CONTACTS
SUBJECTS
CBC Lab WBC 12.8 Elevated Blister Big Toe Left Foot VA for Meeting D
2903 -
2903 - ..
2904 - Summary/Objective
2905 -
290501 - Follow up ref SDS 74 0000. ref SDS 73 0000.
290502 -
290503 -
290504 -
290506 - ..
2906 -
2907 -
2908 - Background
2909 -
290901 - On 131016 1632 submit letter for agenda meeting to review lab results
290902 - scheduled 131017 1000. ref SDS 41 X45G
290904 - ..
290905 - On 140131 0815 ordered another lab - cbc, electrolytes, lipid with NMR
290906 - - from Labcor to get LDL-P. ref SDS 50 X45G
290908 - ..
290909 - On 140201 1159 had full lab with NMR lipid panel drawn at John Muir
290910 - Hospital on Treat, and by Labcorp. ref SDS 51 RP4N
290912 - ..
290913 - On 140203 1147 had partial lab drawn at VA in Martinez. ref SDS 52
290914 - KK9M
290916 - ..
290917 - On 140507 0857 ordered another full lab from Labcorp with NMR lipid
290918 - panel. ref SDS 58 OO5G
290920 - ..
290921 - On 140508 1133 lab blood daw at Labcorp with John Muir Medical Center
290922 - on Treat Blvd in Concord. ref SDS 59 445G
290924 - ..
290925 - On 140514 0950 VA partial lab at Medical Center in San Francisco.
290926 - ref SDS 62 X45G
290928 - ..
290929 - On 140814 1530 VA full lab at Clinic in Martinez. ref SDS 68 X45G
290931 - ..
290932 - On 140827 1422 VA partial lab CBC only at Clinic in Martinez re-check
290933 - elevated WBC. ref SDS 72 X45G
290935 - ..
290936 - On 141020 1025 Labcorp partial lab CBC Electrolytes Urinalysis, but
290937 - mistakenly omitted NMP lipid panel. ref SDS 73 X45G
290939 - ..
290940 - On 141021 1009 Labcorp NMR Lipid panel, ref SDS 0 U45J, and
290941 - Homocyst(e)ine. ref SDS 0 CM6J
290942 -
290943 -
290944 -
290946 - ..
2910 -
2911 -
2912 - Progress
2913 -
291301 - Drove to San Francisco and had blood draw at VA Medical Center
291302 - primarily for lipid panel to review with Doctor Rao in the meeting
291303 - scheduled on Friday, 141024 0800.
291305 - ..
291306 - See directory structure for medical records on 140320 1125.
291307 - ref SDS 56 4M5I
291308 -
291309 -
291311 - ..
291312 - CBC WBC 9.5 Increased 50% After Several Years Stable
291313 - Blood Tests Evaluate Health 5 Years After CABG x4 Surgery
291314 -
291315 - Follow up ref SDS 74 RP4N, ref SDS 73 RP4N.
291316 -
291317 - Prior VA CBC on 120509 1108. ref SDS 26 RP4N
291318 - Prior VA CBC on 120831 1524. ref SDS 27 RP4N
291319 - Prior VA CBC on 121130 1001. ref SDS 31 RP4N
291320 - Prior VA CBC on 130529 0818. ref SDS 38 RP4N
291321 - Prior Labcorp CBC on 140201 1159. ref SDS 51 RP4N
291322 - VA did not order CBC for lab on 140203 1147. ref SDS 52 YX8K
291323 - Prior Labcorp CBC on 140508 1149. ref SDS 59 RP4N
291324 - VA did not order CBC for lab on 140514 0950. ref SDS 62 RP4N
291325 - Prior VA CBC on 140814 1530. ref SDS 68 RP4N
291326 - Prior VA CBC on 140827 1413. ref SDS 72 RP4N
291327 - Prior Labcorp CBC on 141020 1025. ref SDS 73 RP4N
291329 - ..
291330 - VA did not order CBC; here are results from Labcorp blood draw
291331 - yesterday on 141020, and previously at VA in Martinez on 140827, done
291332 - to follow up elevated WBC in VA lab on 140814...
291333 -
291335 - ..
291336 - CBC PANEL
291337 - ..
291338 - Dates......... 2014 10 20 1050 140827 140814 140514 140508 140203 140201 130529
291339 - Labcorp VA VA VA Labcorp VA Labcorp VA VA Labcorp
291340 - Blood Results Results Results Results Results Results Results Results Units Range Range
291341 - WBC 13.3 H 13.8 H 12.8 H 9.5 6.2 7.4 K/cmm 4.8 - 10.8 3.4 - 10.8
291342 - RBC 5.64 5.56 5.44 5.21 5.13 5.09 M/cmm 4.7 - 6.1 4.14 - 5.80
291343 - HGB 16.5 16.4 16.2 15.1 15.2 15.0 g/dL 14 - 18 12.6 - 17.7
291344 - HCT 50.1 48.8 48.3 47.0 44.2 46.2 % 42 - 52 37.5 - 51.0
291345 - MCV 89.0 87.8 88.7 90.0 86.0 90.7 fL 80 - 99 79.0 - 97.0
291346 - MCH 29.3 29.5 29.8 29.0 29.6 29.5 uug 27 - 34 26.6 - 33.0
291347 - MCHC 32.9 33.6 33.6 32.1 34.4 32.5 gm/dL 32 - 35.2 31.5 - 35.7
291348 - RDW 14.3 13.9 13.9 13.8 13.7 14.4 % 11.5 - 14.5 12.3 - 15.4
291349 - PLT 341.0 322.0 295.0 329 303 279 K/cmm 130 - 400 155.0 - 379.0
291350 - MPV 9.1 8.3 8.8 fL 7 - 10.4
291351 - NEUT % 80.0 74.2 78.1 70 69 69.9 % 40 - 80 40.0 - 74.0
291352 - LYMPH % 13.0 14.9 L 13.6 L 20 21 L 19.7 % 20 - 51 14.0 - 46.0
291353 - MONO % 7.0 9.8 7.6 8 8 7.8 % 2 - 13 4.0 - 12.0
291354 - EOS % 0.0 0.3 L 0.4 L 1 1 1.9 % .5 - 7 0.0 - 5.0
291355 - BASO % 0.9 0.8 0.3 1 1 0.7 % 0 - 2 0.0 - 3.0
291356 - NEUT # 10.5 H 10.3 H 10.0 H 6.7 4.3 5.2 K/cmm 1.5 - 7.9 1.4 - 7.0
291357 - LYMPH # 1.7 2.1 1.7 1.9 1.3 1.5 K/cmm 1.2 - 3.4 0.7 - 3.1
291358 - MONO # 0.9 1.3 H 1.0 0.7 0.5 0.6 K/cmm .2 - 1.2 0.1 - 0.9
291359 - EOS # 0.0 0.9 L 0.1 0.1 0.1 0.1 K/cmm .1 - .5 0.0 - 0.4
291360 - BASO # 0.0 0.1 0.0 0.1 0.1 0.1 K/cmm 0 - .2 0.0 - 0.2
291361 - ESRmVES mm/hr 0 - 10
291362 - ESRxCYT mm/hr 2 - 10
291363 - RETIC % % .66 - 2.85
291364 - RETIC # k/uL 27.9 - 121.6
291365 - Immature Granulocytes 0.0 0.0 0.0 % 0.0 - 2.0
291366 - Immature Grans (Abs) 0.0 0.0 0.0 % 0.0 - 0.1
291368 - ..
291369 - Comments:
291370 -
291371 - a. Test Performed at...
