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 82 0000. ref SDS 79 0000.
290502 -
290503 -
290505 - ..
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 51 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 52 RP4N
290912 - ..
290913 - On 140203 1147 had partial lab drawn at VA in Martinez. ref SDS 53
290914 - KK9M
290916 - ..
290917 - On 140507 0857 ordered another full lab from Labcorp with NMR lipid
290918 - panel. ref SDS 59 OO5G
290920 - ..
290921 - On 140508 1133 lab blood daw at Labcorp with John Muir Medical Center
290922 - on Treat Blvd in Concord. ref SDS 60 445G
290924 - ..
290925 - On 140514 0950 VA partial lab at Medical Center in San Francisco.
290926 - ref SDS 63 X45G
290928 - ..
290929 - On 140814 1530 VA full lab at Clinic in Martinez. ref SDS 70 X45G
290931 - ..
290932 - On 140827 1422 VA partial lab CBC only at Clinic in Martinez re-check
290933 - elevated WBC. ref SDS 74 X45G
290935 - ..
290936 - On 141020 1025 Labcorp partial lab CBC Electrolytes Urinalysis, but
290937 - mistakenly omitted NMP lipid panel. ref SDS 75 X45G
290939 - ..
290940 - On 141021 1009 Labcorp NMR Lipid panel, ref SDS 77 U45J, and
290941 - Homocyst(e)ine. ref SDS 77 CM6J
290943 - ..
290944 - On 141201 Health Testing Centers Requisition order # 33541,
290945 - ref SDS 81 FK65, for full panel of blood tests at Labcorp, ref SDS 81
290946 - Q94L - which included NMR Lipid panelto test LDL-P. ref SDS 81 2P5J
290948 - ..
290949 - On 141021 1150 VA labs electrolytes, ref SDS 77 ZG5O, and lipids.
290950 - ref SDS 77 U45J
290952 - ..
290953 - On 150208 Health Testing Centers Requisition order # 34764,
290954 - ref SDS 84 IG6J, for full panel of blood tests at Labcorp, ref SDS 84
290955 - Q94L, which included NMR Lipid panelto test LDL-P. ref SDS 84 2P5J
290956 -
290957 -
290958 -
290959 -
290961 - ..
2910 -
2911 -
2912 - Progress
2913 -
291301 - See directory structure for medical records on 140320 1125.
291302 - ref SDS 57 4M5I
291303 -
291304 -
291306 - ..
291307 - Blood Tests Evaluate Health 5 Years After CABG x4 Surgery
291308 - CBC WBC 11.2 Slightly Elevated Resolve Achalasia Aligns Increased Hiking
291309 -
291310 - Follow up ref SDS 82 RP4N, ref SDS 79 RP4N.
291311 -
291312 - Prior VA CBC on 120509 1108. ref SDS 26 RP4N
291313 - Prior VA CBC on 120831 1524. ref SDS 27 RP4N
291314 - Prior VA CBC on 121130 1001. ref SDS 31 RP4N
291315 - Prior VA CBC on 130529 0818. ref SDS 38 RP4N
291316 - Prior Labcorp CBC on 140201 1159. ref SDS 52 RP4N
291317 - VA did not order CBC for lab on 140203 1147. ref SDS 53 YX8K
291318 - Prior Labcorp CBC on 140508 1149. ref SDS 60 RP4N
291319 - VA did not order CBC for lab on 140514 0950. ref SDS 63 RP4N
291320 - Prior VA CBC on 140814 1530. ref SDS 70 RP4N
291321 - Prior VA CBC on 140827 1413. ref SDS 74 RP4N
291322 - Prior Labcorp CBC on 141020 1025. ref SDS 75 RP4N
291323 - Prior Labcorp CBC on 141201 0850. ref SDS 82 RP4N
291324 - Prior Labcorp CBC on 150208 1438. ref SDS 0 RP4N
291326 - ..
291327 - Liposcience lab report stored in...
291328 -
291329 - F:\05\00003\SM\CC\AGMJ\20150208-145200\ROD_WELCH.pdf
291331 - ..
291332 - Labcorp Telephone 954 485 3322
291333 - Patient Report
291334 - Rte............................. 28
291339 - ..
291340 - Health Testing Centers
291341 - 2760 W. OAKLAND PARK BLVD.
291342 - FORT LAUDERDALE FL 33311
291343 -
291357 - ..
291358 - Specimen Details
291359 - Date collected.................. 02/08/2015 1452 Local
291360 - Date entered.................... 02/08/2015
291361 - Date reported................... 02/10/2015 1321 ET
291363 - ..
291364 - Physician Details
291365 - Ordering......................... F AN
291366 - Referring:
291367 - ID............................... 1558345843
291368 - NPI.............................. 1558345843
291370 - ..
291371 - General Comments & Additional Information
291373 - Total Volume..................... Not Provided
291374 - Alternate Patient ID............. Not Provided
291375 - Fasting.......................... Yes
291377 - ..
291378 - Ordered Items
291380 - ..
291381 - CMP12+8AC+CBC/D/Plt+UA
291382 - NMR LipoProfile
291383 - LP without VLDL+Chol/HDL+CH...
291384 - ALT (SGPT)
291385 - Venipuncture
291387 - ..
291388 - CBC PANEL
291389 - x
291390 - Dates......... 2015 02 08 1452 141201 141020 140827 140814 140514 140508 140203 140201 130529
291391 - Labcorp Labcorp Labcorp VA VA VA Labcorp VA Labcorp VA VA Labcorp
291392 - Blood Results Results Results Results Results Results Results Results Results Results Units Range Range
291393 - WBC 10.6 11.2 H 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
291394 - RBC 5.46 5.24 5.64 5.56 5.44 5.21 5.13 5.09 M/cmm 4.7 - 6.1 4.14 - 5.80
291395 - HGB 16.2 15.7 16.5 16.4 16.2 15.1 15.2 15.0 g/dL 14 - 18 12.6 - 17.7
291396 - HCT 47.7 47.4 50.1 48.8 48.3 47.0 44.2 46.2 % 42 - 52 37.5 - 51.0
291397 - MCV 87.0 91.0 89.0 87.8 88.7 90.0 86.0 90.7 fL 80 - 99 79.0 - 97.0
291398 - MCH 29.7 30.0 29.3 29.5 29.8 29.0 29.6 29.5 uug 27 - 34 26.6 - 33.0
291399 - MCHC 34.0 33.1 32.9 33.6 33.6 32.1 34.4 32.5 gm/dL 32 - 35.2 31.5 - 35.7
291400 - RDW 13.6 13.9 14.3 13.9 13.9 13.8 13.7 14.4 % 11.5 - 14.5 12.3 - 15.4
291401 - PLT 321.0 314.0 341.0 322.0 295.0 329 303 279 K/cmm 130 - 400 155.0 - 379.0
291402 - MPV 9.1 8.3 8.8 fL 7 - 10.4
291403 - NEUT % 76.0 82.0 80.0 74.2 78.1 70 69 69.9 % 40 - 80 40.0 - 74.0
291404 - LYMPH % 15.0 12.0 13.0 14.9 L 13.6 L 20 21 L 19.7 % 20 - 51 14.0 - 46.0
291405 - MONO % 7.0 5.0 7.0 9.8 7.6 8 8 7.8 % 2 - 13 4.0 - 12.0
291406 - EOS % 1.0 1.0 0.0 0.3 L 0.4 L 1 1 1.9 % .5 - 7 0.0 - 5.0
291407 - BASO % 1.0 0.0 0.9 0.8 0.3 1 1 0.7 % 0 - 2 0.0 - 3.0
291408 - NEUT # 8.2 H 9.1 H 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
291409 - LYMPH # 1.6 1.4 1.7 2.1 1.7 1.9 1.3 1.5 K/cmm 1.2 - 3.4 0.7 - 3.1
291410 - MONO # 0.7 0.6 0.9 1.3 H 1.0 0.7 0.5 0.6 K/cmm .2 - 1.2 0.1 - 0.9
291411 - EOS # 0.1 0.1 0.0 0.9 L 0.1 0.1 0.1 0.1 K/cmm .1 - .5 0.0 - 0.4
291412 - BASO # 0.1 0.1 0.0 0.1 0.0 0.1 0.1 0.1 K/cmm 0 - .2 0.0 - 0.2
291413 - ESRmVES mm/hr 0 - 10
291414 - ESRxCYT mm/hr 2 - 10
291415 - RETIC % % .66 - 2.85
291416 - RETIC # k/uL 27.9 - 121.6
291417 - Immature Granulocytes 0.0 0.0 0.0 0.0 0.0 % 0.0 - 2.0
291418 - Immature Grans (Abs) 0.0 0.0 0.0 0.0 0.0 % 0.0 - 0.1
291420 - ..
