750 ML per day. Raising HDL consistently 7%
760601 - over 4 weeks for 6 months taking only 541 ML in this case,
760602 - presents improved results compared to study results finding
760603 - 500 ML of orange juice for 4 weeks had no effect on HDL
760604 - levels. Improved results in this case may indicate that
760605 - orange juice at 540 ML/day combined with hiking 11 miles
760606 - per day, explained above (see para a), ref SDS 57 I17G,
760607 - provides a direct path to improve lipid profiles toward
760608 - avoiding and regressing atherosclerosis plaque.
760610 - ..
760611 - f. Atorvastatin 10 mg with Ezetimibe 10 begun on 131230,
760612 - reported in case study on 120101. ref SDS 17 6A6H
760614 - ..
760615 - Research studies report Atorvastatin 10 mg + Ezetimibe 10
760616 - mg achieves LDL < 70, and favorably changes triglycerides
760617 - and HDL by 5%, reported on 131125 0005. ref SDS 42 CO45
760618 - While low LDL < 70 conflicts with goal of "discordance"
760619 - that lowers health risk for arterialsclorosis and CVD when
760620 - LDL-P low and LDL-C high, shown in research on 131125 0005,
760621 - ref SDS 42 FI3G, even "concordant" results today are good
760622 - news.
760624 - ..
760625 - Since prior lab on 140201, until lab at VA today on 140508,
760626 - case study shows on 120101, ref SDS 17 E47L, patient has
760627 - taken...
760628 -
760629 - 1. Atorvastatin............... 900 mg
760630 - 2. Ezetimibe.................. 900 mg
760631 -
760633 - ..
760634 - Lipid History Trend Analysis
760635 -
760636 - Follow up ref SDS 57 W25L, ref SDS 55 W25L.
760637 -
760638 - Small LDL LP-IR
760639 - Collection DT CHOL TRIGL HDL LDL-C LDL-P HDL-P LDL-P SIZE SCORE LDL-D
760640 - 08/14/2014 15:28 161 72 55 92 ......................................... ref SDS 0 BE6O
760641 - 05/14/2014 10:16 164 58 66 87 .................................... 93.. ref SDS 57 BE6O
760642 - 05/08/2014 11:49 162 59 67 83 851 38.1 < 90 21.2 < 25 ..... ref SDS 55 BE6O
760643 - 02/03/2014 12:28 160 H 47 58 93 ......................................... ref SDS 48 BE6O
760644 - 02/01/2014 12:31 156 68 61 81 861 31.4 < 90 21.3 < 25 ..... ref SDS 47 BE6O
760645 - 10/15/2013 08:25 321 H 109 50 249 H ......................................... ref SDS 36 BE6O
760646 - 05/29/2013 08:18 307 H 85 50 240 H ......................................... ref SDS 32 BE6O
760647 - 02/28/2013 08:39 310 H 73 47 248 H ......................................... ref SDS 32 BE6O
760648 - 11/30/2012 10:01 173 53 57 105 ......................................... ref SDS 27 BE6O
760649 - 08/31/2012 15:25 176 94 47 110 ......................................... ref SDS 23 U89N
760650 - 05/09/2012 11:24 158 76 49 94 ......................................... ref SDS 22 U89N
760651 - 02/09/2012 11:18 285 82 41 228 H ......................................... ref SDS 18 2A4G
760652 - 11/17/2011 14:27 260 84 43 200 H ......................................... ref SDS 16 2A4G
760653 - 07/27/2011 12:58 163 81 45 102 ......................................... ref SDS 12 E19L
760654 - 12/07/2010 09:17 151 41 47 96 ......................................... ref SDS 11 E19L
760655 - 07/21/2010 08:54 261 H 87 35 L 209 H ......................................... ref SDS 7 E19L
760656 - 06/10/2010 10:33 217 H 83 36 L 164 H ......................................... ref SDS 6 QV4F
760657 - * 12/14/2009 11:10 241 H 136 44 170 H ......................................... 100928 0706, ref SDS 8 VW6J
760658 - 08/13/2009 15:09 233 H 118 30 L 179 H ......................................... 100610 1046, ref SDS 6 U45G
760659 - 06/16/2006 10:59 238 H 68 32 L 192 H ......................................... 091002 0900, ref SDS 3 LJ5H
760660 -
760661 - * Lab at VA San Francisco Medical Center reported on 100928 0706.
