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 85 0000. ref SDS 82 0000.
290502 -
290503 - VA lab today yielded healthy results, lipids HDL 70 is highest in
290504 - patient history, and Triglycerides 50 is lowest in patient history.
290505 - ref SDS 0 U45J This 20% improvement from results on Labcorp test
290506 - yesterday after 1 more day hiking 11 miles averaging 15 minute miles.
290507 - Analysis indicates VA lab would yield LDL-P 600, assuming improvement
290508 - of LDL-P 709 reported by Liposcience the day before on 150208.
290509 - ref SDS 0 QV5G
290510 -
290511 -
290512 -
290513 -
290514 -
290515 -
290517 - ..
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 10.6 Elevated at High End of Range Resolve Achalasia Aligns Increased Hiking
291309 -
291310 - Follow up ref SDS 85 RP4N, ref SDS 82 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 85 RP4N
291326 - ..
291327 - For some reason VA did not test CBC panel today for evaluating
291328 - persistent elevated WBC past 6 months. Labcorp performed CBC
291329 - yesterday, shown here for reference...
291331 - ..
291332 - Labcorp and Liposcience lab report stored in...
291333 -
291334 - F:\05\00003\SM\CC\AGMJ\20150208-145200\ROD_WELCH.pdf
291335 -
291337 - ..
291338 - CBC PANEL
291339 - x
291340 - Dates......... 2015 02 08 1452 141201 141020 140827 140814 140514 140508 140203 140201 130529
291341 - Labcorp Labcorp Labcorp VA VA VA Labcorp VA Labcorp VA VA Labcorp
291342 - Blood Results Results Results Results Results Results Results Results Results Results Units Range Range
291343 - 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
291344 - 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
291345 - 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
291346 - HCT 47.7 47.4 50.1 48.8 48.3 47.0 44.2 46.2 % 42 - 52 37.5 - 51.0
291347 - MCV 87.0 91.0 89.0 87.8 88.7 90.0 86.0 90.7 fL 80 - 99 79.0 - 97.0
291348 - MCH 29.7 30.0 29.3 29.5 29.8 29.0 29.6 29.5 uug 27 - 34 26.6 - 33.0
291349 - 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
291350 - 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
291351 - PLT 321.0 314.0 341.0 322.0 295.0 329 303 279 K/cmm 130 - 400 155.0 - 379.0
291352 - MPV 9.1 8.3 8.8 fL 7 - 10.4
291353 - NEUT % 76.0 82.0 80.0 74.2 78.1 70 69 69.9 % 40 - 80 40.0 - 74.0
291354 - LYMPH % 15.0 12.0 13.0 14.9 L 13.6 L 20 21 L 19.7 % 20 - 51 14.0 - 46.0
291355 - MONO % 7.0 5.0 7.0 9.8 7.6 8 8 7.8 % 2 - 13 4.0 - 12.0
291356 - EOS % 1.0 1.0 0.0 0.3 L 0.4 L 1 1 1.9 % .5 - 7 0.0 - 5.0
291357 - BASO % 1.0 0.0 0.9 0.8 0.3 1 1 0.7 % 0 - 2 0.0 - 3.0
291358 - 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
291359 - 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
291360 - 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
291361 - 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
291362 - 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
291363 - ESRmVES mm/hr 0 - 10
291364 - ESRxCYT mm/hr 2 - 10
291365 - RETIC % % .66 - 2.85
291366 - RETIC # k/uL 27.9 - 121.6
291367 - Immature Granulocytes 0.0 0.0 0.0 0.0 0.0 % 0.0 - 2.0
291368 - Immature Grans (Abs) 0.0 0.0 0.0 0.0 0.0 % 0.0 - 0.1
291370 - ..
291371 - Comments:
291372 -
291373 - a. Test Performed at...
291374 - Health Testing Centers
291375 - 2760 W. OAKLAND PARK BLVD.
291376 - FORT LAUDERDALE FL 33311
291377 -
291379 - ..
291380 - WBC 10.6 High End of Range
291381 -
291382 - Follow up ref SDS 85 EC5L, ref SDS 82 EC5L.
291383 -
291384 - WBC 10.6, declined significantly from persistently elevated WBC > 12
291385 - over past 6 months. ref SDS 85 FK6I,
291387 - ..
291388 - Decline in WBC may reflect emergency (exigent) care in Podiatry to
291389 - resolve infectious blisters on 141021 1411. ref SDS 78 DR9G
291391 - ..
291392 - Decline may further result in part from EGD dilation on 141107, that
291393 - resolved swallowing stricture in LESV. ref SDS 80 VV6N Prior to
291394 - Heller Myotomy surgery to recover from achalasia on 091216 0600,
291395 - ref SDS 8 KE9U, WBC was elevated for several years. On 050816, Doctor
291396 - Sandhu reported WBC elevated and ordered retest. ref SDS 2 G540 CBC
291397 - retest was ordered and WBC remained high on 050818, so the doctor
291398 - prescribed antibiotics. ref SDS 3 BM8O Initial diagnosis of achalasia
291399 - cited persistent elevated WBC part of patient profile, reported on
291400 - 051202 1430. ref SDS 4 H26M
291402 - ..
291403 - Increased exercise the past 4 months may have stimulated bone marrow
291404 - to produce more new blood cells that maintain WBC elevated at high end
291405 - of range, explained by Doctor Johnson during a meeting at Kaiser on
291406 - 030606. ref SDS 1 JP7G In November hiked over 300 miles and over 100
291407 - miles the last week in November. Similarly, last week in December
291408 - hiked 127 miles. January yielded hiking only 242 miles due to severe
291409 - weather and injuries.
291411 - ..
291412 - WBC elevated at high end of range indicates EPCs may also be elevated
291413 - by increased endurance exercise, e.g., hiking 127 miles the last week
291414 - in December and hiking 11 miles per day for last 14 days in a row.
291415 - Testing for elevated EPC will show likelihood of regression from
291416 - atherosclerosis, based on elevated HDL 66 reported in labs today,
291417 - shown below. ref SDS 85 U45J
291418 -
291419 -
291420 -
291421 -
291422 -
291423 -
291424 -
2915 -
SUBJECTS
Urinalysis Lab VA No Results
4403 -
440401 - ..
440402 - Urinalysis Ketones Trace Abnormal Sp Gravity Above Range
440403 -
440404 - Follow up ref SDS 85 0X72, ref SDS 82 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 85 0X72
440416 - ..
440417 - For some reason VA did not test Urinalysis panel today for evaluating
440418 - persistent elevated WBC past 6 months. Labcorp performed Urinalysis
440419 - yesterday, shown here for reference...
440421 - ..
440422 - Labcorp and Liposcience lab report stored in...