291372 - Health Testing Centers
291373 - 2760 W. OAKLAND PARK BLVD.
291374 - FORT LAUDERDALE FL 33311
291375 -
291377 - ..
291378 - Background Elevated WBC
291379 -
291380 - Follow up ref SDS 74 EC5L, ref SDS 73 EC5L.
291381 -
291382 - Increased exercise explained on 140814 1530, ref SDS 68 I17G, may have
291383 - stimulated bone marrow to produce more new blood that increased WBC
291384 - 30% in VA blood test on 140814, per above, ref SDS 68 FK6I, explained
291385 - by Doctor Johnson during a meeting at Kaiser on 030606. ref SDS 1 JP7G
291386 - However, this effect was significantly less, WBC 9.5, in prior lab on
291387 - 140508, and at that time exercise was more than twice the level of
291388 - effort that occurred during the several months prior to the lab on
291389 - 140814.
291391 - ..
291392 - Recent infection on left big toe may have elevated WBC 12.8 in VA lab
291393 - on 140814 1530. ref SDS 68 PS6G This was noted in letter to Primary
291394 - Care later today on 140814 2227, ref SDS 69 K055, citing possible side
291395 - effect from treatment for regression of atherosclerosis.
291397 - ..
291398 - On 140819 0800 Doctor Sandhu in Primary Care examined blister on big
291399 - toe left foot, and determined healing was occurring; no treatment was
291400 - prescribed. Ordered follow up CBC lab to re-check WBC for indication
291401 - of continued infection. ref SDS 71 318I
291403 - ..
291404 - On 140826 follow lab for CBC shows WBC 13.8 went up instead of going
291405 - down, ref SDS 72 FK6I, as expected. This might indicate continued
291406 - mild infection of toe blister, and compounded with acalasia symptoms
291407 - of swallowing difficulties, shown in the record of vomitting the past
291408 - few months possibly due to omitting injections of triamcinolone
291409 - steriods during EGD dilation reported on 140509 0900. ref SDS 60 O36G
291411 - ..
291412 - Prior to Heller Myotomy surgery to recover from achalasia on 091216
291413 - 0600, ref SDS 8 KE9U, WBC was elevated for several years. On 050816,
291414 - Doctor Sandhu reported WBC elevated and ordered retest. ref SDS 2 G540
291415 - CBC retest was ordered and WBC remained high on 050818, so the doctor
291416 - prescribed antibiotics. ref SDS 3 BM8O Initial diagnosis of achalasia
291417 - cited persistent elevated WBC part of patient profile, reported on
291418 - 051202 1430. ref SDS 4 H26M
291420 - ..
291421 - Work plan - perform EGD dilation scheduled at VA in Sacramento on
291422 - 140907 0800 with Doctor Lee, and evaluate if resolution of swallowing
291423 - problems resolves elevated WBC.
291424 -
291425 -
291426 -
291427 -
291428 -
291429 -
291430 -
2915 -
SUBJECTS
Urinalysis Lab VA No Results
4403 -
440401 - ..
440402 - Urinalysis Ketones Trace Abnormal Sp Gravity Above Range
440403 -
440404 - Follow up ref SDS 74 0X72, ref SDS 73 0X72.
440405 -
440406 - Prior Urinalysis test on 101207 0906. ref SDS 15 0X72
440407 - Prior Urinalysis test on 120509 1108. ref SDS 26 0X72
440408 - Prior Urinalysis test on 140201 1159. ref SDS 51 0X72
440409 - VA did not order urinalysis for lab on 140203 1147. ref SDS 52 0X72
440410 - Prior Urinalysis Labcorp test on 140508 1149. ref SDS 59 0X72
440411 - Prior Urinalysis test on 140814 1530. ref SDS 68 0X72
440412 - Prior Urinalysis Labcorp test on 141020 1025. ref SDS 73 0X72
440414 - ..
440415 - VA did not order urinalysis; here are results from Labcorp blood draw
440416 - yesterday on 141020, and previously at VA in Martinez on 140814...
440417 -
440418 -
440420 - ..
440421 - URINALYSIS PANEL
440422 - ..
440423 - Dates.......... 2014 10 20 1050 140814 140514 140203 140201 120509
440424 - Labcorp VA VA Labcorp VA Labcorp VA VA Labcorp
440425 - Results Results Results Results Results Results Results Units Range Range
440426 - PH 6.0 6.0 5.5 5.5 6.0 5 - 9 5.0 - 7.5
440427 - PROTEIN Trace NEG NEG NEG NEG mg/dL NEG - TRACE NEG - TRACE
440428 - GLUCOSE NEG NEG NEG NEG NEG mg/dL Ref: NEG NEG
440429 - KETONES Trace Abnormal 15 Trace Abnormal NEG NEG mg/dL Ref: NEG NEG
440430 - BILI NEG NEG NEG NEG NEG Ref: NEG NEG
440431 - BILIcnf Ref: NEG
440432 - BLOOD TRACE TRACE TRACE TRACE Ref: NEG
440433 - NITRITE, URINE NEG NEG NEG NEG NEG Ref: NEG NEG
440434 - UROBILI 0.2 0.2 0.2 0.2 0.2 EU/dL .2 - 1 0.0 - 1.9
440435 - LEU EST NEG NEG Ref: NEG
440436 - SP.GRAV 1.030 >=1.030 H 1.036 1.026 1.025 1.003- 1.035 1.005 - 1.030
440437 - COLOR YELLOW YELLOW YELLOW YELLOW YELLOW
440438 - APPEAR CLEAR CLEAR CLEAR CLEAR CLEAR
440439 - WBC ESTERASE NEG NEG NEG
440440 - OCCULT BLOOD NEG NEG NEG NEG
440441 - HAYALINE CASTS NORM(0-1) per lpf 0 - 1
440442 - GRANULAR CASTS None per lpf Ref: None
440443 - CELLULAR CASTS None per lpf Ref: None
440444 - RBC/HPF NORM(0-3) per lpf 0 - 3
440445 - BACTERIA NORM(0-1) per lpf 0 - 1
440446 - EPITHELIAL CELLS NORM(0-1) per lpf 0 - 1
440447 - RENAL EPITHELIAL CELLS None per lpf Ref: None
440448 - CALCIUM OXILATE CRYST NORM(0-1) per lpf 0 - 1
440449 - URIC ACID CRYSTALS NORM(0-1) per lpf 0 - 1
440450 - TRIPLE PHOSPHATE CRYST NORM(0-1) per lpf 0 - 1
440451 - AMORPHOUS SEDIMENT None per lpf Ref: None
440452 - MUCOUS None per lpf Ref: None
440453 - TRICHOMONAS None per lpf Ref: None
440454 - YEAST None per lpf Ref: None
440455 - CULTURE REFLEXED No
440456 - TR EPTH None per lpf Ref: None
440457 - Urobilinogen, Semi-On 0.2
440458 - NITRITE, URINE NEG
440459 -
440461 - ..
440462 - Comments:
440463 -
440464 - a. Test Performed at...
440465 - Health Testing Centers
440466 - 2760 W. OAKLAND PARK BLVD.
440467 - FORT LAUDERDALE FL 33311
440469 - ..
440470 - Ketones trace abnormal continues recent labs Ketones 15 review by VA,
440471 - follow up prior lab showning Ketones trace abnormal, reported on
440472 - 140514 0950. ref SDS 62 MT4L
440473 -
440474 -
440475 -
440476 -
440477 -
440478 -
440479 -
440480 -
4405 -
SUBJECTS
Lab Electrolytes Chem Profile Glucose 97 Sodium NA 144 Potasium K 5.
6103 -
610401 - ..
