CONTACTS
SUBJECTS
Examination Heart Surgery Recovery Good Health Improved Achalasia He
2203 -
2203 - ..
2204 - Summary/Objective
2205 -
220501 - Follow up ref SDS 54 0000. ref SDS 51 0000.
220502 -
220503 -
220504 -
220505 -
220506 -
220507 -
220509 - ..
2206 -
2207 -
2208 - Background
2209 -
220901 - On 090908 1130 Doctor Lee prepared work plan, ref SDS 10 BU6W, for
220902 - treating achalasia and including resolving new symptom of chest pains.
220903 - ref SDS 10 FT6M
220905 - ..
220906 - On 091002 met with Doctor Egan, Cardiologist at the VA. The doctor
220907 - advised that 10 of 11 test points in the stress test showed positive
220908 - for circulation problems, and so the doctor ordered angiogram.
220909 - ref SDS 11 1W5I
220911 - ..
220912 - 091021 0716 Meeting at VA to complete angiogram test meeting,
220913 - ref SDS 12 01F9, and perform test. ref SDS 12 025B Results show
220914 - requirement for heart bypass surgery. ref SDS 12 7L47
220916 - ..
220917 - On 091022 0700 Doctor Tseng, Casey and others performed quadruple
220918 - heart bypass surgery at VA in San Francisco. ref SDS 13 01F9
220920 - ..
220921 - On 091031 0730 discussed scheduling surgery to fix achalasia problem
220922 - as essential predicate to maintain nutrition required for recovering
220923 - from heart surgery. ref SDS 16 PW5H
220925 - ..
220926 - On 091103 Paula reported the VA has scheduled a meeting today with
220927 - Doctor Stewart for planning Heller Myotomy surgery to correct
220928 - achalasia problem. ref SDS 18 PS60 On 091104 0718 Medical Chart
220929 - discharge guidance lists meeting with Doctor Stewart 091117 1300,
220930 - which conflicts with patient history today. ref SDS 19 Q03J On 091119
220931 - 1000 Erick confirmed visit with Doctor Stewart on 091208, and is
220932 - reviewing date of surgery scheduled for 091217. ref SDS 21 935H
220934 - ..
220935 - On 091104 0718 discharged from VA recovering from quadruple heart
220936 - bypass surgery, ref SDS 19 PR4V, performed on 091022 0700. ref SDS 13
220937 - PQWU; received medical record with list of medications, also on 091104
220938 - 0718, ref SDS 19 1Q6P, and follow up meetings. ref SDS 19 9T6O
220940 - ..
220941 - On 091208 Doctor Stewart advanced the schedule for surgery one day to
220942 - 091216. ref SDS 23 6E41
220944 - ..
220945 - On 091216 0600 meeting Doctor Stewart for Heller Myotomy surgery to
220946 - correct achalasia; check in at ASU. ref SDS 27 PP8W
220948 - ..
220949 - On 091217 0600 meeting with Joe and Jon on recovring from Heller
220950 - Myotomy surgery; report of complication during surgery on 091216,
220951 - which was repaired, with plan for test to evaluate recovery. reported
220952 - on 091217 0600, ref SDS 28 0042 Doctor Stewart visited and expects
220953 - can start eating after favorable test. ref SDS 28 027A
220955 - ..
220956 - On 091218 0600 xray with gastrogafin to evaluate repair for
220957 - complicaiton during Heller Myotomoy surgery Wednesday, ref SDS 29 PP8W,
220959 - ..
220960 - On 091219 0600 doctor plans discharge tomorrow after evaluating
220961 - progress eating solid food today. ref SDS 30 PP5V Since now eating
220962 - solid food, switched to oral pill medication to replace IV injections;
220963 - this relieved pain that has been increasing using IV catheters set on
220964 - Wednesday, ref SDS 30 PQPX, and also eliminated need to replace IV
220965 - catheters per TCU protocol. ref SDS 30 7Q55 Doctors prescribed hiking
220966 - to recover from Heller Myotomy surgery resolving achalasia.
220967 - ref SDS 30 7Q6P Doctor Ratcliff and Neil visit and discuss doing a
220968 - small business trial to apply SDS technology for upgrading VA and UCSF
220969 - case management. ref SDS 30 0M6S Nurse advises that patient approved
220970 - for moving to a ward for non-critical care, as a predicate to
220971 - discharge, but since there are no rooms available, patient will remain
220972 - in TCU untill a room is available. ref SDS 30 0M8S
220974 - ..