440423 -
440424 - F:\05\00003\SM\CC\AGMJ\20150208-145200\ROD_WELCH.pdf
440425 -
440427 - ..
440428 - URINALYSIS PANEL
440429 - x
440430 - Dates.......... 2015 02 08 1452 141201 141020 140814 140514 140203 140201 120509
440431 - Labcorp Labcorp Labcorp VA VA Labcorp VA Labcorp VA VA Labcorp
440432 - Results Results Results Results Results Results Results Results Results Units Range Range
440433 - PH 6.0 5.5 6.0 6.0 5.5 5.5 6.0 5 - 9 5.0 - 7.5
440434 - PROTEIN NEG Trace Trace NEG NEG NEG NEG mg/dL NEG - TRACE NEG - TRACE
440435 - GLUCOSE NEG NEG NEG NEG NEG NEG NEG mg/dL Ref: NEG NEG
440436 - KETONES 1+ Abnormal 1+ Abnormal Trace Abnormal 15 Trace Abnormal NEG NEG mg/dL Ref: NEG NEG
440437 - BILI NEG NEG NEG NEG NEG NEG NEG Ref: NEG NEG
440438 - BILIcnf Ref: NEG
440439 - BLOOD TRACE TRACE TRACE TRACE Ref: NEG
440440 - NITRITE, URINE NEG NEG NEG NEG NEG NEG NEG Ref: NEG NEG
440441 - UROBILI 0.2 0.2 0.2 0.2 0.2 0.2 0.2 EU/dL .2 - 1 0.0 - 1.9
440442 - LEU EST NEG NEG Ref: NEG
440443 - 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
440444 - COLOR YELLOW YELLOW YELLOW YELLOW YELLOW YELLOW YELLOW
440445 - APPEAR CLEAR CLEAR CLEAR CLEAR CLEAR CLEAR CLEAR
440446 - WBC 0-5 /hpf 0 - 5
440447 - WBC ESTERASE NEG NEG NEG NEG NEG
440448 - RBC 0-2 /hpf 0 - 2
440449 - OCCULT BLOOD NEG NEG NEG NEG NEG NEG
440450 - HAYALINE CASTS NORM(0-1) per lpf 0 - 1
440451 - GRANULAR CASTS None per lpf Ref: None
440452 - CELLULAR CASTS None per lpf Ref: None
440453 - RBC/HPF NORM(0-3) per lpf 0 - 3
440454 - BACTERIA None seen 0 - 1 None seen / Few
440455 - EPITHELIAL CELLS 0-10 NORM(0-1) /hpf 0 - 10
440456 - RENAL EPITHELIAL CELLS None per lpf Ref: None
440457 - CALCIUM OXILATE CRYST Present Abnormal N/A
440458 - URIC ACID CRYSTALS NORM(0-1) per lpf 0 - 1
440459 - TRIPLE PHOSPHATE CRYST NORM(0-1) per lpf 0 - 1
440460 - AMORPHOUS SEDIMENT None per lpf Ref: None
440461 - MUCOUS Present Present Not Established
440462 - TRICHOMONAS None per lpf Ref: None
440463 - YEAST None per lpf Ref: None
440464 - CULTURE REFLEXED No
440465 - TR EPTH None per lpf Ref: None
440466 - Urobilinogen, Semi-On 0.2 0.2 0.2
440467 - NITRITE, URINE NEG NEG NEG
440468 - Microscopic Examination
440469 - Microscopic follows if indicated
440471 - ..
440472 - Comments:
440473 -
440474 - a. Test Performed at...
440475 - Health Testing Centers
440476 - 2760 W. OAKLAND PARK BLVD.
440477 - FORT LAUDERDALE FL 33311
440479 - ..
440480 - Ketones trace abnormal signals elevated physical activity, in this
440481 - case hiking 11 miles yesterday and again this morning; continues
440482 - recent labs Ketones 15 review by VA, follow up prior lab showning
440483 - Ketones trace abnormal, reported on prior lab 2 months ago on 141201
440484 - 0850, ref SDS 82 MT4L
440485 -
440486 -
440487 -
440488 -
440489 -
440490 -
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 85 KK9M, ref SDS 82 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 85 KK9M
610424 - Prior CHEM PROFILE on 150209 10120 ref SDS 0 KK9M
610425 -
610427 - ..
610428 - ELECTROLYTES - CHEM PROFILE
610430 - ..
610431 - Dates..........2015 02 09 1121 150208 141201 141021 141020 140814 140520 140514 140508 140203 140201 131015 130529
610432 - VA Labcorp Labcorp VA Labcorp VA VA VA Labcorp VA Labcorp VA VA VA Labcorp
610433 - PLASMA Results Results Results Results Results Results Results Results Results Results Results Results Results Units Range Range
610434 - GLUCOSE 108 89 104 H 110 H 105 98 98 97 103 98 108 H 120 mg/dL 65 - 115 65.0 - 99.0
610435 - GLUfast mg/dL Ref: <=99
610436 - NA (salt) 145 144 147 H 138 144 144 139 144 140 140 139 139 mmol/L 136 - 144 134.0 - 144.0
610437 - K (potassium) 5.5 H 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
610438 - CL 109 103 106 103 H 108 H 108 102 105 103 102 105 105 mmol/L 98 - 106 97.0 - 108.0
610439 - CO2 29 28 29 29 29.0 30.0 37.0 30.0 mmol/L 23 - 33
610440 - AGAP 7.0 7.0 8.0 mmol/L 5 - 20
610441 - BUN 29 H 26 H 28 H mg/dL 8 - 26 8.0 - 27.0
610442 - * BUN/Creati Ratio H 26 H 24 H 22 H 28 19 H 23 17 20 24 18 10.0 - 22.0
610443 - CREAT 0.9 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
610444 - eGFR INA 80 77 64 91 66 >60 102 79 >60 91 >60 >60 mL/min Ref: >=60 >59
610445 - eGFR IA 89 74 76 92 106 mL/min >59
610446 - CALCIUM 9.6 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
610447 - CA CORR mg/dL 8.7 - 10.2
610448 - PO4 mg/dL 2.4 - 4.5
610449 - MG 85 mg/dL 1.8 - 2.5
610450 - ALK PHO 98 96 107 85 86 100 105 84 87 U/L 40 - 125 39.0 - 117.0
610451 - SGOT 27 U/L 5 - 35
610452 - SGPT 28 U/L 7 - 56
610454 - ..