760662 - ref SDS 8 VW6J
760664 - ..
760665 - Research on cholesterol reported on 091002 0900. ref SDS 3 2F8K
760667 - ..
760668 - On 131125 0005 research found ezetimibe (zetia) mg added to
760669 - Atorvastatin 20 mg yielded after 6 weeks significantly greater changes
760670 - to lipids than taking Atorvastatin in higher doses, e.g., 20 or 40 mg.
760671 - ref SDS 42 CO56
760673 - ..
760674 - On 131125 0005 research found discordance LDL-P low and LDL-C high
760675 - lipid panel HDL 65 TG 77 healthy patient profile with LDL 246.
760676 - ref SDS 42 MN98 Discordance with LDL-P low and LDL-C high is lowest
760677 - risk for CVD, arterialsclorosis. ref SDS 42 FI3G
760678 -
760679 -
760681 - ..
760682 - Coronary CTA or IVUS Test Athereosclerosis Plaque 4 Years After CABG
760683 - Athereosclerosis Plaque 4 Years After CABG Coronary CTA or IVUS Test
760684 -
760685 - Follow up ref SDS 57 QA4M.
760686 -
760687 - On 131125 0005 research further found radiology imaging tests can
760688 - evaluate level of plaque build up resulting from elevated cholesterol.
760689 - ref SDS 42 N73K Radiology imaging technologies are Coronary CT
760690 - angiography - CTA - and Intravascular ultrasound - IVUS. ref SDS 42
760691 - KZ8O
760693 - ..
760694 - Lipid history and particularly the past 6 months with HDL > 60 and
760695 - Triglycerides < 100, ref SDS 55 W25L, indicates patient may have change
760696 - body chemestry sufficient to cause rapid regression of atherosclerosis
760697 - plaque, cited in research on 131125 0005. ref SDS 42 RA7K Research
760698 - indicates that favorable lipid profile, weight loss, and production of
760699 - EPC in the bone marrow, all stimulated by exercise, drives regression
760700 - of plaque. ref SDS 42 XY7L
760702 - ..
760703 - The next step monitoring results of medical, diet, and exercise
760704 - interventions the past 4 years, since CABG +4 on 091022 0700,
760705 - ref SDS 4 PQWU, is to perform radiology imaging study with coronary CT
760706 - angiography or IVUS to assess regression of atherosclerosis plaque,
760707 - which previously required major surgery to fix.
760709 - ..
760710 - This step is supported by patient history using CT radiology imaging
760711 - to assess regression of esophageal bubble after 4 years of medical
760712 - interventions, reported favorable by Doctor Stewart, Chief General
760713 - Surgery at VA on 130122 1330. ref SDS 30 03H6
760714 -
760715 -
760716 -
760717 -
760718 -
760719 -
7608 -
SUBJECTS
VA Lab Cardiac Enzymnes Creatine Kinase CK also CPK Creatine Phospho
8403 -
840401 - ..
840402 - Myopathy Muscle Pain Side Effects Simvistatin Decline
840403 -
840404 - Follow up ref SDS 57 D26G, ref SDS 55 D26G.
840405 -
840406 - Prior Cardiac Enzymes Profile on 120209 1118. ref SDS 18 D26G
840407 - Prior Cardiac Enzymes Profile on 120509 1108. ref SDS 22 D26G
840408 - Prior Cardiac Enzymes, 131015 0724, ref SDS 36 D26G
840409 - Prior Cardiac Enzymes Profile VA on 140203 1147. ref SDS 48 NX6G
840411 - ..
840412 - This test not performed by Labcorp with blood draw on 140508...
840413 -
840414 - CARDIAC ENZYMES
840415 -
840416 - Dates 2014 05 14 1016 140508 140203 131015 120509
840417 - VA Labcorp VA VA VA
840418 - PLASMA Results Results Results Results Results Units Range
840419 - CPK (CK) 192 149 110 152 U/L 30 - 235
840420 - TRPONIN ng/ml 0 - 0.07
840421 - CK-MB ng/ml 0.6 - 3.5
840422 - MYOGLOB ng/ml 20 - 82
840424 - ..
840425 - a. CPK/CK test not performed by Labcorp
840427 - ..
840428 - b. SLIGHTLY ICTERIC SPECIMEN /HN
840430 - ..