291421 - Comments:
291422 -
291423 - a. Test Performed at...
291424 - Health Testing Centers
291425 - 2760 W. OAKLAND PARK BLVD.
291426 - FORT LAUDERDALE FL 33311
291427 -
291429 - ..
291430 - WBC 10.6 High End of Range
291431 -
291432 - Follow up ref SDS 82 EC5L, ref SDS 79 EC5L.
291433 -
291434 - WBC 10.6, declined significantly from persistently elevated WBC > 12
291435 - over past 6 months. ref SDS 0 FK6I,
291437 - ..
291438 - Decline in WBC may reflect emergency (exigent) care in Podiatry to
291439 - resolve infectious blisters on 141021 1411. ref SDS 78 DR9G
291441 - ..
291442 - Decline may further result in part from EGD dilation on 141107, that
291443 - resolved swallowing stricture in LESV. ref SDS 80 VV6N Prior to
291444 - Heller Myotomy surgery to recover from achalasia on 091216 0600,
291445 - ref SDS 8 KE9U, WBC was elevated for several years. On 050816, Doctor
291446 - Sandhu reported WBC elevated and ordered retest. ref SDS 2 G540 CBC
291447 - retest was ordered and WBC remained high on 050818, so the doctor
291448 - prescribed antibiotics. ref SDS 3 BM8O Initial diagnosis of achalasia
291449 - cited persistent elevated WBC part of patient profile, reported on
291450 - 051202 1430. ref SDS 4 H26M
291452 - ..
291453 - Increased exercise the past 4 months may have stimulated bone marrow
291454 - to produce more new blood cells that maintain WBC elevated at high end
291455 - of range, explained by Doctor Johnson during a meeting at Kaiser on
291456 - 030606. ref SDS 1 JP7G In November hiked over 300 miles and over 100
291457 - miles the last week in November. Similarly, last week in December
291458 - hiked 127 miles. January yielded hiking only 242 miles due to severe
291459 - weather and injuries.
291461 - ..
291462 - WBC elevated at high end of range indicates EPCs may also be elevated
291463 - by increased endurance exercise, e.g., hiking 127 miles the last week
291464 - in December and hiking 11 miles per day for last 14 days in a row.
291465 - Testing for elevated EPC will show likelihood of regression from
291466 - atherosclerosis, based on elevated HDL 66 reported in labs today,
291467 - shown below. ref SDS 0 U45J
291468 -
291469 -
291470 -
291471 -
291472 -
291473 -
291474 -
2915 -
SUBJECTS
Urinalysis Lab VA No Results
4403 -
440401 - ..
440402 - Urinalysis Ketones Trace Abnormal Sp Gravity Above Range
440403 -
440404 - Follow up ref SDS 82 0X72, ref SDS 79 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 52 0X72
440409 - VA did not order urinalysis for lab on 140203 1147. ref SDS 53 0X72
440410 - Prior Urinalysis Labcorp test on 140508 1149. ref SDS 60 0X72
440411 - Prior Urinalysis test on 140814 1530. ref SDS 70 0X72
440412 - Prior Urinalysis Labcorp test on 141020 1025. ref SDS 75 0X72
440413 - Prior Urinalysis Labcorp test on 141201 0850. ref SDS 82 0X72
440414 - Prior Urinalysis Labcorp test on 150208 1438. ref SDS 0 0X72
440415 -
440417 - ..
440418 - URINALYSIS PANEL
440419 - x
440420 - Dates.......... 2015 02 08 1452 141201 141020 140814 140514 140203 140201 120509
440421 - Labcorp Labcorp Labcorp VA VA Labcorp VA Labcorp VA VA Labcorp
440422 - Results Results Results Results Results Results Results Results Results Units Range Range
440423 - PH 6.0 5.5 6.0 6.0 5.5 5.5 6.0 5 - 9 5.0 - 7.5
440424 - PROTEIN NEG Trace Trace NEG NEG NEG NEG mg/dL NEG - TRACE NEG - TRACE
440425 - GLUCOSE NEG NEG NEG NEG NEG NEG NEG mg/dL Ref: NEG NEG
440426 - KETONES 1+ Abnormal 1+ Abnormal Trace Abnormal 15 Trace Abnormal NEG NEG mg/dL Ref: NEG NEG
440427 - BILI NEG NEG NEG NEG NEG NEG NEG Ref: NEG NEG
440428 - BILIcnf Ref: NEG
440429 - BLOOD TRACE TRACE TRACE TRACE Ref: NEG
440430 - NITRITE, URINE NEG NEG NEG NEG NEG NEG NEG Ref: NEG NEG
440431 - UROBILI 0.2 0.2 0.2 0.2 0.2 0.2 0.2 EU/dL .2 - 1 0.0 - 1.9
440432 - LEU EST NEG NEG Ref: NEG
440433 - SP.GRAV 1.028 1.035 H 1.030 >=1.030 H 1.036 1.026 1.025 1.003- 1.035 1.005 - 1.030
440434 - COLOR YELLOW YELLOW YELLOW YELLOW YELLOW YELLOW YELLOW
440435 - APPEAR CLEAR CLEAR CLEAR CLEAR CLEAR CLEAR CLEAR
440436 - WBC 0-5 /hpf 0 - 5
440437 - WBC ESTERASE NEG NEG NEG NEG NEG
440438 - RBC 0-2 /hpf 0 - 2
440439 - OCCULT BLOOD NEG NEG NEG NEG NEG NEG
440440 - HAYALINE CASTS NORM(0-1) per lpf 0 - 1
440441 - GRANULAR CASTS None per lpf Ref: None
440442 - CELLULAR CASTS None per lpf Ref: None
440443 - RBC/HPF NORM(0-3) per lpf 0 - 3
440444 - BACTERIA None seen 0 - 1 None seen / Few
440445 - EPITHELIAL CELLS 0-10 NORM(0-1) /hpf 0 - 10
440446 - RENAL EPITHELIAL CELLS None per lpf Ref: None
440447 - CALCIUM OXILATE CRYST Present Abnormal N/A
440448 - URIC ACID CRYSTALS NORM(0-1) per lpf 0 - 1
440449 - TRIPLE PHOSPHATE CRYST NORM(0-1) per lpf 0 - 1
440450 - AMORPHOUS SEDIMENT None per lpf Ref: None
440451 - MUCOUS Present Present Not Established
440452 - TRICHOMONAS None per lpf Ref: None
440453 - YEAST None per lpf Ref: None
440454 - CULTURE REFLEXED No
440455 - TR EPTH None per lpf Ref: None
440456 - Urobilinogen, Semi-On 0.2 0.2 0.2
440457 - NITRITE, URINE NEG NEG NEG
440458 - Microscopic Examination
440459 - Microscopic follows if indicated
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 signals elevated physical activity, in this
440471 - case hiking 11 miles yesterday and again this morning; continues
440472 - recent labs Ketones 15 review by VA, follow up prior lab showning
440473 - Ketones trace abnormal, reported on prior lab 2 months ago on 141201
440474 - 0850, ref SDS 82 MT4L
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 1.5 Hyperbilirubinemia Improves with Pause Atorvastatin Ezetimibe
610403 - Potasium K 5.3 Elevated Increased Electrical Problems Heart
610404 - Bun/Creatinine Ratio Elevated Slightly
610405 - LDH Elevated and Electrolytes May Correlate Increased Endurance Exercise
610406 -
610407 - Follow up ref SDS 82 KK9M, ref SDS 79 KK9M.