610455 - 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
610456 - 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
610457 - Bilirubin, Indir 1.19 H 1.52 H H 1.62 0.98 1.26 H mg/dL 0.10 - 0.80
610458 - AST (SGOT) 23 26 31 25 23 26 23 21 20 22 IntUnits/L 8 - 42 0.0 - 40.0
610459 - ALT (SGPT) 18 23 30 21 21 17 21 19 17 19 IntUnits/L 5 - 55 0.0 - 44.0
610460 - ALBUMIN 4.5 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
610461 - 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
610462 - Globulin, Total 2.1 1.9 2.1 2.0 2.1 g/dL 1.4 - 4.5
610463 - A/G Ratio 2.3 2.5 2.3 2.3 2.1 1.1 - 2.5
610464 - LDH 240 H 241 H 223 200.0 180.0 IntUnits/L 90 - 208 0.0 - 225.0
610465 - GGT 13 11.0 9.0 IU/L 0.0 - 65.0
610466 - Iron, Serum 89 101 146 100.0 114.0 ug/dL 40.0 - 155.0
610467 - AMYLASE Units/L 28 - 100
610468 - LIPASE Units/L 7 - 58
610469 - NH3 mcmol/L 15 - 56
610470 - URIC AC 5.4 5.4 5.3 6.9 5.6 mg/dL 4.8 - 8.7 3.7 - 8.6
610471 - ..
610472 - Cholesterol, Total 167 161 174 164.0 162.0 mg/dL 100.0 - 199.0
610473 - Triglycerides 60 66 79 55.0 64.0 mg/dL 0.0 - 149.0
610474 - HDL Cholesterol 68 67 61 > 39
610475 - LDL Cholesterol 87 81 96 0 - 99
610476 - T Chol/HDL ratio 2.5 2.4 2.8 0.0 - 5.0
610477 -
610478 - Please Note:
610479 -
610480 - T Chol/HDL Ratio Men Women
610481 -
610482 - 1/2 Avg Risk 3.4 3.3
610483 - Avg Risk 5.0 4.4
610484 - 2x Avg Risk 9.6 7.1
610485 - 3x Avg Risk 23.4 11.0
610487 - ..
610488 - Estimated CHD Risk <0.5 times avg 0.0 - 1.0
610489 -
610490 - T Chol/HDL Ratio Men Women
610491 -
610492 - 1/2 Avg Risk 3.4 3.3
610493 - Avg Risk 5.0 4.4
610494 - 2x Avg Risk 9.6 7.1
610495 - 3x Avg Risk 23.4 11.0
610497 - ..
610498 - The CHD Risk is based on the T Chol/HDL ratio.
610499 - Other factors affect CHD Risk such as hypertension,
610500 - smoking, diabetes, severe obesity, and family history
610501 - of premature CHD.
610503 - ..
610504 - On 150212 called Health Testing Centers and talked with Karen. She
610505 - said that the table below "T Chol/HDL ratio" above, ref SDS 85 1O6N, is
610506 - identical to the table below "Estimated CHD Risk", also above.
610507 - ref SDS 85 AL5J
610509 - ..
610510 - Comments VA test 150209...
610511 -
610512 - a. Ordering Provider: Madhu Rao
610513 - Report Released..: Feb 09, 2015@11:59
610514 - Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]
610515 - 4150 CLEMENT STREET
610516 - SAN FRANCISCO, CA 94121-1545
610517 - Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]
610518 -
610520 - ..
610521 - Comments Labcorp test 150208...
610522 -
610523 - a. Test Performed at...
610524 - Jenny Galloway, MD
610525 - LabCorp San Diego
610526 - 13112 Evening Creek Dr So Ste 200, San Diego, CA 92128-4108
610528 - ..
610529 - For inquiries, the physician may contact Branch:
610530 - 800-762-4344 Lab: 858-668-3700
610531 -
610532 -
610533 -
610535 - ..
610536 - Notes on Electrolytes Lab Hyperbilirubinemia Potassium Heart Problems
610537 - Hyperbilirubinemia Potassium Heart Problems Notes on Electrolytes Lab
610538 - Potassium Heart Problems Hyperbilirubinemia Notes on Electrolytes Lab
610539 -
610540 - Follow up ref SDS 85 G34G, ref SDS 82 G34G.
610541 -
610542 - 1. T Bilirubin 1.5...0.3 - 1.2..... ref SDS 85 015M
610544 - ..
610545 - Collection DT T Bili Range Source
610546 - 02/08/2015 14:52 1.5 H...0.3 - 1.2.. ref SDS 85 015M
610547 - 01/12/2014 08:40 1.9 H...0.3 - 1.2.. ref SDS 82 015M
610548 - 20/10/2014 10:60 2.0 H...0.3 - 1.2.. ref SDS 75 015M
610549 - 14/08/2014 15:28 2.5 H...0.3 - 1.2.. ref SDS 70 WJ5H
610550 - 20/05/2014 10:20 1.2 ....0.3 - 1.2.. ref SDS 66 015M
610551 - 08/05/2014 11:49 1.3 H...0.0 - 1.2.. ref SDS 60 015M
610552 - 03/02/2014 09:52 2.1 H...0.3 - 1.2.. ref SDS 53 015M
610553 - 01/02/2014 12:28 1.6 H...0.0 - 1.2.. ref SDS 52 015M
610554 - 15/10/2013 08:25 1.7 H...0.3 - 1.2.. ref SDS 40 015M
610555 - 29/05/2013 08:18 1.3 H...0.3 - 1.2.. ref SDS 38 1Y9G
610556 - 28/02/2013 08:36 1.3 H...0.3 - 1.2.. ref SDS 36 6S4F
610557 - 31/08/2012 15:24 2.3 H...0.3 - 1.2.. ref SDS 27 NV9M
610558 - 09/05/2012 11:24 2.5 H...0.3 - 1.2.. ref SDS 26 O46K
610559 - 09/02/2012 11:18 1.8 H...0.3 - 1.2.. ref SDS 22 KK9M
610560 - 17/11/2011 14:27 1.3 H.............. ref SDS 20 KK9M
610561 - 13/10/2011 14:35 1.3 H.............. ref SDS 19 GM65
610562 - 27/07/2011 12:58 2.0 H.............. ref SDS 16 GM65
610563 - 07/12/2010 09:17 1.0 ............... ref SDS 15 GM65
610564 - 21/07/2010 08:54 1.3 H.............. ref SDS 11 GM65
610565 - 14/12/2009 1.3 H ............. ref DRP 1 DE4O
610566 - 02/11/2009 0.9 ............... ref DRP 1 LG4L
610567 - 13/08/2009 15:09 1.7 H.............. ref SDS 5 VG8R
610569 - ..
610570 - On 131017 1000 VA medical chart Progress Notes assessment
610571 - reports Doctor Egan diagnosed chronic hyperbilirubinemia.
610572 - ref SDS 42 PSXT
610574 - ..
610575 - For some reason VA did not test T Bilirubin for recovery from
610576 - diagnosis of hyperbilirubinemia associated with statin
610577 - medication treating hyperlipidemia.
610579 - ..