610402 - T Bili 2.2 Hyperbilirubinemia Worse Atorvastatin Ezetimibe
610403 - Potasium K 5.6 Elevated Increased Electrical Problems Heart
610404 - Bun/Creatinine Ratio Elevated Slightly
610405 -
610406 - Follow up ref SDS 74 KK9M, ref SDS 73 KK9M.
610407 -
610408 - Prior CHEM PROFILE on 120509 1108. ref SDS 26 KK9M
610409 - Prior CHEM PROFILE on 120831 1524. ref SDS 27 KK9M
610410 - Prior CHEM PROFILE on 130228 1140. ref SDS 36 KK9M
610411 - Prior CHEM PROFILE on 130529 0818. ref SDS 38 KK9M
610412 - Prior CHEM PROFILE on 131015 0724. ref SDS 40 KK9M
610413 - Prior CHEM PROFILE Labcorp on 140201 1159. ref SDS 51 KK9M
610414 - Prior CHEM PROFILE on 140203 1147. ref SDS 52 KK9M
610415 - Prior CHEM PROFILE Labcorp on 140508 1149. ref SDS 59 KK9M
610416 - Prior CHEM PROFILE on 140520 0732. ref SDS 64 KK9M
610417 - Prior CHEM PROFILE on 140814 1530. ref SDS 68 KK9M
610418 - Prior CHEM PROFILE Labcorp on 141020 1025. ref SDS 73 KK9M
610419 - Prior CHEM PROFILE on 141021 11150 ref SDS 0 KK9M
610420 -
610422 - ..
610423 - ELECTROLYTES - CHEM PROFILE
610425 - ..
610426 - Dates..........2014 10 21 1148 10 20 1050 140814 140520 140514 140508 140203 140201 131015 130529
610427 - VA Labcorp VA VA VA Labcorp VA Labcorp VA VA VA Labcorp
610428 - PLASMA Reslults Results Results Results Results Results Results Results Results Results Units Range Range
610429 - GLUCOSE 110 H 105 98 98 97 103 98 108 H 120 mg/dL 74 - 118 65.0 - 99.0
610430 - GLUfast mg/dL Ref: <=99
610431 - NA (salt) 138 144 144 139 144 140 140 139 139 mmol/L 136 - 144 134.0 - 144.0
610432 - K (potasium) 4.4 4.3 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
610433 - CL 103 H 108 H 108 102 105 103 102 105 105 mmol/L 98 - 106 97.0 - 108.0
610434 - CO2 28 29 29 29.0 30.0 37.0 30.0 mmol/L 23 - 33
610435 - AGAP 7.0 8.0 mmol/L 5 - 20
610436 - BUN/Creati Ratio 22 H 28 19 H 23 17 20 24 18 mg/dL 8 - 26 10.0 - 22.0
610437 - CREAT 0.8 1.13 1.03 0.80 0.97 0.82 0.81 0.83 0.83 mg/dL .5 - 1.1 0.76 - 1.27
610438 - eGFR INA 91 66 >60 102 79 >60 91 >60 >60 mL/min Ref: >=60 >59
610439 - eGFR IA 76 92 106 mL/min >59
610440 - CALCIUM 8.8 9.9 9.1 8.9 9.5 9.3 9.4 9.2 9.2 mg/dL 8.7 - 10.2 8.6 - 10.2
610441 - CA CORR mg/dL 8.7 - 10.2
610442 - PO4 mg/dL 2.4 - 4.5
610443 - MG 85 mg/dL 1.8 - 2.5
610444 - ALK PHO 107 85 86 100 105 84 87 U/L 40 - 125 39.0 - 117.0
610445 - SGOT 27 U/L 5 - 35
610446 - SGPT 28 U/L 7 - 56
610448 - ..
610449 - T. BIL H 2.0 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
610450 - D. BILI 0.38 0.3 0.2 0.2 0.32 0.3 0.34 < 0.1 mg/dL .1 - .5 0.00 - 0.40
610451 - Bilirubin, Indir H 1.62 0.98 1.26 H mg/dL 0.10 - 0.80
610452 - AST (SGOT) 31 25 23 26 23 21 20 22 IntUnits/L 8 - 42 0.0 - 40.0
610453 - ALT (SGPT) 30 21 21 17 21 19 17 19 IntUnits/L 5 - 55 0.0 - 44.0
610454 - ALBUMIN 4.8 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
610455 - PROTEIN 6.9 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
610456 - Globulin, Total 2.1 2.0 2.1 g/dL 1.4 - 4.5
610457 - A/G Ratio 2.3 2.3 2.1 1.1 - 2.5
610458 - LDH 223 200.0 180.0 IntUnits/L 90 - 208 0.0 - 225.0
610459 - GGT 13 11.0 9.0 IU/L 0.0 - 65.0
610460 - Iron, Serum 146 100.0 114.0 ug/dL 40.0 - 155.0
610461 - AMYLASE Units/L 28 - 100
610462 - LIPASE Units/L 7 - 58
610463 - NH3 mcmol/L 15 - 56
610464 - URIC AC 6.9 5.6 mg/dL 4.8 - 8.7 3.7 - 8.6
610465 - ..
610466 - Cholesterol, Total 174 164.0 162.0 mg/dL 100.0 - 199.0
610467 - Triglycerides 79 55.0 64.0 mg/dL 0.0 - 149.0
610468 - HDL Cholesterol 61 > 39
610469 - LDL Cholesterol 96 0 - 99
610470 - T Chol/HDL ratio 2.8 0.0 - 5.0
610472 - ..
610473 - TG/HDL ratio 1.3
610475 - ..
610476 - Comments VA test 141021...
610477 -
610478 - a. Ordering Provider: Diana Alba
610479 - Report Released..: Oct 21, 2014@12:33
610480 - Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]
610481 - 4150 CLEMENT STREET
610482 - SAN FRANCISCO, CA 94121-1545
610483 - Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]
610484 -
610486 - ..
610487 - Comments Labcorp test 141020...
610488 -
610489 - a. Test Performed at...
610490 - Jenny Galloway, MD
610491 - LabCorp San Diego
610492 - 13112 Evening Creek Dr So Ste 200, San Diego, CA 92128-4108
610494 - ..
610495 - For inquiries, the physician may contact Branch:
610496 - 800-762-4344 Lab: 858-668-3700
610498 - ..
610499 - b. Please Note:
610500 -
610501 - T Chol/HDL Ratio Men Women
610502 -
610503 - 1/2 Avg Risk 3.4 3.3
610504 - Avg Risk 5.0 4.4
610505 - 2x Avg Risk 9.6 7.1
610506 - 3x Avg Risk 23.4 11.0
610508 - ..
610509 - Estimated CHD Risk <0.5 times avg 0.0 - 1.0
610510 -
610512 - ..
610513 - The CHD Risk is based on the T Chol/HDL ratio.
610514 - Other factors affect CHD Risk such as hypertension,
610515 - smoking, diabetes, severe obesity, and family history
610516 - of premature CHD.
610517 -
610519 - ..
610520 - Notes on Electrolytes Lab Hyperbilirubinemia Potassium Heart Problems
610521 - Hyperbilirubinemia Potassium Heart Problems Notes on Electrolytes Lab
610522 - Potassium Heart Problems Hyperbilirubinemia Notes on Electrolytes Lab
610523 -
610524 - Follow up ref SDS 74 G34G, ref SDS 73 G34G.
610525 -
610526 - 1. T Bilirubin 2.0................. ref SDS 73 015M
610528 - ..
610529 - VAMC San Francisco did not test Electrolytes on 141021. Labcorp
610530 - test the day before on 141020 provides continuity evaluating T
610531 - Bili...