610408 -
610409 - Prior CHEM PROFILE on 120509 1108. ref SDS 26 KK9M
610410 - Prior CHEM PROFILE on 120831 1524. ref SDS 27 KK9M
610411 - Prior CHEM PROFILE on 130228 1140. ref SDS 36 KK9M
610412 - Prior CHEM PROFILE on 130529 0818. ref SDS 38 KK9M
610413 - Prior CHEM PROFILE on 131015 0724. ref SDS 40 KK9M
610414 - Prior CHEM PROFILE Labcorp on 140201 1159. ref SDS 52 KK9M
610415 - Prior CHEM PROFILE on 140203 1147. ref SDS 53 KK9M
610416 - Prior CHEM PROFILE Labcorp on 140508 1149. ref SDS 60 KK9M
610417 - Prior CHEM PROFILE on 140520 0732. ref SDS 66 KK9M
610418 - Prior CHEM PROFILE on 140814 1530. ref SDS 70 KK9M
610419 - Prior CHEM PROFILE Labcorp on 141020 1025. ref SDS 75 KK9M
610420 - Prior CHEM PROFILE on 141021 11150 ref SDS 77 KK9M
610421 - Prior CHEM PROFILE Labcorp on 141201 0840. ref SDS 82 KK9M
610422 - Prior CHEM PROFILE Labcorp on 150208 1438. ref SDS 84 KK9M
610423 - Prior CHEM PROFILE Labcorp on 150208 14380 ref SDS 0 KK9M
610424 -
610426 - ..
610427 - ELECTROLYTES - CHEM PROFILE
610429 - ..
610430 - Dates..........2015 02 08 1452 141201 141021 141020 140814 140520 140514 140508 140203 140201 131015 130529
610431 - Labcorp Labcorp VA Labcorp VA VA VA Labcorp VA Labcorp VA VA VA Labcorp
610432 - PLASMA Results Results Results Results Results Results Results Results Results Results Results Results Units Range Range
610433 - GLUCOSE 89 104 H 110 H 105 98 98 97 103 98 108 H 120 mg/dL 74 - 118 65.0 - 99.0
610434 - GLUfast mg/dL Ref: <=99
610435 - NA (salt) 144 147 H 138 144 144 139 144 140 140 139 139 mmol/L 136 - 144 134.0 - 144.0
610436 - K (potasium) 5.3 H 5.6 H 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
610437 - CL 103 106 103 H 108 H 108 102 105 103 102 105 105 mmol/L 98 - 106 97.0 - 108.0
610438 - CO2 28 29 29 29.0 30.0 37.0 30.0 mmol/L 23 - 33
610439 - AGAP 7.0 8.0 mmol/L 5 - 20
610440 - BUN 26 H 28 H mg/dL 8 - 26 8.0 - 27.0
610441 - BUN/Creati Ratio 26 H 24 H 22 H 28 19 H 23 17 20 24 18 10.0 - 22.0
610442 - CREAT 0.99 1.16 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
610443 - eGFR INA 77 64 91 66 >60 102 79 >60 91 >60 >60 mL/min Ref: >=60 >59
610444 - eGFR IA 89 74 76 92 106 mL/min >59
610445 - CALCIUM 10.0 10.0 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
610446 - CA CORR mg/dL 8.7 - 10.2
610447 - PO4 mg/dL 2.4 - 4.5
610448 - MG 85 mg/dL 1.8 - 2.5
610449 - ALK PHO 98 96 107 85 86 100 105 84 87 U/L 40 - 125 39.0 - 117.0
610450 - SGOT 27 U/L 5 - 35
610451 - SGPT 28 U/L 7 - 56
610453 - ..
610454 - T. BIL 1.5 H 1.9 H 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
610455 - D. BILI 0.31 0.38 0.38 0.3 0.2 0.2 0.32 0.3 0.34 < 0.1 mg/dL .1 - .5 0.00 - 0.40
610456 - Bilirubin, Indir 1.19 H 1.52 H H 1.62 0.98 1.26 H mg/dL 0.10 - 0.80
610457 - AST (SGOT) 23 26 31 25 23 26 23 21 20 22 IntUnits/L 8 - 42 0.0 - 40.0
610458 - ALT (SGPT) 18 23 30 21 21 17 21 19 17 19 IntUnits/L 5 - 55 0.0 - 44.0
610459 - ALBUMIN 4.8 4.7 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
610460 - PROTEIN 6.9 6.6 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
610461 - Globulin, Total 2.1 1.9 2.1 2.0 2.1 g/dL 1.4 - 4.5
610462 - A/G Ratio 2.3 2.5 2.3 2.3 2.1 1.1 - 2.5
610463 - LDH 240 H 241 H 223 200.0 180.0 IntUnits/L 90 - 208 0.0 - 225.0
610464 - GGT 13 11.0 9.0 IU/L 0.0 - 65.0
610465 - Iron, Serum 89 101 146 100.0 114.0 ug/dL 40.0 - 155.0
610466 - AMYLASE Units/L 28 - 100
610467 - LIPASE Units/L 7 - 58
610468 - NH3 mcmol/L 15 - 56
610469 - URIC AC 5.4 5.3 6.9 5.6 mg/dL 4.8 - 8.7 3.7 - 8.6
610470 - ..