610580 - T Bilirubin 1.5 elevated slightly above range shows decline
610581 - from 1.9 in lab 2 months ago on 141201, and dramatic decline
610582 - from Bilirubin 2.5 reported for lab at VA Martinez Clinic
610583 - performed 6 months ago on 140814 1530. ref SDS 70 015M This
610584 - latest result for T Bili in patient history, may demonstrate
610585 - chronic side effects statin medications causing poor liver
610586 - function, as reviewed previously on prior lab on 140514 0950.
610587 - ref SDS 63 G34G Side effects of peripheral neuropathy in right
610588 - foot have ebbed and flowed, reported on 140510, shown in case
610589 - study on 120101 0900. ref SDS 21 TV6I
610591 - ..
610592 - Bilirubin may have declined this cycle because statin treatment
610593 - was reduced by missing treatment for 12 days due to delays
610594 - receiving refills for Ezetimibe, reported to VA in the letter
610595 - on 141218 0359. ref SDS 83 5N3O Effects missing statin
610596 - treatment further evident when prescription was resumed on
610597 - delivery of Ezetimibe. Patient suffered significant
610598 - dehydration for several weeks readjusting to statin treatment,
610599 - shown by frequent urination and feet becoming dry with skin
610600 - cracking and bleeding. The problem was compounded by pausing
610601 - hiking 11 miles per day due to weather and injuries. Several
610602 - weeks after weather improved and injuries were resolved through
610603 - healing and bandaging resuming hiking 11 miles per day further
610604 - resolved dehydration, shown by resolution of cracking and
610605 - bleeding on bottom of both feet.
610607 - ..
610608 - On 140819 0800 during meeting with Doctor Sandhu in Primary
610609 - Care VA Clinic in Martinez, there was no review of chronic
610610 - hyperbilirubinemia, with T Bilirubin 2.5 rising 110% above
610611 - range, ref SDS 72 9K7I, shown in lab ordered by the doctor on
610612 - 140814. ref SDS 70 015M
610614 - ..
610615 - Background on Rosuvastatin causing elevated T Bilirubin with
610616 - associated severe side effects is reported on 121206 0900,
610617 - ref SDS 32 NI9L, and further explained in the record on 121130
610618 - 0846. ref SDS 31 ER4K
610620 - ..
610621 - On 131017 1000 Doctor Egan explained patient history of
610622 - intermittant and mild peripheral neuropathy that correlates
610623 - with persistent elevated T Bilirubin in lab on 131015,
610624 - ref SDS 40 015M, and further reported with vitals, diet and
610625 - exercise since prior meeting at VA on 130603, see case study on
610626 - 120101 0900, ref SDS 21 X14N, suggests intervention is not
610627 - required at this time to improve recovery from side effects
610628 - taking Rosuvastatin. ref SDS 42 LV5J
610629 -
610631 - ..
610632 - 2. Potassium K 5.5 above range.................. ref SDS 0 ZG5O
610633 -
610634 - Potassium 5.5 in VA lab comparable to 5.3 in Labcorp results
610635 - rising 20% above VA range of 4.8, and noticably above prior VA
610636 - results of Potassium 4.4 on 141021, may reflect increased
610637 - hiking since last VA test, see history of hiking mileage below.
610638 - ref SDS 0 ZY7M
610640 - ..
610641 - Similarly, dramatic decline in hiking for 6 weeks from June to
610642 - August last year (see again hiking history below, ref SDS 0
610643 - ZY7M), and reported on the agenda for meeting with Doctor
610644 - Sandhu in Primary Care, which was submitted on 140814 2227.
610645 - ref SDS 71 K098, may correlate with potassium falling back
610646 - within range, at that time. This record shows correlation
610647 - between elevated Potassium and extended endurance hiking.
610649 - ..
610650 - Doctor Egan, referring cardiology physician at Martinez VA,
610651 - noted in a letter that meeting at VA Medical Center in San
610652 - Francisco on 140213 0830, ref SDS 56 GT7G, did not address
610653 - elevated potassium in labs performed by Labcorp and VA, shown
610654 - on 140203 1147. ref SDS 53 ZG5O Doctor Egan again notified
610655 - that this condition of elevated potassium represents exposure
610656 - to "electrical problems" with the heart, reported on 140430.
610657 - ref SDS 58 UV5I
610659 - ..
610660 - Doctor Egan was concerned last year about potassium (K) rising
610661 - above range for good health. He explained potassium effects
610662 - electrical signals to the heart, and so has significance for
610663 - CVD, reported during meeting at VA on 121206 0900. ref SDS 32
610664 - 6K56
610666 - ..
610667 - At that time on 121206, the doctor cited medication conflicts
610668 - as possibly causing elevated potassium. ref SDS 32 FI7L Doctor
610669 - Egan further considered dehydration (urination) caused by
610670 - Rosuvastatin may have skewed lab results for electrolytes on
610671 - 121130, and so ordered re-test. ref SDS 32 6K4J
610673 - ..
610674 - On 121212 0941 re-test lab reported Glucose 111, sodium 139,
610675 - and potassium (K) 4.6, all within range, ref SDS 33 KK9M,
610676 - correcting errors noted by Doctor Egan during meeting at VA on
610677 - 121206 0900. ref SDS 32 6K4J
610678 -
610680 - ..
610681 - 3. Glucose 108......65 - 115......... ref SDS 0 ZG5O
610682 -
610683 - VA test today showing glucose 108 for range 65-115 appears
610684 - comparable to Labcorp test yesterday showing glucose 89 for
610685 - range 65 - 99, and has remained within VA range, compared to
610686 - prior VA test on 141021. ref SDS 77 ZG5O
610688 - ..
610689 - Diabetes concern from reduced hiking due to metatarsalgia side
610690 - effects, causing weight to increase at times above 180; this
610691 - has subisded the past month, because hiking increased
610692 - significantly, as set out below. ref SDS 0 DC6L
610694 - ..
610695 - On 140814 VA Martinez lab reported HGBA1c 5.6 within range 4 -
610696 - 6, seems to indicate no evident exposure for diabetes.
610697 - ref SDS 77 H66G
610699 - ..
610700 - On 140514 0950 VA lab for HGBA1c 5.4 within range 4 - 6, seems
610701 - to indicate no evident exposure for diabetes. ref SDS 63 H66G
610702 -
610704 - ..
610705 - 4. Salt NA 145..................... ref SDS 0 WJ5H
610706 -
610707 - NA salt 145 increased from prior level 138 on VA test performed
610708 - 141021, but still within range.
610710 - ..
610711 - 5. LDH 240......................... ref SDS 85 015M
610712 -
610713 - For some reason LDH was not tested in VA lab today, despite
610714 - recent history of elevated results. LDH 240 in Labcorp test
610715 - yesterday, showing slight decline may reflect reduced hiking
610716 - compared to prior test on 141201, but since hiking overall
610717 - increased to 300 miles per month LDH remains elevated above
610718 - range.