220975 - On 091220 0527 discharge approved from hospital today. ref SDS 31 PP8W
220976 - Left the hospital about 1220. ref SDS 31 HB5O
220978 - ..
220979 - On 091221 1532 Isagani called to schedule meeting with Doctor Stewart
220980 - at VA in San Francisco on 100105. ref SDS 32 PP8W
220982 - ..
220983 - On 091222 1109 letter from Isagana says meeting with Doctor Stewart is
220984 - scheduled on 100112 1400. ref SDS 33 PP8W
220986 - ..
220987 - On 091223 1452 letter came in regular mail scheduling a meeting with
220988 - Doctor Stewart on 100105 1400. ref SDS 34 PP8W
220990 - ..
220991 - On 100104 0930 met with Doctor Sandhu to begin care for heart surgery
220992 - and follow up on Heller Myotomy surgery to recover from achalasia.
220993 - ref SDS 37 PP8W
220995 - ..
220996 - On 100610 1046 went to VA in Martinez and had blood draw for
220997 - cholesterol. ref SDS 39 QV4F
220999 - ..
221000 - On 100721 0800 Doctor Sandhu ordered lab in 3 months to evaluate
221001 - trends based on lab today, 100721, ref SDS 43 RP4N, and for effect of
221002 - doubling Simvastatin to control cholesterol. ref SDS 43 PP8W
221004 - ..
221005 - On 101112 Connie advised that meeting with Doctor Sandhu is scheduled
221006 - on 101223, so lab can be drawn several weeks earlier. ref SDS 51 4R4G
221008 - ..
221009 - On 101206 1542 letter to medical team with work plan to get blood draw
221010 - on 101207 to support EGD test on 101210. ref SDS 53 7Q6Q
221012 - ..
221013 - On 110415 0900 Doctor Egan added mercury (Hg) to the blood test
221014 - ordered by Doctor Sandhu to assess effects of eating tuna for lunch.
221015 - ref SDS 61 JE6O
221017 - ..
221018 - On 110429 1230 visited Connie in VA Primary Care and scheduled lab
221019 - before meeting with Doctor Sandhu in July; Connie confirmed that
221020 - Doctor Egan added mercury to the lab. ref SDS 62 UN8N
221022 - ..
221023 - On 110603 visited VA and scheduled meeting with Doctor Sandhu in
221024 - Prmary Care on 110719 0830; Connie confirmed that lab is ordered for
221025 - anytime a week before meeting with the doctor. ref SDS 64 6I5H
221027 - ..
221028 - On 110727 1238 visited VA in Martinez for lab, ref SDS 0 PP8W, Melissa
221029 - tried to correct an error in the VA medical chart that failed to
221030 - implement Doctor Egan's work plan testing for mercury in the lab
221031 - today. ref SDS 0 KG5U
221032 -
221033 -
221034 -
221035 -
221037 - ..
2211 -
2212 -
2213 - Progess
2214 -
221401 - Bloood draw was performed this morning, scheduled by Connie on 110603
221402 - 1523, ref SDS 64 6I5H, and implementing Doctor Sandhu's order planned
221403 - in the meeting on 101223 0800. ref SDS 56 RP4F
221405 - ..
221406 - When the clerk handed the lab nurse a list of labels for blood tests,
221407 - asked if there is a label for mercury.
221409 - ..
221410 - The nurse said no.
221412 - ..
221413 - Reviewed the record of Doctor Egan ordering mercury test, reported on
221414 - 110415 0900, ref SDS 61 JE6O, and that Connie in Primary Care advised
221415 - that mercury was included in the scope of the lab, reported 2 weeks
221416 - later on 110429 1230. ref SDS 62 UN8N
221418 - ..
221419 - The nurse said to go get the problem fixed in Primary Care down the
221420 - hall.
221422 - ..
221423 - After visiting with Melissa in Primary Care, returned and completed
221424 - the blood draw without mercury, as determined by Doctor Sandhu,
221425 - explained below. ref SDS 0 UT4L
221427 - ..
221428 - Results of the lab received a few days later are listed in this record
221429 - below. ref SDS 0 RP4N
221430 -
221431 -
221432 -
221434 - ..