610533 - ..
610534 - Collection DT T Bili Range Source
610535 - 20/10/2014 10:60 2.0 H...0.3 - 1.2.. ref SDS 73 015M
610536 - 14/08/2014 15:28 2.5 H...0.3 - 1.2.. ref SDS 68 WJ5H
610537 - 20/05/2014 10:20 1.2 ....0.3 - 1.2.. ref SDS 64 015M
610538 - 08/05/2014 11:49 1.3 H...0.0 - 1.2.. ref SDS 59 015M
610539 - 03/02/2014 09:52 2.1 H...0.3 - 1.2.. ref SDS 52 015M
610540 - 01/02/2014 12:28 1.6 H...0.0 - 1.2.. ref SDS 51 015M
610541 - 15/10/2013 08:25 1.7 H...0.3 - 1.2.. ref SDS 40 015M
610542 - 29/05/2013 08:18 1.3 H...0.3 - 1.2.. ref SDS 38 1Y9G
610543 - 28/02/2013 08:36 1.3 H...0.3 - 1.2.. ref SDS 36 6S4F
610544 - 31/08/2012 15:24 2.3 H...0.3 - 1.2.. ref SDS 27 NV9M
610545 - 09/05/2012 11:24 2.5 H...0.3 - 1.2.. ref SDS 26 O46K
610546 - 09/02/2012 11:18 1.8 H...0.3 - 1.2.. ref SDS 22 KK9M
610547 - 17/11/2011 14:27 1.3 H.............. ref SDS 20 KK9M
610548 - 13/10/2011 14:35 1.3 H.............. ref SDS 19 GM65
610549 - 27/07/2011 12:58 2.0 H.............. ref SDS 16 GM65
610550 - 07/12/2010 09:17 1.0 ............... ref SDS 15 GM65
610551 - 21/07/2010 08:54 1.3 H.............. ref SDS 11 GM65
610552 - 14/12/2009 1.3 H ............. ref DRP 1 DE4O
610553 - 02/11/2009 0.9 ............... ref DRP 1 LG4L
610554 - 13/08/2009 15:09 1.7 H.............. ref SDS 5 VG8R
610556 - ..
610557 - On 131017 1000 VA medical chart Progress Notes assessment
610558 - reports Doctor Egan diagnosed chronic hyperbilirubinemia.
610559 - ref SDS 42 PSXT
610561 - ..
610562 - Bilirubin 2.5 elevated 110% above range shows dramatic increase
610563 - from 1.2 in lab at VA San Francisco Medical Center on 140520.
610564 - ref SDS 64 015M This is highest result for T Bili in patient
610565 - history, may demonstrate chronic side effects statin
610566 - medications causing poor liver function, as reviewed previously
610567 - on prior lab on 140514 0950. ref SDS 62 G34G Side effects of
610568 - peripheral neuropathy in right foot have ebbed and flowed,
610569 - reported on 140510, shown in case study on 120101 0900.
610570 - ref SDS 21 TV6I
610571 -
610572 - [On 140819 0800 during meeting with Doctor Sandhu in
610573 - Primary Care VA Clinic in Martinez, there was no review of
610574 - chronic hyperbilirubinemia, with T Bilirubin 2.5 rising
610575 - 110% above range, ref SDS 70 9K7I, shown in lab ordered by
610576 - the doctor on 140814. ref SDS 68 015M
610578 - ..
610579 - Background on Rosuvastatin causing elevated T Bilirubin with
610580 - associated severe side effects is reported on 121206 0900,
610581 - ref SDS 32 NI9L, and further explained in the record on 121130
610582 - 0846. ref SDS 31 ER4K
610584 - ..
610585 - On 131017 1000 Doctor Egan explained patient history of
610586 - intermittant and mild peripheral neuropathy that correlates
610587 - with persistent elevated T Bilirubin in lab on 131015,
610588 - ref SDS 40 015M, and further reported with vitals, diet and
610589 - exercise since prior meeting at VA on 130603, see case study on
610590 - 120101 0900, ref SDS 21 X14N, suggests intervention is not
610591 - required at this time to improve recovery from side effects
610592 - taking Rosuvastatin. ref SDS 42 LV5J
610593 -
610595 - ..
610596 - 2. Potasium K 4.3 within range................. ref SDS 73 ZG5O
610597 -
610598 - Until the lab today, potassium (k) has been persistently
610599 - elevated above range for 6 months through several labs,
610600 - reported on 140514 0950. ref SDS 62 TN3M
610602 - ..
610603 - Doctor Egan, referring cardiology physician at Martinez VA,
610604 - noted in a recent letter that meeting at VA Medical Center in
610605 - San Francisco on 140213 0830, ref SDS 55 GT7G, did not address
610606 - elevated potassium in labs performed by Labcorp and VA, shown
610607 - on 140203 1147. ref SDS 52 ZG5O Doctor Egan again notifies
610608 - that this condition of elevated potassium represents exposure
610609 - to "electrical problems" with the heart, reported on 140430.
610610 - ref SDS 57 UV5I
610612 - ..
610613 - Doctor Egan was concerned last year about potasium (K) rising
610614 - above range for good health. He explained potasium effects
610615 - electrical signals to the heart, and so has significance for
610616 - CVD, reported during meeting at VA on 121206 0900. ref SDS 32
610617 - 6K56
610619 - ..
610620 - At that time on 121206, the doctor cited medication conflicts
610621 - as possibly causing elevated potasium. ref SDS 32 FI7L Doctor
610622 - Egan further considered dehydration (urination) caused by
610623 - Rosuvastatin may have skewed lab results for electrolytes on
610624 - 121130, and so ordered re-test. ref SDS 32 6K4J
610626 - ..
610627 - On 121212 0941 re-test lab reported Glucose 111, sodium 139,
610628 - and potasium (K) 4.6, all within range, ref SDS 33 KK9M,
610629 - correcting errors noted by Doctor Egan during meeting at VA on
610630 - 121206 0900. ref SDS 32 6K4J
610632 - ..
610633 - Dramatic decline in hiking the past 6 weeks, shown in case
610634 - study on 120101 0900, ref SDS 21 7718, and reported on the
610635 - agenda for meeting with Doctor Sandhu in Primary Care, which
610636 - was submitted later today in another record on 140814 2227.
610637 - ref SDS 69 K098, may correlate with potassium falling back
610638 - within range.
610639 -
610641 - ..
610642 - 3. Glucose 110 105 98.............. ref SDS 0 ZG5O
610643 -
610644 - VA lab on 141021 shows glucose 110 within range; Labcorp test
610645 - the day before on 141020 shows glucose 105 above their range; A
610646 - month ago on 140814, Doctor Sandhu VA in Martinez ordered tests
610647 - showing glucose 98 within range, so results are unclear.
610649 - ..
610650 - Diabetes concern arises from reduced hiking due to
610651 - metatarsalgia side effects, causing weight to increase at
610652 - times above 180.
610654 - ..
610655 - On 140814 VA Martinez lab reported HGBA1c 5.6 within range 4 -
610656 - 6, seems to indicate no evident exposure for diabetes.
610657 - ref SDS 0 H66G
610659 - ..
610660 - On 140514 0950 VA lab for HGBA1c 5.4 within range 4 - 6, seems
610661 - to indicate no evident exposure for diabetes. ref SDS 62 H66G
610662 -
610664 - ..
610665 - 4. Cloride 103 108................. ref SDS 0 WJ5H
610666 -
610667 - VA reports cl 103 within range on 141021; Labcorp the day
610668 - before reports cl 108 above range, same as VA test ordered by
610669 - Doctor Sandhu on 140814.