610719 -
610720 -
610721 -
610722 -
610723 -
610724 -
610725 -
610726 -
6108 -
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 85 IM9N, ref SDS 82 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 85 IM9N
810424 -
810426 - ..
810427 - LIPID PANEL
810429 - ..
810430 - Dates..........2015 02 09 1121 150208 141201 141106 0714 141021 1148 141021 1021 140814 140514 140508 140203 140201 131015 130529
810431 - VA 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 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 161 162 157 137 159 157 161 (a) 164 162 160 156 321 H 307 mg/dL 100 - 240 < 200
810443 - (b) 169
810444 - TRIGLYC 50 66 73 85 65 80 72 (a) 58 59 47 68 109 85 mg/dL 10 - 190 < 150
810445 - (b) 59
810446 - HDL-C 70 66 63 53 57 55 55 (a) 66 67 58 61 50 50 mg/dL Ref: >=35 >= 40
810447 - (b) 67
810448 - LDL-C 81 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 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 - --------------------------------------------------------
810465 - ** INTERPRETATIVE INFORMATION**
810466 - PARTICLE CONCENTRATION AND SIZE
810468 - ..
810469 - LDL AND HDL PARTICLES Percentile in Reference Population
810470 - HDL-P (total) High 75th 50th 25th Low
810471 - >34.9 34.9 30.5 26.7 <25.7
810472 - ..
810473 - Small LDL-P Low 25th 50th 75th High
810474 - <117 117 527 839 >839
810476 - ..
810477 - LDL Size <- Large (Pattern A)-> <- (Pattern B) ->
810478 - 23.0 20.6 20.5 19.0
810480 - ..
810481 - --------------------------------------------------------
810482 - Insulin Resistance/Diab. Risk
810483 - Large VLDL-P < 0.8 nmol/L <= 2.7
810484 - Small LDL-P < 90.0 nmol/L < 527
810485 - Large HDL-P 9.4 umol/L >= 4.8
810487 - ..
810488 - VLDL Size NOTES
810489 -
810490 - VLDL concentration too low to allow determination of VLDL
810491 - Size. Low VLDL concentration contributes minimally to the
810492 - LP-IR score.
810494 - ..
810495 - LDL Size 21.2 >= 20.8
810496 - HDL Size 9.8 >= 9.2
810497 -
810498 - Small LDL-P, LDL Particle Size, Large HDL-P VLDL Size, HDL
810499 - Size, HDL Particle, and LP-IR Score have been validated by
810500 - LipoScience but not cleared by US FDA; the clinical
810501 - utility of these tests has not been fully established.
810503 - ..
810504 - Insulin Resistance Score
810505 - LP-IR Score < 25 H 46.0 < 25.0 < 25.0 <= 45.0
810507 - ..
810508 - LP-IR Score is inaccurate if patient is non-fasting. The
810509 - LP-IR Score combines the information from Large VLDL-P,
810510 - Small LDL-P, Large HDL-P, VLDL Size, LDL Size and HDL Size
810511 - to give improved assessment of insulin resistance and
810512 - diabetes risk.
810514 - ..
810515 - INSULIN RESISTANCE MARKER
810516 -
810517 - <--Insulin Sensitive Insulin Resistant-->
810518 - Percentile in Reference Population
810519 -
810520 - Large VLDL-P Low 25th 50th 75th High
810521 - <0.9 0.9 2.7 6.9 >6.9
810523 - ..
810524 - Small LDL-P Low 25th 50th 75th High
810525 - <117 117 527 839 >839
810527 - ..
810528 - Large HDL-P High 75th 50th 25th Low
810529 - >7.3 7.3 4.8 3.1 <3.1
810531 - ..
810532 - VLDL Size Small 25th 50th 75th Large
810533 - <42.4 42.4 46.6 52.5 >52.5
810535 - ..
810536 - LDL Size Large 75th 50th 25th Small
810537 - >21.2 21.2 20.8 20.4 <20.4
810539 - ..
810540 - HDL Size Large 75th 50th 25th Small
810541 - > 9.6 9.6 9.2 8.9 < 8.9
810543 - ..
810544 - Insulin Resistance Score
810545 - LP-IR Score Low 25th 50th 75th High
810546 - <27 27 45 63 >63
810548 - ..
810549 - Final Report
810551 - ..
810552 - Date Issued: 02/10/15 1323 ET
810554 - ..
810555 - This document contains private and confidential health
810556 - information protected by state and federal law.
810557 - If you have received this document in error, please call
810558 - 858-668-3700
810559 -
810560 - 1995-2014 Laboratory Corporation of America® Holdings
810561 - All Rights Reserved - Enterprise Report Version 1.00
810563 - ..
810564 - 01 S7 Deanna Franke, PhD
810565 - Liposcience Inc
810566 - 2500 Sumner Blvd, Raleigh, NC 27616-3235
810567 - 877 547 6837
810568 -
810569 - customer.service@liposcience.com
810571 - ..
810572 - 02 SO Jenny Galloway, MD
810573 - Labcorp San Diego
810574 - 13112 Evening Creek Dr So Ste 200 San Diego, CA
810575 - 92128-4108
810577 - ..
810578 - For inquiries, the physician may contact Branch: 800 762 4344
810579 - Lab: 858 668 3700
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 -
810596 - ..
810597 - Comments VA test 150209...
810598 -
810599 - a. Ordering Provider: Madhu Rao
810600 - Report Released..: Feb 09, 2015@11:59
810601 - Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]
810602 - 4150 CLEMENT STREET
810603 - SAN FRANCISCO, CA 94121-1545
810604 - Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]
810605 -
810606 -
810607 -
810609 - ..
810610 - Lipid History Trend Analysis
810611 -
810612 - Follow up ref SDS 85 W25L, ref SDS 82 W25L.
810613 -
810614 - There are currently 3 tests for cholesterol performed for an
810615 - examination cycle: (1) VA, (2) Liposcience NMR lipids, and (3)
810616 - Labcorp lipids. Confidence in lab results is high when these labs are
810617 - in close proximity...