610471 - Cholesterol, Total 167 161 174 164.0 162.0 mg/dL 100.0 - 199.0
610472 - Triglycerides 60 66 79 55.0 64.0 mg/dL 0.0 - 149.0
610473 - HDL Cholesterol 68 67 61 > 39
610474 - LDL Cholesterol 87 81 96 0 - 99
610475 - T Chol/HDL ratio 2.5 2.4 2.8 0.0 - 5.0
610476 -
610477 - Please Note:
610478 -
610479 - T Chol/HDL Ratio Men Women
610480 -
610481 - 1/2 Avg Risk 3.4 3.3
610482 - Avg Risk 5.0 4.4
610483 - 2x Avg Risk 9.6 7.1
610484 - 3x Avg Risk 23.4 11.0
610486 - ..
610487 - Estimated CHD Risk <0.5 times avg 0.0 - 1.0
610488 -
610489 - T Chol/HDL Ratio Men Women
610490 -
610491 - 1/2 Avg Risk 3.4 3.3
610492 - Avg Risk 5.0 4.4
610493 - 2x Avg Risk 9.6 7.1
610494 - 3x Avg Risk 23.4 11.0
610496 - ..
610497 - The CHD Risk is based on the T Chol/HDL ratio.
610498 - Other factors affect CHD Risk such as hypertension,
610499 - smoking, diabetes, severe obesity, and family history
610500 - of premature CHD.
610502 - ..
610503 - On 150212 called Health Testing Centers and talked with Karen. She
610504 - said that the table below "T Chol/HDL ratio" above, ref SDS 0 1O6N, is
610505 - identical to the table below "Estimated CHD Risk", also above.
610506 - ref SDS 0 AL5J
610507 -
610509 - ..
610510 - Notes on Electrolytes Lab Hyperbilirubinemia Potassium Heart Problems
610511 - Hyperbilirubinemia Potassium Heart Problems Notes on Electrolytes Lab
610512 - Potassium Heart Problems Hyperbilirubinemia Notes on Electrolytes Lab
610513 -
610514 - Follow up ref SDS 82 G34G, ref SDS 79 G34G.
610515 -
610516 - 1. T Bilirubin 1.5................. ref SDS 0 015M
610518 - ..
610519 - Collection DT T Bili Range Source
610520 - 02/08/2015 14:52 1.5 H...0.3 - 1.2.. ref SDS 0 015M
610521 - 01/12/2014 08:40 1.9 H...0.3 - 1.2.. ref SDS 82 015M
610522 - 20/10/2014 10:60 2.0 H...0.3 - 1.2.. ref SDS 75 015M
610523 - 14/08/2014 15:28 2.5 H...0.3 - 1.2.. ref SDS 70 WJ5H
610524 - 20/05/2014 10:20 1.2 ....0.3 - 1.2.. ref SDS 66 015M
610525 - 08/05/2014 11:49 1.3 H...0.0 - 1.2.. ref SDS 60 015M
610526 - 03/02/2014 09:52 2.1 H...0.3 - 1.2.. ref SDS 53 015M
610527 - 01/02/2014 12:28 1.6 H...0.0 - 1.2.. ref SDS 52 015M
610528 - 15/10/2013 08:25 1.7 H...0.3 - 1.2.. ref SDS 40 015M
610529 - 29/05/2013 08:18 1.3 H...0.3 - 1.2.. ref SDS 38 1Y9G
610530 - 28/02/2013 08:36 1.3 H...0.3 - 1.2.. ref SDS 36 6S4F
610531 - 31/08/2012 15:24 2.3 H...0.3 - 1.2.. ref SDS 27 NV9M
610532 - 09/05/2012 11:24 2.5 H...0.3 - 1.2.. ref SDS 26 O46K
610533 - 09/02/2012 11:18 1.8 H...0.3 - 1.2.. ref SDS 22 KK9M
610534 - 17/11/2011 14:27 1.3 H.............. ref SDS 20 KK9M
610535 - 13/10/2011 14:35 1.3 H.............. ref SDS 19 GM65
610536 - 27/07/2011 12:58 2.0 H.............. ref SDS 16 GM65
610537 - 07/12/2010 09:17 1.0 ............... ref SDS 15 GM65
610538 - 21/07/2010 08:54 1.3 H.............. ref SDS 11 GM65
610539 - 14/12/2009 1.3 H ............. ref DRP 1 DE4O
610540 - 02/11/2009 0.9 ............... ref DRP 1 LG4L
610541 - 13/08/2009 15:09 1.7 H.............. ref SDS 5 VG8R
610543 - ..
610544 - On 131017 1000 VA medical chart Progress Notes assessment
610545 - reports Doctor Egan diagnosed chronic hyperbilirubinemia.
610546 - ref SDS 42 PSXT
610548 - ..
610549 - Bilirubin 1.5 elevated slightly above range shows decline from
610550 - 1.9 in lab 2 months ago on 141201, and dramatic decline from
610551 - Bilirubin 2.5 reported for lab at VA Martinez Clinic performed
610552 - 6 months ago on 140814 1530. ref SDS 70 015M This latest
610553 - result for T Bili in patient history, may demonstrate chronic
610554 - side effects statin medications causing poor liver function, as
610555 - reviewed previously on prior lab on 140514 0950. ref SDS 63
610556 - G34G Side effects of peripheral neuropathy in right foot have
610557 - ebbed and flowed, reported on 140510, shown in case study on
610558 - 120101 0900. ref SDS 21 TV6I
610560 - ..
610561 - Bilirubin may have declined this cycle because statin treatment
610562 - was reduced by missing treatment for 12 days due to delays
610563 - receiving refills for Ezetimibe, reported to VA in the letter
610564 - on 141218 0359. ref SDS 83 5N3O Effects missing statin
610565 - treatment further evident when prescription was resumed on
610566 - delivery of Ezetimibe. Patient suffered significant
610567 - dehydration for several weeks readjusting to statin treatment,
610568 - shown by frequent urination and feet becoming dry with skin
610569 - cracking and bleeding. The problem was compounded by pausing
610570 - hiking 11 miles per day due to weather and injuries. Several
610571 - weeks after weather improved and injuries were resolved through
610572 - healing and bandaging resuming hiking 11 miles per day further
610573 - resolved dehydration, shown by resolution of cracking and
610574 - bleeding on bottom of both feet.
610576 - ..
610577 - On 140819 0800 during meeting with Doctor Sandhu in Primary
610578 - Care VA Clinic in Martinez, there was no review of chronic
610579 - hyperbilirubinemia, with T Bilirubin 2.5 rising 110% above
610580 - range, ref SDS 72 9K7I, shown in lab ordered by the doctor on
610581 - 140814. ref SDS 70 015M
610583 - ..
610584 - Background on Rosuvastatin causing elevated T Bilirubin with
610585 - associated severe side effects is reported on 121206 0900,
610586 - ref SDS 32 NI9L, and further explained in the record on 121130
610587 - 0846. ref SDS 31 ER4K
610589 - ..
610590 - On 131017 1000 Doctor Egan explained patient history of
610591 - intermittant and mild peripheral neuropathy that correlates
610592 - with persistent elevated T Bilirubin in lab on 131015,
610593 - ref SDS 40 015M, and further reported with vitals, diet and
610594 - exercise since prior meeting at VA on 130603, see case study on
610595 - 120101 0900, ref SDS 21 X14N, suggests intervention is not
610596 - required at this time to improve recovery from side effects
610597 - taking Rosuvastatin. ref SDS 42 LV5J
610598 -
610600 - ..