610671 - ..
610672 - There is no record on cause and implications of elevated CL.
610673 -
610674 -
610675 -
610676 -
610677 -
610678 -
610679 -
610680 -
6107 -
SUBJECTS
VA Lab Lipid Cholesterol 164 with Medication Hiking 1000 Miles Weigh
8103 -
810401 - ..
810402 - LDL-C 90 LDL-P 1586 HDL 57 Hike 200 Miles Weight Maintain 180
810403 -
810404 - Follow up ref SDS 74 IM9N, ref SDS 73 IM9N.
810405 -
810406 - Poor VA lab results today align with decline Labcorp blood test using
810407 - NMR technology reported last week on 140508 1133. ref SDS 59 5C7M
810408 - This reflects increased hiking and weight control past 3.5 months,
810409 - reported in case study on 120101 0900, ref SDS 21 PYXR, and supported
810410 - with low carb diet (including orange juice) and low dose medication,
810411 - reported on 140513, in the same study. ref SDS 21 ZU5G
810413 - ..
810414 - Prior LIPID PANEL 120509 1108. ref SDS 26 IM9N
810415 - Prior LIPID PANEL 120831 1525. ref SDS 27 IM9N
810416 - Prior LIPID PANEL 130228 1140. ref SDS 36 IM9N
810417 - Prior LIPID PANEL 130529 0818. ref SDS 38 IM9N
810418 - Prior LIPID PANEL 131015 0724, ref SDS 40 IM9N
810419 - Prior LIPID PANEL Labcorp, 140201 1159, ref SDS 51 IM9N
810420 - Prior LIPID PANEL, 140203 1147, ref SDS 52 IM9N
810421 - Prior LIPID PANEL Labcorp, 140508 1149. ref SDS 59 IM9N
810422 - Prior LIPID PANEL, 140814 1530, ref SDS 68 IM9N
810423 - Prior LIPID PANEL Labcorp, 141021 1009. ref SDS 74 IM9N
810424 - Prior LIPID PANEL, 140821 1150, ref SDS 0 IM9N
810425 -
810427 - ..
810428 - LIPID PANEL
810430 - ..
810431 - Dates..........2014 10 21 1148 141021 1021 140814 140514 140508 140203 140201 131015 130529
810432 - VA Labcorp VA VA Labcorp VA Labcorp VA VA VA Labcorp
810433 - NMR LipoProfile Results Results Results Results Results Results Results Results Results Units Range Range
810434 - LDL Particle Number H 1586
810435 - LDL-P 851.0 861.0 nmol/L < 1000
810436 - Low < 1000
810437 - Moderate 1000 - 1299
810438 - Borderline High 1300 - 1599
810439 - High 1600 - 2000
810440 - Very High > 2000
810442 - ..
810443 - Lipids
810444 - CHOL (a) 159 157 161 164 162 160 156 321 H 307 mg/dL 100 - 240 < 200
810445 - (b) 169
810446 - TRIGLYC (a) 65 80 72 58 59 47 68 109 85 mg/dL 10 - 190 < 150
810447 - (b) 59
810448 - HDL-C (a) 57 55 55 66 67 58 61 50 50 mg/dL Ref: >=35 >= 40
810449 - (b) 67
810450 - LDL-C (a) 90 86 92 87 83 93 81 249 H 240 mg/dL Ref: <=131 < 160
810451 - (b) 90
810452 - ** LDL Dir 93 mg/dL 0 - 130
810453 - TRIG NF mg/dL Ref: <=150
810455 - ..
810456 - TG/HDL ratio (a).... 1.14 .. 1.46 1.31 0.88 0.88 0.81 1.11 < 2.0
810457 - (b).... .. 0.88
810459 - ..
810460 - LDL-P/TG&HDL ratio 1391 1086
810461 -
810463 - ..
810464 - LDL and HDL Particles
810465 - HDL-P (Total) 36.4 38.1 31.4 umol/L >= 30.5
810466 - Small LDL-P H 1277.0 < 90.0 < 90.0 umol/L <=527.0
810467 - LDL Size L 19.7 21.2 21.3 nm > 20.5
810469 - ..
810470 - --------------------------------------------------------
810471 - ** INTERPRETATIVE INFORMATION**
810472 - PARTICLE CONCENTRATION AND SIZE
810474 - ..
810475 - LDL AND HDL PARTICLES Percentile in Reference Population
810476 - HDL-P (total) High 75th 50th 25th Low
810477 - >34.9 34.9 30.5 26.7 <25.7
810478 - ..
810479 - Small LDL-P Low 25th 50th 75th High
810480 - <117 117 527 839 >839
810482 - ..
810483 - LDL Size <- Large (Pattern A)-> <- (Pattern B) ->
810484 - 23.0 20.6 20.5 19.0
810486 - ..
810487 - --------------------------------------------------------
810488 - Insulin Resistance/Diab. Risk
810489 - Large VLDL-P < 0.8 nmol/L <= 2.7
810490 - Small LDL-P < 90.0 nmol/L < 527
810491 - Large HDL-P 9.4 umol/L >= 4.8
810493 - ..
810494 - VLDL Size NOTES
810495 -
810496 - VLDL concentration too low to allow determination of VLDL
810497 - Size. Low VLDL concentration contributes minimally to the
810498 - LP-IR score.
810500 - ..
810501 - LDL Size 21.2 >= 20.8
810502 - HDL Size 9.8 >= 9.2
810503 -
810504 - Small LDL-P, LDL Particle Size, Large HDL-P VLDL Size, HDL
810505 - Size, HDL Particle, and LP-IR Score have been validated by
810506 - LipoScience but not cleared by US FDA; the clinical
810507 - utility of these tests has not been fully established.
810509 - ..
810510 - Insulin Resistance Score
810511 - LP-IR Score H 46.0 < 25.0 < 25.0 <= 45.0
810512 -
810513 - LP-IR Score is inaccurate if patient is non-fasting. The
810514 - LP-IR Score combines the information from Large VLDL-P,
810515 - Small LDL-P, Large HDL-P, VLDL Size, LDL Size and HDL Size
810516 - to give improved assessment of insulin resistance and
810517 - diabetes risk.
810519 - ..
810520 - INSULIN RESISTANCE MARKER
810521 -
810522 - <--Insulin Sensitive Insulin Resistant-->
810523 - Percentile in Reference Population
810524 -
810525 - Large VLDL-P Low 25th 50th 75th High
810526 - <0.9 0.9 2.7 6.9 >6.9
810528 - ..
810529 - Small LDL-P Low 25th 50th 75th High
810530 - <117 117 527 839 >839
810532 - ..
810533 - Large HDL-P High 75th 50th 25th Low
810534 - >7.3 7.3 4.8 3.1 <3.1
810536 - ..
810537 - VLDL Size Small 25th 50th 75th Large
810538 - <42.4 42.4 46.6 52.5 >52.5
810540 - ..
810541 - LDL Size Large 75th 50th 25th Small
810542 - >21.2 21.2 20.8 20.4 <20.4
810544 - ..
810545 - HDL Size Large 75th 50th 25th Small
810546 - > 9.6 9.6 9.2 8.9 < 8.9
810548 - ..
810549 - Insulin Resistance Score
810550 - LP-IR Score Low 25th 50th 75th High
810551 - <27 27 45 63 >63
810553 - ..
810554 - Homocyst(e)ine, Plasma 12.3 umol/L 0.0 - 15.0
810555 -
810557 - ..
810558 - Final Report
810560 - ..