810618 -
810619 - Small LDL LP-IR
810620 - Collection DT CHOL TRIGL HDL LDL-C LDL-P HDL-P LDL-P SIZE SCORE LDL-D
810621 - 02/09/2015 11:21 161 50 70 81 ......................................... ref SDS 0 BE6O
810622 - 02/08/2015 14:52 162 66 66 83 ..709....39.5...153...21.0....< 25....... ref SDS 85 BE6O
810623 - 02/08/2015 14:52 167 60 68 87 ......................................... ref SDS 85 BE6O
810624 - 12/01/2014 08:40 157 73 63 79 ..656....38.9...310...20.4....< 25....... ref SDS 82 BE6O
810625 - 12/01/2014 08:40 161 66 67 81 ......................................... ref SDS 82 1O6N
810626 - 11/06/2014 07:14 137 85 53 67 ..997....35.2...387...20.8......30....... ref SDS 79 BE6O
810627 - 10/21/2014 11:48 159 65 57 90 ......................................... ref SDS 77 BE6O
810628 - 10/21/2014 10:21 157 80 55 86 .1586....36.4..1277...19.7......46....... ref SDS 76 BE6O
810629 - 10/20/2014 10:50 174 79 61 96 ......................................... ref SDS 75 IN5N
810630 - 08/14/2014 15:28 161 72 55 92 ......................................... ref SDS 70 BE6O
810631 - 05/14/2014 10:16 164 58 66 87 .................................... 93.. ref SDS 63 BE6O
810632 - 05/08/2014 11:49 162 59 67 83 851 38.1 < 90 21.2 < 25 ..... ref SDS 60 BE6O
810633 - 02/03/2014 12:28 160 47 58 93 ......................................... ref SDS 53 BE6O
810634 - 02/01/2014 12:31 156 68 61 81 861 31.4 < 90 21.3 < 25 ..... ref SDS 52 BE6O
810635 - 10/15/2013 08:25 321 H 109 50 249 H ......................................... ref SDS 40 BE6O
810636 - 05/29/2013 08:18 307 H 85 50 240 H ......................................... ref SDS 36 BE6O
810637 - 02/28/2013 08:39 310 H 73 47 248 H ......................................... ref SDS 36 BE6O
810638 - 11/30/2012 10:01 173 53 57 105 ......................................... ref SDS 31 BE6O
810639 - 08/31/2012 15:25 176 94 47 110 ......................................... ref SDS 27 U89N
810640 - 05/09/2012 11:24 158 76 49 94 ......................................... ref SDS 26 U89N
810641 - 02/09/2012 11:18 285 82 41 228 H ......................................... ref SDS 22 2A4G
810642 - 11/17/2011 14:27 260 84 43 200 H ......................................... ref SDS 20 2A4G
810643 - 07/27/2011 12:58 163 81 45 102 ......................................... ref SDS 16 E19L
810644 - 12/07/2010 09:17 151 41 47 96 ......................................... ref SDS 15 E19L
810645 - 07/21/2010 08:54 261 H 87 35 L 209 H ......................................... ref SDS 11 E19L
810646 - 06/10/2010 10:33 217 H 83 36 L 164 H ......................................... ref SDS 10 QV4F
810647 - * 12/14/2009 11:10 241 H 136 44 170 H ......................................... 100928 0706, ref SDS 12 VW6J
810648 - 08/13/2009 15:09 233 H 118 30 L 179 H ......................................... 100610 1046, ref SDS 10 U45G
810649 - 06/16/2006 10:59 238 H 68 32 L 192 H ......................................... 091002 0900, ref SDS 6 LJ5H
810650 -
810651 - * Lab at VA San Francisco Medical Center reported on 100928 0706.
810652 - ref SDS 12 VW6J
810654 - ..
810655 - Research on cholesterol reported on 091002 0900. ref SDS 6 2F8K
810657 - ..
810658 - On 131125 0005 research found ezetimibe (zetia) mg added to
810659 - Atorvastatin 20 mg yielded after 6 weeks significantly greater changes
810660 - to lipids than taking Atorvastatin in higher doses, e.g., 20 or 40 mg.
810661 - ref SDS 46 CO56
810663 - ..
810664 - On 131125 0005 research found discordance LDL-P low and LDL-C high
810665 - lipid panel HDL 65 TG 77 healthy patient profile with LDL 246.
810666 - ref SDS 46 MN98 Discordance with LDL-P low and LDL-C high is lowest
810667 - risk for CVD, arterialsclorosis. ref SDS 46 FI3G
810668 -
810670 - ..
810671 - Analysis....
810672 -
810673 - 1. VA results today HDL 70 and Triglycerides 50 are approximately
810674 - 20% better than Labcorp HDL 66 and TG 66, reported the day
810675 - before on 150208, ref SDS 0 U45J, indicating effects on lipid
810676 - labs from endurance exercise hiking 11 miles in 167 minutes,
810677 - i.e., 15 minute miles, for 1 more day.
810679 - ..
810680 - LDL-P 600 estimated from VA results for HDL and TG on 150809,
810681 - based on Liposcience NMR LDL-P 709 reported in lipid test the
810682 - day before on 150208, ref SDS 0 U45J, and indicating continued
810683 - improvement reported for prior lab finding LDL-P 656 on 141201
810684 - 0850. ref SDS 82 U45J
810686 - ..
810687 - The test today shows high levels of physical activity in
810688 - relation to patient history, hiking 11 miles in < 170 minutes
810689 - for 21 days in a row, including the best time ever, 158
810690 - minutes. This is a breakthrough in conditioning that exceeds
810691 - prior levels, since the longest period hiking < 170 minutes for
810692 - 11 miles was only 6 days in a row. Conditioning deteriorated
810693 - to doing 11 miles in 192 minutes on 141011, shown in case study
810694 - on 120101 0900. ref SDS 21 PUWT Now 2 tests 2+ months apart
810695 - yield comparable results, with slightly higher LDL-P this cycle
810696 - reflecting reduced hiking due to inclement weather and
810697 - injuries.
810699 - ..
810700 - 2. Research indicates healthiest cardiovascular condition occurs
810701 - with lowest risk for CVD, when lipids are discordant, with
810702 - LDL-P low and LDL-C high. However, greatest risk for CVD is
810703 - LDL-P high and LDL-C low, shown in the record on 131125 0005.
810704 - ref SDS 46 FI3G
810706 - ..
810707 - VA published goal LDL-C <= 131; Labcorp published goal LCL-C <
810708 - 100. ref SDS 63 5C7M New AHA guidelines show LDL-C < 190,
810709 - reported on 131112 1422. ref SDS 44 HT87
810711 - ..
810712 - VA lowering goal to HDL > 35, per above, ref SDS 85 5C7M, from >
810713 - 40 seems conflicting with patient history of CABG +4 on 091022
810714 - 0700. ref SDS 7 PQWU Since HDL 30 was found at that time (see
810715 - Lipid history below, ref SDS 63 W25L, setting the bar at HDL 35
810716 - has little tolerance for genetic variation to avoid and repair
810717 - endothelium lesions causing atheriosclerotic plaque.
810719 - ..
810720 - 3. Resting heart rate getting up in the mornings has dropped below
810721 - 50. Blood pressure averages about 127 68; however, systolic
810722 - often drops below 120, and diastolic often falls below 60.
810723 - After 11 mile hikes blood pressure drops to about 105 55.