2215 -
2216 -
2217 - 1307
2218 -
221801 - Visited with the clerk in Primary Care. Connie is not behind the desk
221802 - today. The clerk seemed to say that mercury is in the computer for
221803 - the lab today, and that she would advise the nurse in the lab, as
221804 - planned by Doctor Egan on 110415 0900. ref SDS 61 YE7M
221806 - ..
221807 - Walked back to the lab a few feet down the hall. By this time,
221808 - another customer was getting a blood draw, so there was a delay.
221809 - During this delay, after about 5 minutes a nurse opened the door from
221810 - Primary Care to the waiting area and called for a meeting.
221811 -
221812 -
221814 - ..
2219 -
2220 -
2221 - 1319
2222 -
222201 - Visited with Melissa, the manager for Primary Care Department.
222202 -
222203 - Melissa advised that the telephone message left by the VA last
222204 - Thursday saying to come in an hour early on 110803 at 0730, and before
222205 - meeting with Doctor Sandhu, and further to fast the day before meeting
222206 - the doctor on 110803 0830, reported in the record on 110724 1113.
222207 - ref SDS 65 0001, is not necessary, since arriving at 0730 on 110803
222208 - was intended to get a blood draw, so results would be available in
222209 - time for meeting with the doctor at 0830. She explained that since
222210 - the lab was done today, it is not necessary to come in an hour early
222211 - next week.
222213 - ..
222214 - Melissa feels it is good practice for communications to explain the
222215 - purpose of scheduling meetings.
222217 - ..
222218 - Melissa checked the VA computer and discovered Doctor Egan did not
222219 - enter into the medical chart his work plan for adding mercury to the
222220 - lab, reported on 110415 0900. ref SDS 61 YE7M
222222 - ..
222223 - Suggested Melissa do a general search on Doctor Egan's Progress Notes
222224 - for "mercury" or Hg, since it was discussed extensively on 110415
222225 - 0900. ref SDS 61 JE6O
222227 - ..
222228 - Melissa said her computer does not support general search, like "Ctrl
222229 - F" in a browser to find specific words and phrases.
222231 - ..
222232 - This aligns with experience in the GI Department last April, when
222233 - Kendall could not find the medical chart for 091216 showing Heller
222234 - Myotomy surgery, reported on 110429 1230, ref SDS 62 EK5J Growing
222235 - problems using computers to manage complex medical records at the VA
222236 - and everywhere was reviewed last year on 100911 0800. ref SDS 45 OL50
222238 - ..
222239 - Melissa said Progress Notes in the Cardiology Department are lengthy,
222240 - so it's easy to overlook things. She said that scanning through
222241 - Doctor Egan's file on the computer screen she cannot find anything
222242 - about adding mercury to the lab for today.
222243 -
222244 -
222246 - ..
222247 - This was surprising, since testing for mercury due to high tuna
222248 - content in the diet the past year was discussed extensively with the
222249 - doctor on 110415. ref SDS 61 JE6O
222251 - ..
222252 - Melissa asked why there is concern about mercury?
222254 - ..
222255 - During the meeting, she found following research indicating concern
222256 - for patients at the VA generally arises from occupational exposure to
222257 - mercury....
222258 -
222259 - KODI - Document View
222260 - Northern California Health Care System
222261 - Support Krames on-demand
222262 - Search Krames on-demand
222264 - ..
222265 - Mercury Test.......................... at a glance
222266 - Also known as......................... Hg
222267 - Formal name........................... Mercury Urine and Blood
222268 - Related tests......................... Lead, Arsenic, Heavy Metals
222269 - Why get tested?....................... Detect excessive exposure to Mercury
222270 - When to get tested?...................
222271 -
222272 - When you have symptoms of mercury poisening, to
222273 - evaluate a known exposure to mercury, or to monitor
222274 - occupational exposure to mercury
222276 - ..
222277 - Page 2 of the VA report states in part...
222278 -
222279 - About 95% of methyl mercury (the type found in fish and
222280 - other seafood) is absorbed by the gastrointestinal
222281 - tract. The most common source of human exposure to
222282 - methyl mercury is as a result of eating contaminated
222283 - seafood.
222285 - ..