610601 - 2. Potasium K 5.3 within range................. ref SDS 0 ZG5O
610602 -
610603 - Potassium 5.3 falling to only slightly above range may reflect
610604 - increased hiking during current period.
610606 - ..
610607 - Doctor Egan, referring cardiology physician at Martinez VA,
610608 - noted in a recent letter that meeting at VA Medical Center in
610609 - San Francisco on 140213 0830, ref SDS 56 GT7G, did not address
610610 - elevated potassium in labs performed by Labcorp and VA, shown
610611 - on 140203 1147. ref SDS 53 ZG5O Doctor Egan again notified
610612 - that this condition of elevated potassium represents exposure
610613 - to "electrical problems" with the heart, reported on 140430.
610614 - ref SDS 58 UV5I
610616 - ..
610617 - Doctor Egan was concerned last year about potasium (K) rising
610618 - above range for good health. He explained potasium effects
610619 - electrical signals to the heart, and so has significance for
610620 - CVD, reported during meeting at VA on 121206 0900. ref SDS 32
610621 - 6K56
610623 - ..
610624 - At that time on 121206, the doctor cited medication conflicts
610625 - as possibly causing elevated potasium. ref SDS 32 FI7L Doctor
610626 - Egan further considered dehydration (urination) caused by
610627 - Rosuvastatin may have skewed lab results for electrolytes on
610628 - 121130, and so ordered re-test. ref SDS 32 6K4J
610630 - ..
610631 - On 121212 0941 re-test lab reported Glucose 111, sodium 139,
610632 - and potasium (K) 4.6, all within range, ref SDS 33 KK9M,
610633 - correcting errors noted by Doctor Egan during meeting at VA on
610634 - 121206 0900. ref SDS 32 6K4J
610636 - ..
610637 - Dramatic decline in hiking during 6 weeks, shown in case study
610638 - on 140101 0900, ref SDS 48 7718, and reported on the agenda for
610639 - meeting with Doctor Sandhu in Primary Care, which was submitted
610640 - on 140814 2227. ref SDS 71 K098, may correlate with potassium
610641 - falling back within range, at that time.
610642 -
610644 - ..
610645 - 3. Glucose 89....65 - 99.......... ref SDS 0 ZG5O
610646 -
610647 - Labcorp test today showing glucose 89 has fallen back within
610648 - Labcorp range, compared to prior test on 141201.
610650 - ..
610651 - Diabetes concern from reduced hiking due to metatarsalgia side
610652 - effects, causing weight to increase at times above 180; this
610653 - has subisded the past month, because hiking increased above
610654 - 300 miles per month.
610656 - ..
610657 - On 140814 VA Martinez lab reported HGBA1c 5.6 within range 4 -
610658 - 6, seems to indicate no evident exposure for diabetes.
610659 - ref SDS 77 H66G
610661 - ..
610662 - On 140514 0950 VA lab for HGBA1c 5.4 within range 4 - 6, seems
610663 - to indicate no evident exposure for diabetes. ref SDS 63 H66G
610664 -
610666 - ..
610667 - 4. Salt NA 144..................... ref SDS 0 WJ5H
610668 -
610669 - NA salt 144 falling back within range may reflect reduced
610670 - hiking compared to prior test on 141201.
610672 - ..
610673 - 5. LDH 240......................... ref SDS 0 015M
610674 -
610675 - LDH 240 declining slightly may reflect reduced hiking compared
610676 - to prior test on 141201, but since hiking overall increased to
610677 - 300 miles per month LDH remains elevated above range.
610678 -
610679 -
610680 -
610681 -
610682 -
610683 -
610684 -
610685 -
6107 -
SUBJECTS
VA Lab Lipid Cholesterol 164 with Medication Hiking 1000 Miles Weigh
8103 -
810401 - ..
810402 - LDL-C 79 LDL-P 656 HDL 63 Hike 250 Miles in 3 Weeks
810403 -
810404 - Follow up ref SDS 82 IM9N, ref SDS 79 IM9N.
810405 -
810406 - Improved LDL-P declined 33% and HDL increased 20% nominally represent
810407 - significantly lower CVD risk.
810409 - ..
810410 - Prior LIPID PANEL 120509 1108. ref SDS 26 IM9N
810411 - Prior LIPID PANEL 120831 1525. ref SDS 27 IM9N
810412 - Prior LIPID PANEL 130228 1140. ref SDS 36 IM9N
810413 - Prior LIPID PANEL 130529 0818. ref SDS 38 IM9N
810414 - Prior LIPID PANEL 131015 0724, ref SDS 40 IM9N
810415 - Prior LIPID PANEL Labcorp, 140201 1159, ref SDS 52 IM9N
810416 - Prior LIPID PANEL, 140203 1147, ref SDS 53 IM9N
810417 - Prior LIPID PANEL Labcorp, 140508 1149. ref SDS 60 IM9N
810418 - Prior LIPID PANEL, 140814 1530, ref SDS 70 IM9N
810419 - Prior LIPID PANEL Labcorp, 141021 1009. ref SDS 76 IM9N
810420 - Prior LIPID PANEL, 141021 1150, ref SDS 77 IM9N
810421 - Prior LIPID PANEL Labcorp, 141106 0630, ref SDS 79 IM9N
810422 - Prior LIPID PANEL Labcorp, 141201 0852, ref SDS 82 IM9N
810423 - Prior LIPID PANEL Labcorp, 150208 1438, ref SDS 0 IM9N
810424 -
810426 - ..
810427 - LIPID PANEL
810429 - ..
810430 - Dates..........2015 02 08 1452 141201 141106 0714 141021 1148 141021 1021 140814 140514 140508 140203 140201 131015 130529
810431 - Labcorp Labcorp Labcorp VA Labcorp VA VA Labcorp VA Labcorp VA VA VA Labcorp
810432 - NMR LipoProfile Results Results Results Results Results Results Results Results Results Results Results Results Units Range Range
810433 - LDL Particle Number
810434 - LDL P 709 656 997 H 1586 851 861 nmol/L Low < 1000
810435 - Moderate 1000 - 1299
810436 - Borderline High 1300 - 1599
810437 - High 1600 - 2000
810438 - Very High > 2000
810440 - ..
810441 - Lipids
810442 - CHOL 162 157 137 159 157 161 (a) 164 162 160 156 321 H 307 mg/dL 100 - 240 < 200
810443 - (b) 169
810444 - TRIGLYC 66 73 85 65 80 72 (a) 58 59 47 68 109 85 mg/dL 10 - 190 < 150
810445 - (b) 59
810446 - HDL-C 66 63 53 57 55 55 (a) 66 67 58 61 50 50 mg/dL Ref: >=35 >= 40
810447 - (b) 67
810448 - LDL-C 83 79 67 90 86 92 (a) 87 83 93 81 249 H 240 mg/dL Ref: <=131 < 160
810449 - (b) 90
810450 - ** LDL Dir 93 mg/dL 0 - 130
810451 - TRIG NF mg/dL Ref: <=150
810453 - ..