810724 - Systolic on occassion falls below 90. Dystalic has fallen
810725 - below 50 - e.g., see Saturday, 141018, reported in case study
810726 - on 120101 0900, ref SDS 21 V83O Heart rate now recovers well
810727 - after strenuous exercise, often falling back below 60 within 20
810728 - minutes or so.
810730 - ..
810731 - 4. Cholesterol................... 161................ ref SDS 0 U45J
810733 - ..
810734 - 2 unit increase of cholesterol from prior test 4 months ago on
810735 - 141021, aligns with patient history showing Cholesterol has
810736 - been steady taking Atorvastatin 10 mg and Ezetimibe 10 mg for
810737 - 12 months, varying between 157 - 174. ref SDS 79 W25L This
810738 - increase may reflect 12 day pause taking Atorvastatin 10 mg and
810739 - Ezetimibe 10 mg due to delay receiving refills, reported to VA
810740 - in a letter on 141218 0359. ref SDS 83 5N3O
810742 - ..
810743 - LDL-C......................... 81................ ref SDS 0 U45J
810745 - ..
810746 - 9 unit decline of LDL-C from prior test on 141021, aligns
810747 - testing with patient history consistently 10 - 20 units above
810748 - VA goal to lower LDL-C < 70 reported in Progress Notes on
810749 - 140519 0800. ref SDS 65 OW3K LDL-C is calculated and so can be
810750 - "assumed" from the Friedwald equation...Cholesterol - HDL -
810751 - TG/5 (reported on 140213 0830. ref SDS 56 Z37L).
810753 - ..
810754 - 5. Improved lipids reflect...
810756 - ..
810757 - a. Physical activity prescribed by the VA on 140213,
810758 - ref SDS 56 E34O, has recovered after a pause of 5 months to
810759 - recover from side effects, and now continues prior levels
810760 - hiking 300+ miles per month...
810762 - ..
810763 - Mileage 2014 and Beginning 2015 Since Prior Lab
810764 -
810765 - Follow up ref SDS 85 ZY7M, ref SDS 82 ZY7M.
810766 -
810767 - 131103....Oct................. 373 5757 ...... ref SDS 21 6F9N
810768 - 131201....Nov................. 172 2899 ...... ref SDS 21 XRPV
810769 - 131229....Dec................. 234 3324 ...... ref SDS 21 XXQY
810770 - 140202....Jan................. 347 5393 ...... ref SDS 48 YWST
810771 - 140302....Feb................. 234 3681 ...... ref SDS 48 PYWS
810772 - 140330....Mar................. 207 3313 ...... ref SDS 48 RXPR
810773 - 140427....Apr................. 310 4402 ...... ref SDS 48 RXVV
810774 - 140601....May................. 322 5338 ...... ref SDS 48 SXWV
810775 - 140629....Jun................. 156 2337 ...... ref SDS 48 ZW4N
810776 - 140803....Jul................. 81 1023 ...... ref SDS 48 I37G
810777 - 140831....Aug................. 140 1998 ...... ref SDS 48 236I
810778 - 140928....Sep................. 136 2855 ...... ref SDS 48 XWUY
810779 - 141102....Oct................. 215 3540 ...... ref SDS 48 F56L
810780 - 141130....Nov................. 319 4840 ...... ref SDS 48 ST5L
810781 - 141228....Dec................. 284 4533 ...... ref SDS 48 SRTP
810782 - 150201....Jan................. 242 3687 ...... ref SDS 48 TSYW
810783 - 150208....Feb only 1 week..... 74 1122 ...... ref SDS 48 736O
810784 -
810785 -
810787 - ..
810788 - b. Weight - 177 on date of lab 150208 (see case study on
810789 - 140101 0600, ref SDS 48 736O, increased from 173 on 141201,
810790 - ref SDS 48 1N4I; yet, declined from 186 on 141011,
810791 - ref SDS 21 PUWT, but still above 163 on 140513, shown in
810792 - case study on 120101 0900. ref SDS 21 ZU5G Hiking has a
810793 - positive effect on weight consuming calories and
810794 - triglycerides, and also reducing time and interest for
810795 - eating. Lower weight tends to reduce tryglycerides, which
810796 - tends to increase LDL-P size = 21.0, as shown in current
810797 - lab, per above. ref SDS 85 5C86 Evidence indicates weight
810798 - is highly sensitive to eating and exercise, and directly
810799 - correlated to CVD risk.
810801 - ..
810802 - Week ending 121130, hiked 106 miles the most in patient
810803 - history for 1 week. ref SDS 21 ST5L
810805 - ..
810806 - On 141123 hiked 11 miles in 158 minutes, fastest pace in
810807 - patient history. ref SDS 48 OI6N
810809 - ..
810810 - Hiked 11 miles per day in < 170 minutes for 20 days in a
810811 - row; hiking 14 - 15 minute miles every day reflects order
810812 - of magnitude improvement in body condition; previous best
810813 - was only 6 days in a row. This change in body condition
810814 - may reconcile 33% decline in LDL-P 656, and 20% better than
810815 - prior best lipid report before side effect injuries that
810816 - caused hiking to decline 70%, leading to poor Lipids.
810818 - ..
810819 - The last week in December hiked 127 miles, all below 170
810820 - minutes per 11 mile lap, i.e., 15 minute miles, shown in
810821 - case study. ref SDS 48 KU6F
810823 - ..
810824 - January hiking distance declined and speed increased
810825 - slightly because of severe cold weather and also due to
810826 - injuries. This decline in endurance exercise may have
810827 - caused LDL-P to rise slightly from 656 to 709 in the
810828 - current lab on 150208, see above. ref SDS 85 U45J
810829 -
810831 - ..
810832 - c. Low-carbohydrate diet works best in this case with
810833 - elevated physical activity, because exhaustion from hiking
810834 - reduces desire/energy for eating.
810836 - ..
810837 - d. Chia seeds added to diet on 131125, reported in case study
810838 - on 120101 0900, ref SDS 21 746M, and recommended for
810839 - sustained energy hiking by Karen at VA on 131121 0930.
810840 - ref SDS 45 NQ37
810842 - ..
810843 - e. Orange juice may have increased slightly this cycle, likely
810844 - contributing to HDL 66 rising 20%, ref SDS 85 U45J, from HDL
810845 - 55 on 141021, and supplementing increased physical
810846 - activity, and as explained in the prior lab analysis on
810847 - 140514 0950. ref SDS 63 LO4J
810849 - ..
810850 - f. Atorvastatin 10 mg with Ezetimibe 10 begun on 131230,
810851 - reported in case study on 120101, ref SDS 21 6A6H, and
810852 - continued through current cycle.
810854 - ..