222286 - Once mercury is absorbed it finds its way into variety
222287 - of body organs, including the kidneys and brain. The
222288 - body will slowly rid itself of mercury through the
222289 - urine and stool, but if excessive amounts are present
222290 - it can permeanently damage the kidneys, nervous system,
222291 - and brain.
222293 - ..
222294 - VA's research on adverse effects of mercury seems to align with prior
222295 - review of tuna, reported on 110331 0138. ref SDS 60 TG3Q
222297 - ..
222298 - Explained swallowing problems from achalasia, diagnosed in 2005,
222299 - 051202 1430, ref SDS 1 0001, and which Doctor Lee has treated
222300 - effectively beginning last year in March on 100305 1000, ref SDS 38
222301 - 0001, following Heller Myotmy surgery at SFMC by Doctor Stewart,
222302 - reported on 091216 0600. ref SDS 27 KE8T Since tuna is easy to
222303 - swallow, and has health benefits to reduce risks for coronary arterial
222304 - disease (CAD), including myocardial infarction (heart attack), at
222305 - issue in this case cited by Doctor Sandhu in the medical chart for the
222306 - meeting on 101223 1030, ref SDS 56 J64I, tuna has been a major part of
222307 - daily diet beginning on 101204, reported in case study on 101010 0744.
222308 - ref SDS 47 189M
222310 - ..
222311 - Melissa asked if this was discussed with Doctor Egan?
222313 - ..
222314 - Case study on 101010 0744, ref SDS 47 189M, was presented on 110415
222315 - showing diet for the past year has included tuna about 80 of the time.
222316 - ref SDS 61 G36O Doctor Egan cited VA suggestions to eat tuna twice a
222317 - week, and discussed substituting salmon for tuna to further reduce
222318 - exposure to mercury. ref SDS 61 G365
222320 - ..
222321 - Melissa looked through the medical chart again on the computer screen.
222322 - She did not notice anything about the VA recommending tuna only twice
222323 - a week, and to substitute salmon for reducing risks of exposure to
222324 - mercury, as cited in VA research performed today, per above,
222325 - ref SDS 0 UN7O, and also discussed on 110415 0900. ref SDS 61 G365
222327 - ..
222328 - We reviewed the record showing Connie seemed to indicate in a follow
222329 - up meeting 2 weeks later in the Primary Care Department that the VA
222330 - computer showed Doctor Egan added mercury to the order for the lab
222331 - today, reported on 110429 1230. ref SDS 62 UN8N
222333 - ..
222334 - Since it is easy for details to be overlooked in the medical chart,
222335 - noted by Doctor Lee on 090908 1130, ref SDS 10 HX4H, and further
222336 - finding no evident work plan for CABG surgery, from review of medical
222337 - chart on 100928 0706, ref SDS 46 SW6I, therefore, suggested calling
222338 - Doctor Egan or sending him a letter to ask about work plan to add
222339 - mercury to the lab today.
222341 - ..
222342 - Melissa related that since Doctor Egan works down the hall in the
222343 - Cardiology Department she cannot send him a letter nor call to correct
222344 - the error in the medical chart that omits the work plan on testing
222345 - for mercury in the lab today.
222347 - ..
222348 - Melissa sent a letter to Doctor Sandhu asking about Doctor Egan's
222349 - order to test for mercury eating tuna 80% of the time this past year.
222351 - ..
222352 - While waiting for Doctor Sandhu's reply, Melissa asked if the patient
222353 - is eating Albacore tuna, noting it has the worst record for health
222354 - risks from high mercury levels.
222356 - ..
222357 - Melissa received a letter from Doctor Sandhu refusing to approve
222358 - testing for mercury in the absence of Doctor Egan to clarify the
222359 - record on 110415.
222361 - ..
222362 - Melissa commented that since albacore tuna has a reputation for
222363 - dangerous levels of mercury, major manufacturers, like Chicken of the
222364 - Sea, have worked to remove mercury from tuna sold to customers in
222365 - stores like Costco.
222367 - ..
222368 - Thanked Melissa for being available to meet on short notice today, and
222369 - credited the VA for excellent patient care, reported previously in
222370 - case study in the record on
222371 -
222372 -
222374 - ..
2224 -
2225 -
2226 - 1529
2227 -
222701 - Discovered after the meeting that we have albacore tuna in the
222702 - cupboard at home, which we have been buying at Costco for the past 10
222703 - years, based on the label...