810561 - Date Issued: 10/23/14 1316 ET
810563 - ..
810564 - This document contains private and confidential health
810565 - information protected by state and federal law.
810566 - If you have received this document in error, please call
810567 - 858-668-3700
810568 -
810569 - 1995-2014 Laboratory Corporation of America® Holdings
810570 - All Rights Reserved - Enterprise Report Version 1.00
810572 - ..
810573 - 01 S7 Deanna Franke, PhD
810574 - Liposcience Inc
810575 - 2500 Sumner Blvd, Raleigh, NC 27616-3235
810576 - 877 547 6837
810577 -
810597 -
810599 - ..
810600 - Lipid History Trend Analysis
810601 -
810602 - Follow up ref SDS 74 W25L, ref SDS 73 W25L.
810603 -
810604 - Small LDL LP-IR
810605 - Collection DT CHOL TRIGL HDL LDL-C LDL-P HDL-P LDL-P SIZE SCORE LDL-D
810606 - 10/21/2014 11:48 159 65 57 90 ......................................... ref SDS 0 BE6O
810607 - 10/21/2014 10:21 157 80 55 86 .1586....36.4..1277...19.7......46....... ref SDS 74 BE6O
810608 - 10/20/2014 10:50 174 79 61 96 ......................................... ref SDS 73 IN5N
810609 - 08/14/2014 15:28 161 72 55 92 ......................................... ref SDS 68 BE6O
810610 - 05/14/2014 10:16 164 58 66 87 .................................... 93.. ref SDS 62 BE6O
810611 - 05/08/2014 11:49 162 59 67 83 851 38.1 < 90 21.2 < 25 ..... ref SDS 59 BE6O
810612 - 02/03/2014 12:28 160 H 47 58 93 ......................................... ref SDS 52 BE6O
810613 - 02/01/2014 12:31 156 68 61 81 861 31.4 < 90 21.3 < 25 ..... ref SDS 51 BE6O
810614 - 10/15/2013 08:25 321 H 109 50 249 H ......................................... ref SDS 40 BE6O
810615 - 05/29/2013 08:18 307 H 85 50 240 H ......................................... ref SDS 36 BE6O
810616 - 02/28/2013 08:39 310 H 73 47 248 H ......................................... ref SDS 36 BE6O
810617 - 11/30/2012 10:01 173 53 57 105 ......................................... ref SDS 31 BE6O
810618 - 08/31/2012 15:25 176 94 47 110 ......................................... ref SDS 27 U89N
810619 - 05/09/2012 11:24 158 76 49 94 ......................................... ref SDS 26 U89N
810620 - 02/09/2012 11:18 285 82 41 228 H ......................................... ref SDS 22 2A4G
810621 - 11/17/2011 14:27 260 84 43 200 H ......................................... ref SDS 20 2A4G
810622 - 07/27/2011 12:58 163 81 45 102 ......................................... ref SDS 16 E19L
810623 - 12/07/2010 09:17 151 41 47 96 ......................................... ref SDS 15 E19L
810624 - 07/21/2010 08:54 261 H 87 35 L 209 H ......................................... ref SDS 11 E19L
810625 - 06/10/2010 10:33 217 H 83 36 L 164 H ......................................... ref SDS 10 QV4F
810626 - * 12/14/2009 11:10 241 H 136 44 170 H ......................................... 100928 0706, ref SDS 12 VW6J
810627 - 08/13/2009 15:09 233 H 118 30 L 179 H ......................................... 100610 1046, ref SDS 10 U45G
810628 - 06/16/2006 10:59 238 H 68 32 L 192 H ......................................... 091002 0900, ref SDS 6 LJ5H
810629 -
810630 - * Lab at VA San Francisco Medical Center reported on 100928 0706.
810631 - ref SDS 12 VW6J
810633 - ..
810634 - Research on cholesterol reported on 091002 0900. ref SDS 6 2F8K
810636 - ..
810637 - On 131125 0005 research found ezetimibe (zetia) mg added to
810638 - Atorvastatin 20 mg yielded after 6 weeks significantly greater changes
810639 - to lipids than taking Atorvastatin in higher doses, e.g., 20 or 40 mg.
810640 - ref SDS 46 CO56
810642 - ..
810643 - On 131125 0005 research found discordance LDL-P low and LDL-C high
810644 - lipid panel HDL 65 TG 77 healthy patient profile with LDL 246.
810645 - ref SDS 46 MN98 Discordance with LDL-P low and LDL-C high is lowest
810646 - risk for CVD, arterialsclorosis. ref SDS 46 FI3G
810647 -
810649 - ..
810650 - Analysis....
810651 -
810652 - 1. NMR LDL-P 1586 and LDL-C 86, ref SDS 0 U45J, represents
810653 - negative discordance - high risk for CVD, shown in research
810654 - reported on 131125 0005. ref SDS 46 FI3G LDL-P 1586 nearly
810655 - doubled from prior LDL-P 851 on 140508, and represents
810656 - "borderline high" CVD high risk. ref SDS 0 U45J
810657 -
810658 - Low < 1000
810659 - Moderate 1000 - 1299
810660 - Borderline High 1300 - 1599
810661 - High 1600 - 2000
810662 - Very High > 2000
810664 - ..
810665 - 2. VA advised LDL-P can be "assumed" from TG/HDL ratio, reported
810666 - during the meeting at the Medical Center in San Francisco on
810667 - 140213 0830. ref SDS 55 WQ8L This aligns with research on
810668 - 131125, ref SDS 46 338N, and in PubMed article. ref SDS 46 VR5N
810670 - ..
810671 - Assumption of LDL-P from TG/HDL ratio implies relatively stable
810672 - ratio between LDL-P and the TG/HDL ratio, otherwise an
810673 - "assumption" is not reliable. In this case, the record
810674 - shows...
810676 - ..
810677 - Labcorp TG/HDL ratio 80/55 = 1.46 ..... ref SDS 0 5C7M
810678 - VA TG/HDL ratio 65/57 = 1.14 ..... ref SDS 0 5C7M
810679 - Labcorp Electrolyte panel TG/HDL ratio 79/61 = 1.30 ..... ref SDS 0 1O6N
810680 - VA TG Labcorp Electrolyte HDL ratio 65/61 = 1.07
810682 - ..
810683 - Ratio LDL-P and TG/HDL ratio 1586/1.46 = 1086
810684 - Ratio LDL-P and VA TG/HDL ratio 1586/1.14 = 1391
810685 - Ratio LDL-P and Electlt TG/HDL ratio 1586/1.30 = 1220
810686 - Ratio LDL-P and VA TG/HDL ratio 1586/1.07 = 1481
810688 - ..
810689 - These results appear conflicting with prior labs...
810691 - ..
810692 - 140508 - LDL-P 851 TG 59 HDL 67. ref SDS 0 U45J
810694 - ..
810695 - Labcorp TG/HDL ratio 59/67 = 0.88
810696 - Ratio LDL-P and TG/HDL ratio 851/0.88 = 967
810697 -
810698 -
810699 - 140203 - LDL-P 861 TG 59 HDL 67. ref SDS 0 U45J
810701 - ..
810702 - Labcorp TG/HDL ratio 59/67 = 1.11
810703 - Ratio LDL-P and TG/HDL ratio 861/1.11 = 776
810705 - ..
810706 - "Assuming" stable correlation, per VA analysis above,
810707 - ref SDS 0 W57O, for correlation between LDL-P and TG/HDL ratio
810708 - from test on 140203...
810710 - ..