810855 - Cholesterol 167 remained comparable to prior level 157 on
810856 - 141021, per above, ref SDS 85 5C7M, indicating minimal
810857 - effects pausing Atorvastatin 10 mg and Ezetimibe 10 mg for
810858 - 12 days due to delays in refill processing, cited in the
810859 - letter to the VA on 141218 0359. ref SDS 83 5N3O
810861 - ..
810862 - Research studies report Atorvastatin 10 mg + Ezetimibe 10
810863 - mg achieves LDL < 70, and favorably changes triglycerides
810864 - and HDL by 5%, reported on 131125 0005. ref SDS 46 CO45
810865 - While low LDL < 70 conflicts with goal of "discordance"
810866 - that lowers health risk for arterialsclorosis and CVD when
810867 - LDL-P low and LDL-C high, shown in research on 131125 0005,
810868 - ref SDS 46 FI3G, even "concordant" results today are good
810869 - news.
810870 -
810871 -
810873 - ..
810874 - Coronary CTA or IVUS Test Athereosclerosis Plaque 4 Years After CABG
810875 - Athereosclerosis Plaque 4 Years After CABG Coronary CTA or IVUS Test
810876 -
810877 - Follow up ref SDS 85 QA4M, ref SDS 82 QA4M.
810878 -
810879 - On 131125 0005 research further found radiology imaging tests can
810880 - evaluate level of plaque build up resulting from elevated cholesterol.
810881 - ref SDS 46 N73K Radiology imaging technologies are Coronary CT
810882 - angiography - CTA - and Intravascular ultrasound - IVUS. ref SDS 46
810883 - KZ8O
810885 - ..
810886 - Lipid history and particularly the past 3 months with HDL > 60 and
810887 - Triglycerides < 100, ref SDS 0 5C7M, indicates body chemestry may be
810888 - sufficient again to cause rapid regression of atherosclerosis plaque,
810889 - cited in research on 131125 0005. ref SDS 46 RA7K Research indicates
810890 - that favorable lipid profile, weight loss, and production of EPC in
810891 - the bone marrow, all stimulated by exercise, drives regression of
810892 - plaque. ref SDS 46 XY7L
810894 - ..
810895 - The next step monitoring results of medical, diet, and exercise
810896 - interventions the past 4 years, since CABG +4 on 091022 0700,
810897 - ref SDS 7 PQWU, is to perform radiology testing with coronary CT
810898 - angiography or IVUS to assess regression of atherosclerosis plaque,
810899 - which previously required major surgery to fix.
810901 - ..
810902 - This step is supported by patient history using CT radiology imaging
810903 - to assess regression of esophageal bubble after 4 years of medical
810904 - interventions, reported favorable by Doctor Stewart, Chief General
810905 - Surgery at VA on 130122 1330. ref SDS 34 03H6 CT radiology with
810906 - calcium score is commonly used to assess response to treatment for
810907 - regression of athersclerosis, reported during the meeting at the VA on
810908 - 140519 0800. ref SDS 65 OF7N
810909 -
810910 -
810911 -
810912 -
810913 -
810914 -
810915 -
810916 -
810917 -
810918 -
810919 -
810920 -
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 85 D26G, ref SDS 82 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 150208, nor by
890413 - the VA with blood draw today. Most recent testing showed...
890414 -
890415 - CARDIAC ENZYMES
890416 -
890417 - Dates 2014 05 14 1016 140508 140203 131015 120509
890418 - VA Labcorp VA VA VA
890419 - PLASMA Results Results Results Results Results Units Range
890420 - CPK (CK) 192 149 110 152 U/L 30 - 235
890421 - TRPONIN ng/ml 0 - 0.07
890422 - CK-MB ng/ml 0.6 - 3.5
890423 - MYOGLOB ng/ml 20 - 82
890425 - ..
890426 - a. CPK/CK test not performed by Labcorp
890428 - ..
890429 - b. SLIGHTLY ICTERIC SPECIMEN /HN
890431 - ..
890432 - c. Ordering Provider: Diana Alba
890433 - Report Released..: May 14, 2014@11:29
890434 - Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]
890435 - 4150 CLEMENT STREET
890436 - SAN FRANCISCO, CA 94121-1545
890437 - Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]
890439 - ..
890440 - CKP and CK are the same thing - creatine phosphokinase (CPK) also
890441 - called creatine kinase (CK).
890442 -
890443 - http://www.scai.org/SecondsCount/Resources/Detail.aspx?cid=ed385473-d4e8-491e-9ce0-a7c984fe6f8e#.U3b_BfldWi8
890445 - ..
890446 - Research on 111013 explains Creatine Kinase CK, relates to muscle
890447 - disorders caused by cholesterol medications with statins. 111013 1404,
890448 - ref SDS 19 J54K
890450 - ..
890451 - CK lab may align with reduced side effects of muscle pain in left
890452 - shoulder.
890453 -
890454 -
890455 -
890456 -
890457 -
890458 -
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 85 9F4O, ref SDS 82 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 150208, nor by
A60415 - the VA with blood draw today. Most recent testing showed...
A60417 - ..
A60418 - Endocrine IV - HGBA1c - A1c
A60419 -
A60420 - Dates..........2014 08 14 1528 140514 140508 140203 131015 101207
A60421 - VA VA Labcorp VA VA VA
A60422 - BLOOD Results Results Results Results Results Results Units Range
A60423 - HGBA1c 5.6 5.4 5.5 5.5 5.7 % 4.0 - 6.0
A60424 - eAG 114 111 111 mg/dL 74.0 - 118
A60426 - ..
A60427 - Comments:
A60428 -
A60429 - a. Labcorp did not perform HGBA1c lab
A60430 -
A60431 - b. Ordering Provider: Diana Alba
A60432 - Report Released..: May 14, 2014@11:29
A60433 - Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]
A60434 - 4150 CLEMENT STREET
A60435 - SAN FRANCISCO, CA 94121-1545
A60436 - Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]
A60438 - ..
A60439 - This test for diabetes was ordered by Doctor Abrams during a meeting
A60440 - at the San Francisco VA Medical Center on 130227 0930. ref SDS 35 8T5L
A60441 - However, it is not reported for the lab performed the next day on
A60442 - 130228 1140, ref SDS 36 RP4N, nor in the follow up lab 3 months later
A60443 - on 130529 0818. ref SDS 38 RP4N
A60445 - ..
A60446 - HGBA1c was performed previously on 101207 0906, ref SDS 15 IL4N, and 5
A60447 - months earlier on 100721 0800. ref SDS 11 IL4N
A60449 - ..
A60450 - Labcorp test showing LP-IR Score < 25.0, indicating very low risk of
A60451 - diabetes. ref SDS 82 TU6L
A60452 -
A60453 -
A60454 -
A60455 -
A60456 -
A60457 -
A60458 -
A60459 -
A60460 -
A60461 -