CONTACTS 
0201 - Kaiser Permanente - Shadelands                                                                                                                                     O-00000718 0305
020101 - Walnut Creek                                                                                                                                                     O-00000718 0305
020102 - Ms. Nanette NLN; Nurse                                                                                                                                           O-00000718 0305
020103 - Primary Care
0202 - Kaiser Permanente - Shadelands                                                                                                                                     O-00000718 0604
020201 - Walnut Creek, CA                                                                                                                                                 O-00000718 0604
020202 - Ms. Tracy Wong                                                                                                                                                   O-00000718 0604
020203 - Pharmacy Department                                                                                                                                              O-00000718 0604

SUBJECTS
Primary Care Physician
Exam 990628 Physical, Prostrate Cancer
Blood Tests
Cholesterol

0706 -
0706 -    ..
0707 - Summary/Objective
0708 -
070801 - Follow up ref SDS 8 0000, ref SDS 7 0000.
070802 -
070803 - Received report on physical exam.  It confirms bad news on cholesterol
070804 - reported by Tracy last week.  Also received Tracy's letter in the
070805 - mail. Medication options are offered.
070806 -
070807 -
070809 -  ..
0709 -
0710 -
0711 - Discussion
0712 -
071201 - Called Nannett.
071202 -
071203 - Thanked her for coordinating with Tracy, per our call last week.
071205 -  ..
071206 - We have received the letter from Tracy.
071208 -  ..
071209 - Nannette said she did not open the letter to Syed.  She only
071210 - forwarded it to him.
071212 -  ..
071213 - Syed is not in the office again today.
071214 -
071215 -
071217 -  ..
0713 -
0714 -
0715 - 1304
0716 -
071601 - Received ref DRT 1 dated 990701, from Syed at Kaiser, showing
071602 - following results of blood tests on 990628. ref SDS 3 1734
071603 -
071604 -        Test Description      Result          Normal  Range
071605 -        ----------------      ---------      -------  ------
071606 -        LIPID
071607 -        Cholesterol       H    331mg/dL          <      239
071609 -         ..
071610 -        Triglycerides          123mg/dL          <      399
071612 -         ..
071613 -        HDL Cholesterol         44mg/dL          >       35
071615 -         ..
071616 -        LDL Calculated    H    262mg/dL          <      129
071618 -         ..
071619 -        Glucose Fasting         92mg/dL         60      115
071620 -  ..
071621 -        Prostate PSA           1.1ng/mL          0.0      4.0
071622 -
071623 -        Thyroid Test TSH       4.1 uIU/mL        0.2      5.5
071624 -
071626 -  ..
071627 - This report confirms discussion with Tracy on 990713, and later with
071628 - Nannett. ref SDS 7 7469
071629 - ..
071630 - Received ref DRT 2 from Tracy, dated 990713.
071632 -  ..
071633 - Tracy says she tried to send the letter via email, but it did not go
071634 - through.
071636 -  ..
071637 - That is because she appended "internet" to my email address thus...
071638 -
071639 -
071640 -                      rowelch@ibm.net@internet
071641 -
071642 -
071643 -      ...possibly, the appended string is used internally at Kaiser to
071644 -      send email through the Internet.
071645 -
071646 -
071648 -  ..
071649 - Cholesterol - Medication Suggested
071650 -
071651 - Syed's explanation says Cholesterol is 1 of many risk factors for
071652 - heart disease. A desirable number is less than 240 mg%. ref DRT 1 7655
071653 -
071654 -     Healthwise Handbook says above 240 is high risk, shown on 990713.
071655 -     ref SDS 7 1176
071657 -      ..
071658 -     Syed's explanation of "desirable" does not seem to align with the
071659 -     ordinary meaning of "high risk" in Healthwise.
071661 -  ..
071662 - My letter to Syed on 990713, ref DIP 4 8774 suggestes re-test to avoid
071663 - errors in testing. ref SDS 7 4510
071664 -
071665 -      [On 990811 discussed re-test with Syed. ref SDS 10 7933]
071667 -  ..
071668 - Tracy's letter on 990713 says...
071669 -
071670 -     Kaiser reviewed the Welch medical history. ref DRT 2 5980
071671 -
071672 -        This aligns with Syed's comment on 990628 that he relies on
071673 -        medical history. ref SDS 3 2223
071675 -         ..
071676 -        It aligns with Kaiser guidelines on communication for doctors
071677 -        to use medical history, reviewed on 990625. ref SDS 2 0806
071679 -         ..
071680 -        Would like to see the medical history.  Experience so far shows
071681 -        it has been difficult to report history.
071682 -
071683 -           [On 000124 reviewed medical chart. ref SDS 11 3862
071685 -         ..
071686 -        Does this mean that Erick solved the computer problem reported
071687 -        on 990708? ref SDS 6 4896
071689 -      ..
071690 -     LDL goal should be < 190. ref DRT 2 5980
071691 -     ..
071692 -     Because LDL is quite high, we ...offer medication options.
071693 -
071694 -     •  ...B vitamin called niacin is very effective in lowering
071695 -        cholesterol -- side effect: mainly flushing.
071696 -
071697 -     •  ...lovastatin - side effect: liver inflammation, muscle aches.
071699 -      ..
071700 -     We will probably have to do some periodic lab monitoring while you
071701 -     are on these medications. ref DRT 2 7000
071702 -
071703 - ..
071704 - Eating right for a healthy hear...
071705 - 
071706 -    Tracy's letter includes a document that has guidelines for healthy
071707 -    diet.
071708 -
071709 -    I tried to scan it, but the print is too difficult for the computer
071710 -    to read.
071712 -     ..
071713 -    Main point is to keep fat intake to < 30% of calories.
071714 -
071715 -    ...choose foods high in starch and fiber.
071717 -     ..
071718 -    Avoid...
071719 -
071720 -        ice cream, candy, potato chips, milk, cheese, bacon, coconut,
071721 -        sweet rolls, goose, regular lucheon meats, hot dogs, etc.
071722 -
071723 -
071724 -
071725 -
071726 -
071727 -
0718 -

SUBJECTS
Prostrate Cancer Testing

0803 -
080401 -  ..
080402 - Prostate Cancer Test, PSA, Indicates Normal Condition
080403 -
080404 - The blood test results indicate a valuation of 1.1 and that a normal
080405 - range is 4.0.  On 940708 got input on interpreting test results.
080406 - ref SDS 1 9667
080407 -
080408 - Syed's explanation of these results is not informative. ref DRT 1 3716
080409 -
080410 -    [On 990720 received article saying 4.0 is abnormal test result that
080411 -    indicates potential for cancer. ref SDS 9 0899]
080413 -     ..
080414 -    [On 990730 same article says results are false in 30% of cases....
080415 -    ref SDS 9 1440]
080417 -  ..
080418 - These results, in combination with the examination on 990628, as shown
080419 - at ref SDS 3 1584, provide an indication that prostate cancer is not
080420 - an issue at this time.
080421 -
080422 -
080423 -
080424 -
080425 -
080426 -
080427 -
080428 -
080429 -
0805 -