810454 - TG/HDL ratio 1.16 1.16 1.60 1.14 1.46 1.31 (a) 0.88 0.88 0.81 1.11 < 2.0
810455 - TC/HDL ratio 2.49 2.49 2.58 2.79 2.85 2.93 2.48 2.42 2.76 2.56
810457 - ..
810458 - LDL and HDL Particles s s
810459 - HDL-P (Total) 39.5 38.9 35.2 36.4 38.1 31.4 umol/L >= 30.5
810460 - Small LDL-P 153 310 387 H 1277.0 < 90.0 < 90.0 umol/L <=527.0
810461 - LDL Size 21.0 20.4 Low 20.8 L 19.7 21.2 21.3 nm > 20.5
810463 - ..
810464 - Customer Questions...
810465 -
810466 - What drives Small LDL-P?
810467 -
810468 - Not clear how LDL-P count 709 and 656 for Total Cholesterol 162
810469 - and 157 can yield smaller particle size 21.0 and 20.4 than
810470 - larger LDL-P count 851 and 861 for comparable Total Cholesterol
810471 - 162 and 156 with larger particle size 21.2 and 21.3.
810472 -
810474 - ..
810475 - Liposcience report continues...
810476 -
810477 - --------------------------------------------------------
810478 - ** INTERPRETATIVE INFORMATION**
810479 - PARTICLE CONCENTRATION AND SIZE
810481 - ..
810482 - LDL AND HDL PARTICLES Percentile in Reference Population
810483 - HDL-P (total) High 75th 50th 25th Low
810484 - >34.9 34.9 30.5 26.7 <25.7
810485 - ..
810486 - Small LDL-P Low 25th 50th 75th High
810487 - <117 117 527 839 >839
810489 - ..
810490 - LDL Size <- Large (Pattern A)-> <- (Pattern B) ->
810491 - 23.0 20.6 20.5 19.0
810493 - ..
810494 - --------------------------------------------------------
810495 - Insulin Resistance/Diab. Risk
810496 - Large VLDL-P < 0.8 nmol/L <= 2.7
810497 - Small LDL-P < 90.0 nmol/L < 527
810498 - Large HDL-P 9.4 umol/L >= 4.8
810500 - ..
810501 - VLDL Size NOTES
810502 -
810503 - VLDL concentration too low to allow determination of VLDL
810504 - Size. Low VLDL concentration contributes minimally to the
810505 - LP-IR score.
810507 - ..
810508 - LDL Size 21.2 >= 20.8
810509 - HDL Size 9.8 >= 9.2
810510 -
810511 - Small LDL-P, LDL Particle Size, Large HDL-P VLDL Size, HDL
810512 - Size, HDL Particle, and LP-IR Score have been validated by
810513 - LipoScience but not cleared by US FDA; the clinical
810514 - utility of these tests has not been fully established.
810516 - ..
810517 - Insulin Resistance Score
810518 - LP-IR Score < 25 H 46.0 < 25.0 < 25.0 <= 45.0
810520 - ..
810521 - LP-IR Score is inaccurate if patient is non-fasting. The
810522 - LP-IR Score combines the information from Large VLDL-P,
810523 - Small LDL-P, Large HDL-P, VLDL Size, LDL Size and HDL Size
810524 - to give improved assessment of insulin resistance and
810525 - diabetes risk.
810527 - ..
810528 - INSULIN RESISTANCE MARKER
810529 -
810530 - <--Insulin Sensitive Insulin Resistant-->
810531 - Percentile in Reference Population
810532 -
810533 - Large VLDL-P Low 25th 50th 75th High
810534 - <0.9 0.9 2.7 6.9 >6.9
810536 - ..
810537 - Small LDL-P Low 25th 50th 75th High
810538 - <117 117 527 839 >839
810540 - ..
810541 - Large HDL-P High 75th 50th 25th Low
810542 - >7.3 7.3 4.8 3.1 <3.1
810544 - ..
810545 - VLDL Size Small 25th 50th 75th Large
810546 - <42.4 42.4 46.6 52.5 >52.5
810548 - ..
810549 - LDL Size Large 75th 50th 25th Small
810550 - >21.2 21.2 20.8 20.4 <20.4
810552 - ..
810553 - HDL Size Large 75th 50th 25th Small
810554 - > 9.6 9.6 9.2 8.9 < 8.9
810556 - ..
810557 - Insulin Resistance Score
810558 - LP-IR Score Low 25th 50th 75th High
810559 - <27 27 45 63 >63
810560 -
810562 - ..
810563 - Final Report
810565 - ..
810566 - Date Issued: 02/10/15 1323 ET
810568 - ..
810569 - This document contains private and confidential health
810570 - information protected by state and federal law.
810571 - If you have received this document in error, please call
810572 - 858-668-3700
810573 -
810574 - 1995-2014 Laboratory Corporation of America® Holdings
810575 - All Rights Reserved - Enterprise Report Version 1.00
810577 - ..
810578 - 01 S7 Deanna Franke, PhD
810579 - Liposcience Inc
810580 - 2500 Sumner Blvd, Raleigh, NC 27616-3235
810581 - 877 547 6837
810582 -
810583 - customer.service@liposcience.com
810585 - ..
810586 - 02 SO Jenny Galloway, MD
810587 - Labcorp San Diego
810588 - 13112 Evening Creek Dr So Ste 200 San Diego, CA
810589 - 92128-4108
810591 - ..
810592 - For inquiries, the physician may contact Branch: 800 762 4344
810593 - Lab: 858 668 3700
810594 -
810595 -
810596 -
810598 - ..
810599 - Lipid History Trend Analysis
810600 -
810601 - Follow up ref SDS 82 W25L, ref SDS 79 W25L.
810602 -
810603 - There are currently 3 tests for cholesterol performed for an
810604 - examination cycle: VA, Liposcience NMR lipids, and Labcorp lipids.
810605 - Confidence is high when these labs are in close proximity...