222704 -
222705 - Chicken of the Sea............. big red letters
222706 - Solid White.................... big black letters
222707 - albacore....................... small white letters
222708 - Heart Healthy.................. Omega 3
222709 - Fat Free....................... 98%
222710 - Protein........................ high
222711 - Serving size................... 2 oz 56 g .25 cup
222712 - Calories....................... 60
222713 - Cholests....................... 10 mg
222714 - Sodium......................... 140 mg 6%
222715 - Potassium...................... 75 mg 2%
222716 - Protein........................ 1300 mg 23%
222717 - Niacin......................... 30%
222718 - Vitamin B6..................... 10%
222719 - Vitamin B12.................... 10%
222720 - Vitamin D...................... 6%
222721 - Selenium....................... 90%
222723 - ..
222724 - While mercury is not listed in the ingredients, this record indicates
222725 - tuna in the diet the past years has been albacore, which Melissa
222726 - reported today contains the greatest amount of mercury, per above.
222727 - ref SDS 0 FV6K
222729 - ..
222730 - Research on the Internet found...
222731 -
222732 - SFGate.com
222733 -
222734 - Alarming find on mercury levels in canned tuna
222735 -
222736 - http://articles.sfgate.com/2003-06-19/news/17496955_1_light-tuna-tuna-foundation-canned-tuna
222738 - ..
222739 - June 19, 2003
222741 - ..
222742 - By Jane Kay, Chronicle Environment Writer
222744 - ..
222745 - One-third of canned albacore tuna tested by a nonprofit
222746 - watchdog group contained levels of toxic mercury
222747 - exceedinga federally recommended maximum dose for women
222748 - ofchild-bearing age.
222750 - ..
222751 - The study, released Wednesday by the Mercury Policy
222752 - Project in Montpelier, Vt., tested 60 cans of tuna
222753 - selected randomly from Safeway, Whole Foods, Trader Joe's
222754 - and other stores in San Francisco, Los Angeles County and
222755 - Montpelier. The brands included Starkist, Bumblebee and
222756 - Chicken of the Sea.
222758 - ..
222759 - Of the 48 cans of albacore tuna tested, 16 exceeded
222760 - levelsof 0.5 parts per million of mercury. At that
222761 - concentration, a woman of child-bearing age would be
222762 - receiving a dose twice the maximum recommended by the
222763 - U.S.Environmental Protection Agency, the study said.
222765 - ..
222766 - The report also found that canned albacore, labeled as
222767 - "white tuna," had an average level of mercury four times
222768 - that of "light" tuna. Light tuna is made up of other
222769 - typesof smaller tuna, including skipjack, and is actually
222770 - darker in color than albacore.
222772 - ..
222773 - Mercury is toxic to the human nervous system. In a
222774 - pregnant woman, it crosses the placenta and can damage
222775 - thefetus. The Centers for Disease Control and Prevention
222776 - estimates that 8 percent of U.S. women of child-bearing
222777 - age have mercury exceeding the EPA's safe dose.
222779 - ..
222780 - One of the new study's reviewers, Dr. Alan H. Stern, a
222781 - toxicologist and member of the National Academy of
222782 - Sciences committee that reviewed the EPA's safe dose
222783 - limit, said the Mercury Policy Project's calculations
222784 - were accurate.
222786 - ..
222787 - Stern, an adjunct associate professor in the School of
222788 - Public Health at the University of Medicine and Dentistry
222789 - of New Jersey, said he had known from other scientists that
222790 - albacore tuna typically tested higher. "I didn't know that
222791 - it was four times higher," Stern said.
222793 - ..
222794 - At the U.S. Tuna Foundation, an industry group in San
222795 - Diego, executive director Dave Burney said albacore tuna
222796 - doesn't pose a health threat. "There's always been a
222797 - difference between albacore and light meat because
222798 - albacore's a bigger fish. But the mercury level in
222799 - albacore canned tuna is lower than shark, swordfish and
222800 - fresh frozen tuna."
222802 - ..
222803 - Americans eat 1.2 billion cans of tuna a year, about a
222804 - quarter of it albacore, according to the industry. The
222805 - major U.S. canned tuna companies, which Burney's group
222806 - represents, believe that albacore will be vindicated when
222807 - the World Health Organization releases its mercury
222808 - recommendations this summer.
222810 - ..