840431 - c. Ordering Provider: Diana Alba
840432 - Report Released..: May 14, 2014@11:29
840433 - Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]
840434 - 4150 CLEMENT STREET
840435 - SAN FRANCISCO, CA 94121-1545
840436 - Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]
840438 - ..
840439 - CKP and CK are the same thing - creatine phosphokinase (CPK) also
840440 - called creatine kinase (CK).
840441 -
840442 - http://www.scai.org/SecondsCount/Resources/Detail.aspx?cid=ed385473-d4e8-491e-9ce0-a7c984fe6f8e#.U3b_BfldWi8
840444 - ..
840445 - Research on 111013 explains Creatine Kinase CK, relates to muscle
840446 - disorders caused by cholesterol medications with statins. 111013 1404,
840447 - ref SDS 15 J54K
840449 - ..
840450 - CK lab may align with reduced side effects of muscle pain in left
840451 - shoulder.
840452 -
840453 -
840454 -
840455 -
840456 -
840457 -
8405 -
SUBJECTS
HGBA1C 5.4 Range 4.0-6.0 Diabetes Negative Laboratory Blood Test Cro
A103 -
A10401 - ..
A10402 - HGBA1c Diabetes Blood Test A1c
A10403 - A1c Diabetes Blood Test HGBA1c
A10404 - Diabetes HGBA1c A1c Blood Test
A10405 -
A10406 - Follow up ref SDS 57 9F4O, ref SDS 55 9F4O.
A10407 -
A10408 - Prior HGBA1c Profile on 100721 0800. ref SDS 7 IL4N
A10409 - Prior HGBA1c Profile on 101207 0906. ref SDS 11 IL4N
A10410 - Prior HGBA1c Profile on 131015 0724. ref SDS 36 9F4O
A10411 - Prior HGBA1c Profile on 140203 1147. ref SDS 48 9F4O
A10413 - ..
A10414 - This test not performed by Labcorp with blood draw on 140508...
A10416 - ..
A10417 - Endocrine IV - HGBA1c - A1c
A10418 -
A10419 - Dates..........2014 05 14 1016 140508 140203 131015 101207
A10420 - Dates..........2014 08 14 1528 140514 140508 140203 131015 101207
A10421 - VA VA Labcorp VA VA VA
A10422 - BLOOD Results Results Results Results Results Results Units Range
A10423 - HGBA1c 5.6 5.4 5.5 5.5 5.7 % 4.0 - 6.0
A10424 - eAG 114 111 111 mg/dL 74.0 - 118
A10426 - ..
A10427 - Comments:
A10428 -
A10429 - a. Labcorp did not perform HGBA1c lab
A10430 -
A10431 - b. Ordering Provider: Diana Alba
A10432 - Report Released..: May 14, 2014@11:29
A10433 - Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]
A10434 - 4150 CLEMENT STREET
A10435 - SAN FRANCISCO, CA 94121-1545
A10436 - Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]
A10438 - ..
A10439 - This test for diabetes was ordered by Doctor Abrams during a meeting
A10440 - at the San Francisco VA Medical Center on 130227 0930. ref SDS 31 8T5L
A10441 - However, it is not reported for the lab performed the next day on
A10442 - 130228 1140, ref SDS 32 RP4N, nor in the follow up lab 3 months later
A10443 - on 130529 0818. ref SDS 34 RP4N
A10445 - ..
A10446 - HGBA1c was performed previously on 101207 0906, ref SDS 11 IL4N, and 5
A10447 - months earlier on 100721 0800. ref SDS 7 IL4N
A10449 - ..
A10450 - Labcorp test showing LP-IR Score < 25.0, indicating very low risk of
A10451 - diabetes, reported on 140508. ref SDS 55 TU6L
A10453 - ..
A10454 - Glucose 97 near upper range 79 99, Labcorp electrolyte panel last week
A10455 - on 140508, per above, ref SDS 57 ZG5O, indicates potential diabetes
A10456 - risk, but may be elevated by dehydration from statin medication and
A10457 - hiking 22 miles the day before the lab and 11 miles the morning before
A10458 - getting the blood draw, reported on 140508 1133. ref SDS 55 QW6K
A10459 -
A10460 -
A10461 -
A10462 -
A10463 -
A10464 -
A10465 -
A105 -