810606 -
810607 - Small LDL LP-IR
810608 - Collection DT CHOL TRIGL HDL LDL-C LDL-P HDL-P LDL-P SIZE SCORE LDL-D
810609 - 02/08/2015 14:52 162 66 66 83 ..709....39.5...153...21.0....< 25....... ref SDS 0 BE6O
810610 - 02/08/2015 14:52 167 60 68 87 ......................................... ref SDS 0 BE6O
810611 - 12/01/2014 08:40 157 73 63 79 ..656....38.9...310...20.4....< 25....... ref SDS 82 BE6O
810612 - 12/01/2014 08:40 161 66 67 81 ......................................... ref SDS 82 1O6N
810613 - 11/06/2014 07:14 137 85 53 67 ..997....35.2...387...20.8......30....... ref SDS 79 BE6O
810614 - 10/21/2014 11:48 159 65 57 90 ......................................... ref SDS 77 BE6O
810615 - 10/21/2014 10:21 157 80 55 86 .1586....36.4..1277...19.7......46....... ref SDS 76 BE6O
810616 - 10/20/2014 10:50 174 79 61 96 ......................................... ref SDS 75 IN5N
810617 - 08/14/2014 15:28 161 72 55 92 ......................................... ref SDS 70 BE6O
810618 - 05/14/2014 10:16 164 58 66 87 .................................... 93.. ref SDS 63 BE6O
810619 - 05/08/2014 11:49 162 59 67 83 851 38.1 < 90 21.2 < 25 ..... ref SDS 60 BE6O
810620 - 02/03/2014 12:28 160 47 58 93 ......................................... ref SDS 53 BE6O
810621 - 02/01/2014 12:31 156 68 61 81 861 31.4 < 90 21.3 < 25 ..... ref SDS 52 BE6O
810622 - 10/15/2013 08:25 321 H 109 50 249 H ......................................... ref SDS 40 BE6O
810623 - 05/29/2013 08:18 307 H 85 50 240 H ......................................... ref SDS 36 BE6O
810624 - 02/28/2013 08:39 310 H 73 47 248 H ......................................... ref SDS 36 BE6O
810625 - 11/30/2012 10:01 173 53 57 105 ......................................... ref SDS 31 BE6O
810626 - 08/31/2012 15:25 176 94 47 110 ......................................... ref SDS 27 U89N
810627 - 05/09/2012 11:24 158 76 49 94 ......................................... ref SDS 26 U89N
810628 - 02/09/2012 11:18 285 82 41 228 H ......................................... ref SDS 22 2A4G
810629 - 11/17/2011 14:27 260 84 43 200 H ......................................... ref SDS 20 2A4G
810630 - 07/27/2011 12:58 163 81 45 102 ......................................... ref SDS 16 E19L
810631 - 12/07/2010 09:17 151 41 47 96 ......................................... ref SDS 15 E19L
810632 - 07/21/2010 08:54 261 H 87 35 L 209 H ......................................... ref SDS 11 E19L
810633 - 06/10/2010 10:33 217 H 83 36 L 164 H ......................................... ref SDS 10 QV4F
810634 - * 12/14/2009 11:10 241 H 136 44 170 H ......................................... 100928 0706, ref SDS 12 VW6J
810635 - 08/13/2009 15:09 233 H 118 30 L 179 H ......................................... 100610 1046, ref SDS 10 U45G
810636 - 06/16/2006 10:59 238 H 68 32 L 192 H ......................................... 091002 0900, ref SDS 6 LJ5H
810637 -
810638 - * Lab at VA San Francisco Medical Center reported on 100928 0706.
810639 - ref SDS 12 VW6J
810641 - ..
810642 - Research on cholesterol reported on 091002 0900. ref SDS 6 2F8K
810644 - ..
810645 - On 131125 0005 research found ezetimibe (zetia) mg added to
810646 - Atorvastatin 20 mg yielded after 6 weeks significantly greater changes
810647 - to lipids than taking Atorvastatin in higher doses, e.g., 20 or 40 mg.
810648 - ref SDS 46 CO56
810650 - ..
810651 - On 131125 0005 research found discordance LDL-P low and LDL-C high
810652 - lipid panel HDL 65 TG 77 healthy patient profile with LDL 246.
810653 - ref SDS 46 MN98 Discordance with LDL-P low and LDL-C high is lowest
810654 - risk for CVD, arterialsclorosis. ref SDS 46 FI3G
810655 -
810657 - ..
810658 - Analysis....
810659 -
810660 - 1. NMR LDL-P 709 reported in lipid test today on 150208,
810661 - ref SDS 0 U45J, is comparable to 33% improvement reported for
810662 - prior lab finding LDL-P 656 on 141201 0850, ref SDS 82 U45J,
810663 - compared to test 3 weeks earlier. This tends to validate
810664 - correlation between physical activity and favorable lipids that
810665 - lowers CVD risks, as follows.
810667 - ..
810668 - The test today shows high levels of physical activity in
810669 - relation to patient history, hiking 11 miles in < 170 minutes
810670 - for 21 days in a row, including the best time ever, 158
810671 - minutes. This is a breakthrough in conditioning that exceeds
810672 - prior levels, since the longest period hiking < 170 minutes for
810673 - 11 miles was only 6 days in a row. Conditioning deteriorated
810674 - to doing 11 miles in 192 minutes on 141011, shown in case study
810675 - on 120101 0900. ref SDS 21 PUWT Now 2 tests 2+ months apart
810676 - yield comparable results, with slightly higher LDL-P this cycle
810677 - reflecting reduced hiking due to inclement weather and
810678 - injuries.
810680 - ..
810681 - 2. Research indicates healthiest cardiovascular condition occurs
810682 - with lowest risk for CVD, when lipids are discordant, with
810683 - LDL-P low and LDL-C high. However, greatest risk for CVD is
810684 - LDL-P high and LDL-C low, shown in the record on 131125 0005.
810685 - ref SDS 46 FI3G
810687 - ..
810688 - VA published goal LDL-C <= 131; Labcorp published goal LCL-C <
810689 - 100. ref SDS 63 5C7M New AHA guidelines show LDL-C < 190,
810690 - reported on 131112 1422. ref SDS 44 HT87
810692 - ..
810693 - VA lowering goal to HDL > 35, per above, ref SDS 0 5C7M, from >
810694 - 40 seems conflicting with patient history of CABG +4 on 091022
810695 - 0700. ref SDS 7 PQWU Since HDL 30 was found at that time (see
810696 - Lipid history below, ref SDS 63 W25L, setting the bar at HDL 35
810697 - has little tolerance for genetic variation to avoid and repair
810698 - endothelium lesions causing atheriosclerotic plaque.
810700 - ..
810701 - 3. Resting heart rate getting up in the mornings remains slightly
810702 - above 50, though sometimes falls below 50. Blood pressure
810703 - averages about 120 65; however, Diastolic often falls below 60.
810704 - After 11 mile hikes blood pressure drops to about 105 55.
810705 - Systolic on occassion falls below 90. Dystalic has fallen
810706 - below 50 - e.g., see Saturday, 141018, reported in case study
810707 - on 120101 0900, ref SDS 21 V83O Heart rate now recovers well
810708 - after strenuous exercise, often falling back below 60 within 20
810709 - minutes or so.
810711 - ..
810712 - 4. NMR Lipid results on 141106 show...
810713 -
810714 - Cholesterol................... 162................ ref SDS 0 U45J
810716 - ..
810717 - 5 unit increase of cholesterol from prior test 3 months ago on
810718 - 141201, aligns with patient history showing Cholesterol has
810719 - been steady taking Atorvastatin 10 mg and Ezetimibe 10 mg for
810720 - 12 months, varying between 157 - 174. ref SDS 79 W25L This
810721 - increase may reflect 12 pause taking Atorvastatin 10 mg and
810722 - Ezetimibe 10 mg due to delay receiving refills, reported to VA
810723 - in a letter on 141218 0359. ref SDS 83 5N3O
810725 - ..
810726 - LDL-C......................... 83................ ref SDS 0 U45J
810728 - ..
810729 - 4 unit rise of LDL-C from prior Liposcience test on 141201,
810730 - aligns testing with patient history consistently 10 - 20 units
810731 - above VA goal to lower LDL-C < 70 reported in Progress Notes on
810732 - 140519 0800. ref SDS 65 OW3K Since LDL-C is calculated and so
810733 - can be "assumed" from the Friedwald equation...Cholesterol -
810734 - HDL - TG/5 (reported on 140213 0830. ref SDS 56 Z37L), the 20
810735 - unit rise in cholesterol, results in 12 unit rise in LDL-C,
810736 - because TG and HDL remain relatively stable.