222811 - Another Internet address says...
222812 -
222813 - Blognetwork
222814 -
222815 - Chicken of the Sea Tuna Not Off the Hook for Mercury
222816 - Poisoning: Third Circuit Awards Justice in Federal
222817 - Preemption Case
222818 -
222819 - http://cherryhill.injuryboard.com/toxic-substances/chicken-of-the-sea-tuna-not-off-the-hook-for-mercury-poisoning-third-circuit-awards-justice-in-federal-preemption-case-.aspx?googleid=246568
222820 -
222821 - Posted by Mike Ferrara
222823 - ..
222824 - August 30, 2008 2:20 PM
222826 - ..
222827 - In a reversal of a district court decision, the United
222828 - States Court of Appeals for the Third Circuit unanimously
222829 - refused to exempt the company Tri-Union Seafood from
222830 - liability for the mercury poisoning of a New Jersey woman
222831 - due to contaminated canned tuna.
222833 - ..
222834 - Tri-Union Seafood, also known as Chicken of the Sea, had
222835 - previously made the case that the U.S. Food and Drug
222836 - Administration?s informal advisory warnings about
222837 - potentially high levels of mercury in canned tuna
222838 - amountedto a ?pervasive regulatory scheme? that preempted
222839 - the claims of plantiff Deborah Fellner.
222841 - ..
222842 - The Court of Appeals disagreed, determining that the
222843 - FDA?s prior statements, as they were of an informal,
222844 - unregulated nature, could not be construed as preemptive
222845 - federal policy.
222847 - ..
222848 - For several years, the FDA has issued advisories
222849 - regarding the potential risk of mercury in canned tuna.
222850 - The risk of adverse mercury effects is highest among
222851 - babies, young children, and pregnant women, whose fetuses
222852 - are particularly vulnerable.
222854 - ..
222855 - Studies have linked low levels of mercury exposure in
222856 - pregnant women and young children with damage to
222857 - neurological and behavioral function. They have also
222858 - associated frequent adult consumption of fish containing
222859 - high levels of mercury with neurologic, cardiovascular, and
222860 - immune system dysfunction.
222862 - ..
222863 - High-risk populations are encouraged to avoid consuming
222864 - canned tuna, choosing fish that contain low or negligible
222865 - levels of mercury, such as salmon, tilapia, shrimp, and
222866 - clams, instead.
222867 -
222868 -
222870 - ..
222871 - An Internet address for chicken of the Sea fails to disclose the
222872 - amount of mercury in albacore tuna....
222873 -
222874 - Chicken of the Sea
222875 -
222876 - Healthy Living
222878 - ..
222879 - Questions About Mercury
222880 -
222881 - http://chickenofthesea.com/health_mercury.aspx
222882 -
222883 - What is mercury?
222885 - ..
222886 - Mercury is a metal that occurs naturally in air and water
222887 - and is also a by-product of industrial activity. It's
222888 - released into the atmosphere both by nature through
222889 - mercury vapor that is emitted from the Earth's crust and
222890 - through the burning of household and industrial wastes,
222891 - including fossil fuels.
222893 - ..
222894 - Mercury in seawater arises mostly from natural processes,
222895 - including underwater volcanoes.
222896 - How does methylmercury enter our food?
222898 - ..
222899 - Mercury finds it way into seafood from naturally
222900 - occurringmercury found in oceanic underwater volcanoes.
222901 - Ocean-going species swim in deep oceans far from human
222902 - industrial sources of mercury.
222904 - ..
222905 - Mercury enters freshwater species from natural sources as
222906 - well as from anthropogenic (man-made) sources such as air
222907 - pollutants (thanks to rain) deposited into rivers and
222908 - lakes.
222910 - ..
222911 - In the water, bacteria transform the mercury into
222912 - methylmercury, a process called methylation. Larger,
222913 - migratory species, such as shark and swordfish, absorb
222914 - methylmercury from the water and ingest it when eating
222915 - algae and other smaller species of fish. In the deep
222916 - ocean, it would take thousands of years for anthropogenic
222917 - mercury to reach the bottom sediment, be methylated and
222918 - rise through the food chain.
222919 - Who monitors the levels of methylmercury in our food
222920 - supply?
222922 - ..