810711 - Calculated "asumption"................................ LDL-P
810712 - Labcorp TG/HDL ratio 776 x 1.46 = 1133
810713 - VA TG/HDL ratio 776 x 1.14 = 885
810714 - Labcorp Electrolyte panel TG/HDL ratio 776 x 1.30 = 1009
810715 - VA TG Labcorp Electrolyte HDL ratio 776 x 1.07 = 830
810717 - ..
810718 - "Assuming" stable correlation, per VA analysis above,
810719 - ref SDS 0 W57O, for corelation between LDL-P and TG/HDL ratio
810720 - from test on 140508...
810722 - ..
810723 - Calculated "asumption"................................ LDL-P
810724 - Labcorp TG/HDL ratio 967 x 1.46 = 1412
810725 - VA TG/HDL ratio 967 x 1.14 = 1102
810726 - Labcorp Electrolyte panel TG/HDL ratio 967 x 1.30 = 1257
810727 - VA TG Labcorp Electrolyte HDL ratio 967 x 1.07 = 1035
810729 - ..
810730 - Approximate 60% disparity between low LDL-P 830 - very healthy
810731 - - and high LDL-P 1412 - borderline high, unhealthy, based on
810732 - Labcorp's assessment ranges, renders TG/HDL ratio unreliable.
810733 -
810734 - Low < 1000
810735 - Moderate 1000 - 1299
810736 - Borderline High 1300 - 1599
810737 - High 1600 - 2000
810738 - Very High > 2000
810740 - ..
810741 - 3. If the TG/HDL ratio is actually generally reliable for
810742 - calculating LDL-P to diagnose patient CVD risk, then there may
810743 - be an error in Labcorp LDL-P 1856, results, since TG and HDL
810744 - labs are very similar between multiple VA labs and the Labcorp
810745 - lab. ref SDS 0 458H
810747 - ..
810748 - "Assuming" the most optimistic correlation of LDL-P 830 from
810749 - TG/HDL ratio, this result indicates patient CVD risk continued
810750 - to decline in recent labs, which is supported by VA reliance
810751 - solely on LDL-C 90 which declined 2 points from prior lab on
810752 - 140514.
810754 - ..
810755 - 4. Alternatively, sole reliance on LDL-C 90 in VA lab indicating
810756 - stable, healthy lipid profile may be overly optimistic.
810758 - ..
810759 - Research indicates healthiest cardiovascular condition occurs
810760 - with lowest risk for CVD, when lipids are discordant, with
810761 - LDL-P low and LDL-C high. However, greatest risk for CVD is
810762 - LDL-P high and LDL-C low, shown in the record on 131125 0005.
810763 - ref SDS 46 FI3G
810765 - ..
810766 - VA published goal LDL-C <= 131; Labcorp published goal LCL-C <
810767 - 100. ref SDS 62 5C7M New AHA guidelines show LDL-C < 190,
810768 - reported on 131112 1422. ref SDS 44 HT87
810770 - ..
810771 - VA lowering goal to HDL > 35 from > 40 seems conflicting with
810772 - patient history of CABG +4 on 091022 0700. ref SDS 7 PQWU
810773 - Since HDL 30 was found at that time (see Lipid history below,
810774 - ref SDS 62 W25L, setting the bar at HDL 35 has little tolerance
810775 - for genetic variation to avoid and repair endothelium lesions
810776 - causing atheriosclerotic plaque.
810778 - ..
810779 - 5. Resting heart rate getting up in the mornings has increased
810780 - slightly above 50, though sometimes falls below 50. Blood
810781 - pressure varies - averages about 115 65. After hikes about 105
810782 - 55. Systalic on occassion falls below 90. Dystalic has fallen
810783 - below 50 - e.g., see Monday 140428 reported in case study on
810784 - 120101 0900. ref SDS 21 CB6N
810786 - ..
810787 - 6. Less favorable, mixed results in NMR lipid LDL-P 1856 rising
810788 - from 851 and TG 80 rising from 59, and HDL 55 falling from 67
810789 - between 141021 and 140508; and VA labs reporting TG 65 rising
810790 - from 58 and HDL 57 falling from 67 between 141021 and 140514,
810791 - shown in Lipid History Trend Analysis, above, ref SDS 0 W25L,
810792 - appear to result primarily from HDL 55 12 point decline in
810793 - Labcorp and 10 point decline in VA testing.
810795 - ..
810796 - Liposcience (Labcorp subcontractor) will be contacted to
810797 - reconcile disparity between calculated LDL-P 830, and 1586
810798 - reported by Labcorp, reviewed above. ref SDS 0 JF5K
810800 - ..
810801 - In the mean time, decline in HDL and rise in HDL reflects...
810803 - ..
810804 - a. Hiking 130 miles per month declined during current cycle
810805 - June - October compared to prior level of effort hiking 300
810806 - miles per month that yielded better lipid profiles...
810808 - ..
810809 - Mileage 2014
810810 -
810811 - 131103....Oct................. 373 5757 ...... ref SDS 21 6F9N
810812 - 131201....Nov................. 172 2899 ...... ref SDS 21 XRPV
810813 - 131229....Dec................. 234 3324 ...... ref SDS 21 XXQY
810814 - 140202....Jan................. 347 5393 ...... ref SDS 21 YWST
810815 - 140302....Feb................. 234 3681 ...... ref SDS 21 PYWS
810816 - 140330....Mar................. 207 3313 ...... ref SDS 21 RXPR
810817 - 140427....Apr................. 310 4402 ...... ref SDS 21 RXVV
810818 - 140601....May................. 322 5338 ...... ref SDS 21 SXWV
810819 - 140629....Jun................. 156 2337 ...... ref SDS 21 ZW4N
810820 - 140803....Jul................. 81 1023 ...... ref SDS 21 I37G
810821 - 140831....Aug................. 140 1998 ...... ref SDS 21 236I
810822 - 140928....Sep................. 136 2855 ...... ref SDS 21 XWUY
810824 - ..
810825 - b. Weight - 186 on 141011, ref SDS 21 PUWT, increased from 163
810826 - on 140513, shown in case study on 120101 0900. ref SDS 21
810827 - ZU5G Hiking has a positive effect on weight both consuming
810828 - calories and triglycerides, and reducing the time and
810829 - interest in eating.
810831 - ..
810832 - c. Low-carbohydrate diet works best in this case with
810833 - elevated physical activity.
810835 - ..
810836 - d. Chia seeds added to diet on 131125, reported in case study
810837 - on 120101 0900, ref SDS 21 746M, and recommended for
810838 - sustained energy hiking by Karen at VA on 131121 0930.
810839 - ref SDS 45 NQ37
810841 - ..
810842 - e. Orange juice remained constant, likely maintaining HDL
810843 - despite decline in physical activity, and as explained in
810844 - the prior lab analysis on 141021 1009. ref SDS 74 LO4J
810846 - ..
810847 - f. Atorvastatin 10 mg with Ezetimibe 10 begun on 131230,
810848 - reported in case study on 120101, ref SDS 21 6A6H, and
810849 - continued through current cycle - lowered LDL-C 90 from 92
810850 - in prior lab on 140814. ref SDS 0 5C7M
810852 - ..
810853 - Research studies report Atorvastatin 10 mg + Ezetimibe 10
810854 - mg achieves LDL < 70, and favorably changes triglycerides
810855 - and HDL by 5%, reported on 131125 0005. ref SDS 46 CO45
810856 - While low LDL < 70 conflicts with goal of "discordance"
810857 - that lowers health risk for arterialsclorosis and CVD when
810858 - LDL-P low and LDL-C high, shown in research on 131125 0005,
810859 - ref SDS 46 FI3G, even "concordant" results today are good
810860 - news.