810738 - ..
810739 - 5. NMR Lipid results on 150208 show...
810740 -
810741 - Triglycerices (TG)............ 66................ ref SDS 0 U45J
810742 - HDL........................... 66................ ref SDS 0 U45J
810744 - ..
810745 - Improved lipids including LDL-P 709 reflect...
810747 - ..
810748 - a. Physical activity prescribed by the VA on 140213,
810749 - ref SDS 56 E34O, has recovered after a pause of 5 months to
810750 - recover from side effects, and now continues prior levels
810751 - hiking 300+ miles per month...
810753 - ..
810754 - Mileage 2014
810755 -
810756 - Follow up ref SDS 82 ZY7M, ref SDS 79 ZY7M.
810757 -
810758 - 131103....Oct................. 373 5757 ...... ref SDS 21 6F9N
810759 - 131201....Nov................. 172 2899 ...... ref SDS 21 XRPV
810760 - 131229....Dec................. 234 3324 ...... ref SDS 21 XXQY
810761 - 140202....Jan................. 347 5393 ...... ref SDS 48 YWST
810762 - 140302....Feb................. 234 3681 ...... ref SDS 48 PYWS
810763 - 140330....Mar................. 207 3313 ...... ref SDS 48 RXPR
810764 - 140427....Apr................. 310 4402 ...... ref SDS 48 RXVV
810765 - 140601....May................. 322 5338 ...... ref SDS 48 SXWV
810766 - 140629....Jun................. 156 2337 ...... ref SDS 48 ZW4N
810767 - 140803....Jul................. 81 1023 ...... ref SDS 48 I37G
810768 - 140831....Aug................. 140 1998 ...... ref SDS 48 236I
810769 - 140928....Sep................. 136 2855 ...... ref SDS 48 XWUY
810770 - 141102....Oct................. 215 3540 ...... ref SDS 48 F56L
810771 - 141130....Nov................. 319 4840 ...... ref SDS 48 ST5L
810772 - 141228....Dec................. 284 4533 ...... ref SDS 48 SRTP
810773 - 150201....Jan................. 242 3687 ...... ref SDS 48 TSYW
810774 - 150201....Feb................. 74 1122 ...... ref SDS 48 736O
810775 -
810776 -
810778 - ..
810779 - b. Weight - 177 on date of lab 150208 (see case study on
810780 - 140101 0600, ref SDS 48 736O, increased from 173 on 141201,
810781 - ref SDS 48 1N4I; yet, declined from 186 on 141011,
810782 - ref SDS 21 PUWT, but still above 163 on 140513, shown in
810783 - case study on 120101 0900. ref SDS 21 ZU5G Hiking has a
810784 - positive effect on weight consuming calories and
810785 - triglycerides, and also reducing time and interest for
810786 - eating. Lower weight tends to reduce tryglycerides, which
810787 - tends to increase LDL-P size = 21.0, as shown in current
810788 - lab, per above. ref SDS 0 5C86 Evidence indicates weight
810789 - is highly sensitive to eating and exercise, and directly
810790 - correlated to CVD risk.
810792 - ..
810793 - Week ending 121130, hiked 106 miles the most in patient
810794 - history for 1 week. ref SDS 21 ST5L
810796 - ..
810797 - On 141123 hiked 11 miles in 158 minutes, fastest pace in
810798 - patient history. ref SDS 48 OI6N
810800 - ..
810801 - Hiked 11 miles per day in < 170 minutes for 20 days in a
810802 - row; hiking 14 - 15 minute miles every day reflects order
810803 - of magnitude improvement in body condition; previous best
810804 - was only 6 days in a row. This change in body condition
810805 - may reconcile 33% decline in LDL-P 656, and 20% better than
810806 - prior best lipid report before side effect injuries that
810807 - caused hiking to decline 70%, leading to poor Lipids.
810809 - ..
810810 - The last week in December hiked 127 miles, all below 170
810811 - minutes per 11 mile lap, i.e., 15 minute miles, shown in
810812 - case study. ref SDS 48 KU6F
810814 - ..
810815 - January hiking distance declined and speed increased
810816 - slightly because of severe cold weather and also due to
810817 - injuries. This decline in endurance exercise may have
810818 - caused LDL-P to rise slightly from 656 to 709 in the
810819 - current lab on 150208, see above. ref SDS 0 U45J
810820 -
810822 - ..
810823 - c. Low-carbohydrate diet works best in this case with
810824 - elevated physical activity, because exhaustion from hiking
810825 - reduces desire/energy for eating.
810827 - ..
810828 - d. Chia seeds added to diet on 131125, reported in case study
810829 - on 120101 0900, ref SDS 21 746M, and recommended for
810830 - sustained energy hiking by Karen at VA on 131121 0930.
810831 - ref SDS 45 NQ37
810833 - ..
810834 - e. Orange juice may have increased slightly this cycle, likely
810835 - contributing to HDL 66 rising 20%, ref SDS 0 U45J, from HDL
810836 - 55 on 141021, and supplementing increased physical
810837 - activity, and as explained in the prior lab analysis on
810838 - 140514 0950. ref SDS 63 LO4J
810840 - ..
810841 - f. Atorvastatin 10 mg with Ezetimibe 10 begun on 131230,
810842 - reported in case study on 120101, ref SDS 21 6A6H, and
810843 - continued through current cycle.
810845 - ..
810846 - Cholesterol 167 remained comparable to prior level 157 on
810847 - 141021, per above, ref SDS 0 5C7M, indicating minimal
810848 - effects pausing Atorvastatin 10 mg and Ezetimibe 10 mg for
810849 - 12 days due to delays in refill processing, cited in the
810850 - letter to the VA on 141218 0359. ref SDS 83 5N3O
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 82 QA4M, ref SDS 79 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 past 3 weeks with HDL > 60 and
810878 - Triglycerides < 100, ref SDS 82 5C7M, indicates body chemestry may be
810879 - sufficient again to cause rapid regression of atherosclerosis plaque,
810880 - cited in research on 131125 0005. ref SDS 46 RA7K Research indicates
810881 - that favorable lipid profile, weight loss, and production of EPC in
810882 - the bone marrow, all stimulated by exercise, drives regression of
810883 - 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 82 D26G, ref SDS 79 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 53 NX6G
890411 - ..
890412 - This test not performed by Labcorp with blood draw on 141201...
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 82 9F4O, ref SDS 79 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 53 9F4O
A60413 - ..
A60414 - This test not performed by Labcorp with blood draw on 141201...
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. ref SDS 82 TU6L
A60452 - ..
A60453 - Glucose 104 above range 79 99, Labcorp electrolyte panel reported
A60454 - today, per above, ref SDS 82 ZG5O, indicates potential diabetes risk,
A60455 - but may be elevated by dehydration from statin medication and hiking
A60456 - 22 miles the day before the lab and 11 miles the morning before
A60457 - getting the blood draw, reported above. ref SDS 82 QW6K
A60458 -
A60459 -
A60460 -
A60461 -
A60462 -
A60463 -
A60464 -
A60465 -
A60466 -
A60467 -