222923 - In the United States, the responsibility for regulating
222924 - mercury is shared by two federal agencies: the Food and
222925 - Drug Administration (FDA) and the Environmental
222926 - ProtectionAgency (EPA). The FDA regulates commercially
222927 - sold fish and seafood and provides consumption advice for
222928 - consumers, while the EPA regulates the amount of mercury
222929 - released into the environment. The EPA additionally works
222930 - with state governments to develop fresh water fish
222931 - advisories.
222932 - Do fish contain methylmercury?
222934 - ..
222935 - Nearly all fish contain some methylmercury. Large
222936 - predatorspecies such as shark, swordfish, king mackerel
222937 - and tilefish contain the most methylmercury. In general,
222938 - the larger and older a fish is, the more it will contain.
222939 - This is due to the fact that methylmercury accumulates
222940 - over time.
222942 - ..
222943 - How much methylmercury is found in fish?
222945 - ..
222946 - Levels of methylmercury vary greatly, largely based upon
222947 - the species, size and age of the fish.
222949 - ..
222950 - According to the FDA, in general, methylmercury levels
222951 - formost fish range from less than 0.01 parts per million
222952 - (ppm) to 0.5 ppm. The average concentration for
222953 - commercially important species is less than 0.3 ppm. In a
222954 - few species, methylmercury levels can reach 1 ppm, which
222955 - is the limit allowed by the FDA in fish intended for
222956 - humanconsumption. This level is found most often in large
222957 - predator fish, including shark, swordfish, king mackerel
222958 - and tilefish. Fresh-water species -- such as pike and
222959 - walleye (which are also predator fish) -- sometimes have
222960 - methylmercury levels in the 1 ppm range, if they swim in
222961 - waters polluted with high mercury levels.
222963 - ..
222964 - What are the health effects associated with methylmercury
222965 - consumption?
222967 - ..
222968 - Excess exposure to methylmercury can result in adverse
222969 - health effects. The most severe effects have been seen
222970 - following high-dose mercury poisoning situations not from
222971 - average fish consumption.
222973 - ..
222974 - A current study of children in the Seychelles Islands (in
222975 - the Indian Ocean) shows that continuous low-level
222976 - exposuredoes not cause any neurodevelopmental problems.
222978 - ..
222979 - Why does the FDA recommend a limit for methylmercury
222980 - consumption?
222982 - ..
222983 - The FDA is conservative in protecting the health of
222984 - American consumers. As such, it has set consumption
222985 - adviceat the1 ppm level, which is the limit allowed by
222986 - theFDA for fish intended for human consumption. The level
222987 - is purposely set 10 times lower than the lowest level
222988 - associated with health problems (specifically mercury
222989 - poisoning). This conservative level allows for the
222990 - greaterprotection of everyone - adults, children and even
222991 - unborn babies.
222993 - ..
222994 - Are Americans at risk for methylmercury poisoning from
222995 - eating fish?
222997 - ..
222998 - No. Only a very small number of pregnant women and women
222999 - of childbearing age who may become pregnant who eat
223000 - exceedingly large quantities of predator fish (shark,
223001 - swordfish, tilefish and king mackerel) need to be aware of
223002 - certain concerns. The FDA says that it is all right to eat
223003 - other fish, "as long as you select a variety of fish while
223004 - you are pregnant or may become pregnant, you can safely
223005 - enjoy eating them as part of a healthful diet. You can
223006 - safely eat 12 ounces per week of cooked fish. You can
223007 - choose shellfish, canned fish, smaller ocean fish or
223008 - farm-raised fish - just pick a variety of different
223009 - species."
223011 - ..
223012 - Are people who eat extraordinarily large quantities of fish
223013 - at risk?
223015 - ..
223016 - Pregnant women who eat large predator species of fish
223017 - (swordfish, tilefish, king mackerel or shark) may put their
223018 - unborn children at risk. This is because the developing
223019 - nervous system of a fetus is especially susceptible to
223020 - effects of high methylmercury levels. The Environmental
223021 - Protection Agency provides current advice on fish
223022 - consumption from fresh water lakes and streams. Check with
223023 - your state or local health department to see if there are
223024 - special advisories on fish caught from waters in your local
223025 - area.
223027 - ..
223028 - What precautions should women take to reduce these risks?
223030 - ..