810861 -
810862 -
810864 - ..
810865 - Coronary CTA or IVUS Test Athereosclerosis Plaque 4 Years After CABG
810866 - Athereosclerosis Plaque 4 Years After CABG Coronary CTA or IVUS Test
810867 -
810868 - Follow up ref SDS 74 QA4M, ref SDS 73 QA4M.
810869 -
810870 - On 131125 0005 research further found radiology imaging tests can
810871 - evaluate level of plaque build up resulting from elevated cholesterol.
810872 - ref SDS 46 N73K Radiology imaging technologies are Coronary CT
810873 - angiography - CTA - and Intravascular ultrasound - IVUS. ref SDS 46
810874 - KZ8O
810876 - ..
810877 - Lipid history and particularly the prior 6 months with HDL > 60 and
810878 - Triglycerides < 100, ref SDS 59 W25L, indicates patient may have change
810879 - body chemestry sufficient to cause rapid regression of atherosclerosis
810880 - plaque, cited in research on 131125 0005. ref SDS 46 RA7K Research
810881 - indicates that favorable lipid profile, weight loss, and production of
810882 - EPC in the bone marrow, all stimulated by exercise, drives regression
810883 - of plaque. ref SDS 46 XY7L
810885 - ..
810886 - The next step monitoring results of medical, diet, and exercise
810887 - interventions the past 4 years, since CABG +4 on 091022 0700,
810888 - ref SDS 7 PQWU, is to perform radiology imaging study with coronary CT
810889 - angiography or IVUS to assess regression of atherosclerosis plaque,
810890 - which previously required major surgery to fix.
810892 - ..
810893 - This step is supported by patient history using CT radiology imaging
810894 - to assess regression of esophageal bubble after 4 years of medical
810895 - interventions, reported favorable by Doctor Stewart, Chief General
810896 - Surgery at VA on 130122 1330. ref SDS 34 03H6
810897 -
810898 -
810899 -
810900 -
810901 -
810902 -
8110 -
SUBJECTS
VA Lab Cardiac Enzymnes Creatine Kinase CK also CPK Creatine Phospho
8903 -
890401 - ..
890402 - Myopathy Muscle Pain Side Effects Simvistatin Decline
890403 -
890404 - Follow up ref SDS 74 D26G, ref SDS 73 D26G.
890405 -
890406 - Prior Cardiac Enzymes Profile on 120209 1118. ref SDS 22 D26G
890407 - Prior Cardiac Enzymes Profile on 120509 1108. ref SDS 26 D26G
890408 - Prior Cardiac Enzymes, 131015 0724, ref SDS 40 D26G
890409 - Prior Cardiac Enzymes Profile VA on 140203 1147. ref SDS 52 NX6G
890411 - ..
890412 - This test not performed by Labcorp with blood draw on 140508...
890413 -
890414 - CARDIAC ENZYMES
890415 -
890416 - Dates 2014 05 14 1016 140508 140203 131015 120509
890417 - VA Labcorp VA VA VA
890418 - PLASMA Results Results Results Results Results Units Range
890419 - CPK (CK) 192 149 110 152 U/L 30 - 235
890420 - TRPONIN ng/ml 0 - 0.07
890421 - CK-MB ng/ml 0.6 - 3.5
890422 - MYOGLOB ng/ml 20 - 82
890424 - ..
890425 - a. CPK/CK test not performed by Labcorp
890427 - ..
890428 - b. SLIGHTLY ICTERIC SPECIMEN /HN
890430 - ..
890431 - c. Ordering Provider: Diana Alba
890432 - Report Released..: May 14, 2014@11:29
890433 - Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]
890434 - 4150 CLEMENT STREET
890435 - SAN FRANCISCO, CA 94121-1545
890436 - Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]
890438 - ..
890439 - CKP and CK are the same thing - creatine phosphokinase (CPK) also
890440 - called creatine kinase (CK).
890441 -
890442 - http://www.scai.org/SecondsCount/Resources/Detail.aspx?cid=ed385473-d4e8-491e-9ce0-a7c984fe6f8e#.U3b_BfldWi8
890444 - ..
890445 - Research on 111013 explains Creatine Kinase CK, relates to muscle
890446 - disorders caused by cholesterol medications with statins. 111013 1404,
890447 - ref SDS 19 J54K
890449 - ..
890450 - CK lab may align with reduced side effects of muscle pain in left
890451 - shoulder.
890452 -
890453 -
890454 -
890455 -
890456 -
890457 -
8905 -
SUBJECTS
HGBA1C 5.4 Range 4.0-6.0 Diabetes Negative Laboratory Blood Test Cro
A603 -
A60401 - ..
A60402 - HGBA1c Diabetes Blood Test A1c
A60403 - A1c Diabetes Blood Test HGBA1c
A60404 - Diabetes HGBA1c A1c Blood Test
A60405 -
A60406 - Follow up ref SDS 74 9F4O, ref SDS 73 9F4O.
A60407 -
A60408 - Prior HGBA1c Profile on 100721 0800. ref SDS 11 IL4N
A60409 - Prior HGBA1c Profile on 101207 0906. ref SDS 15 IL4N
A60410 - Prior HGBA1c Profile on 131015 0724. ref SDS 40 9F4O
A60411 - Prior HGBA1c Profile on 140203 1147. ref SDS 52 9F4O
A60413 - ..
A60414 - This test not performed by Labcorp with blood draw on 140508...
A60416 - ..
A60417 - Endocrine IV - HGBA1c - A1c
A60418 -
A60419 - Dates..........2014 08 14 1528 140514 140508 140203 131015 101207
A60420 - VA VA Labcorp VA VA VA
A60421 - BLOOD Results Results Results Results Results Results Units Range
A60422 - HGBA1c 5.6 5.4 5.5 5.5 5.7 % 4.0 - 6.0
A60423 - eAG 114 111 111 mg/dL 74.0 - 118
A60425 - ..
A60426 - Comments:
A60427 -
A60428 - a. Labcorp did not perform HGBA1c lab
A60429 -
A60430 - b. Ordering Provider: Diana Alba
A60431 - Report Released..: May 14, 2014@11:29
A60432 - Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]
A60433 - 4150 CLEMENT STREET
A60434 - SAN FRANCISCO, CA 94121-1545
A60435 - Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]
A60437 - ..
A60438 - This test for diabetes was ordered by Doctor Abrams during a meeting
A60439 - at the San Francisco VA Medical Center on 130227 0930. ref SDS 35 8T5L
A60440 - However, it is not reported for the lab performed the next day on
A60441 - 130228 1140, ref SDS 36 RP4N, nor in the follow up lab 3 months later
A60442 - on 130529 0818. ref SDS 38 RP4N
A60444 - ..
A60445 - HGBA1c was performed previously on 101207 0906, ref SDS 15 IL4N, and 5
A60446 - months earlier on 100721 0800. ref SDS 11 IL4N
A60448 - ..
A60449 - Labcorp test showing LP-IR Score < 25.0, indicating very low risk of
A60450 - diabetes, reported on 140508. ref SDS 59 TU6L
A60452 - ..
A60453 - Glucose 97 near upper range 79 99, Labcorp electrolyte panel last week
A60454 - on 140508, per above, ref SDS 62 ZG5O, indicates potential diabetes
A60455 - risk, but may be elevated by dehydration from statin medication and
A60456 - hiking 22 miles the day before the lab and 11 miles the morning before
A60457 - getting the blood draw, reported on 140508 1133. ref SDS 59 QW6K
A60458 -
A60459 -
A60460 -
A60461 -
A60462 -
A60463 -
A60464 -
A605 -