223031 - The FDA recommends that pregnant women and women of
223032 - childbearing age who may become pregnant should not eat
223033 - shark, swordfish, king mackerel or tilefish. FDA advises
223034 - that pregnant women and women of childbearing age who may
223035 - become pregnant "can safely eat 12 ounces per week of
223036 - cooked fish. A typical serving size of fish is from 3 to
223037 - 6ounces. Of course, if your serving sizes are smaller,
223038 - youcan eat fish more frequently. You can choose
223039 - shellfish,canned fish, smaller ocean fish or farm-raised
223040 - fish-just pick a variety of different species." The EPA
223041 - recommends that pregnant women or who may become
223042 - pregnant,nursing mothers and young children should limit
223043 - their consumption of fish caught by family and friends to
223044 - one meal per week. Of course, all consumers and
223045 - especiallypregnant women should follow the basic
223046 - nutritional guidelines.
223048 - ..
223049 - Are children at increased risk?
223051 - ..
223052 - No. However, the FDA advises "it is prudent for nursing
223053 - mothers and young children not to eat these fish"
223054 - (swordfish, shark, tilefish, and king mackerel). The EPA
223055 - recommends young children limit their consumption of fish
223056 - caught by family and friends to one meal per week. Should
223057 - Americans eliminate fish from their diets because of
223058 - methylmercury?
223060 - ..
223061 - No. Fish is an excellent source of lean protein, vitamins
223062 - and minerals. In addition, research has shown that omega-3
223063 - fatty acids found naturally in certain species of fish help
223064 - lower the risk of heart disease and ease the pain of
223065 - arthritis, among other things. There are ways to decrease
223066 - one's risk of methylmercury without denying oneself the
223067 - good taste and health benefits of fish. What's more, FDA
223068 - acknowledges that seafood is an important part of a
223069 - balanced diet for pregnant women and those of childbearing
223070 - age who may become pregnant. According to a recent report
223071 - authored by a committee from the National Academy of
223072 - Sciences' National Research Council (NAS/NRC) for the EPA,
223073 - "Because of the beneficial effects offish consumption, the
223074 - long-term goal needs to bea reduction in the concentrations
223075 - of methylmercury in fish rather than a replacement offish
223076 - in the diet by other foods. Eliminating an entire type of
223077 - food or food group from the diet isgenerally unwise from a
223078 - nutritional standpoint."
223079 -
223080 -
223081 -
223082 -
223083 -
2231 -
SUBJECTS
WBC 7.5 Increase 12% CBC Blood Test Lab 110727
3403 -
3404 - 0854
340501 - ..
340502 - Blood Tests Evaluate Health 8 Months After Surgery
340503 -
340504 - Follow up ref SDS 54 RP4N, ref SDS 43 RP4N. ref SDS 39 QV4F.
340505 -
340506 - [On 110801 1043 received printed lab report from VA ROI
340507 - Department for Patient Records, ref SDS 67 MJ7H, showing
340508 - results of lab today.
340510 - ..
340511 - Lab report in VA's letter dated 110801, ref DRP 1 0001, shows...
340512 -
340513 - CBC.......................... 2011 07 27 1258
340514 - Blood Results Units Range
340515 - WBC +++ 7.5 K/cmm 4.8 - 10.8
340516 - RBC 5.09 M/cmm 4.7 - 6.1
340517 - HGB 15.5 g/dL 14 - 18
340518 - HCT 46.4 % 42 - 52
340519 - MCV 91.2 fL 80 - 99
340520 - MCH 30.5 uug 27 - 34
340521 - MCHC 33.4 gm/dL 32 - 35.2
340522 - RDW 13.5 % 11.5 - 14.5
340523 - PLT --- 286 K/cmm 130 - 400
340524 - MPV 8.5 fL 7 - 10.4
340525 - NEUT % 72.8 % 40 - 80
340526 - LYMPH % 19.6 L % 20 - 51
340527 - MONO % 6.4 % 2 - 13
340528 - EOS % --- 0.9 % .5 - 7
340529 - BASO % 0.3 % 0 - 2
340530 - NEUT # +++ 5.5 K/cmm 1.5 - 7.9
340531 - LYMPH # 1.5 K/cmm 1.2 - 3.4
340532 - MONO # 0.5 K/cmm .2 - 1.2
340533 - EOS # 0.1 K/cmm .1 - .5
340534 - BASO # 0.0 K/cmm 0 - .2
340535 - ESRmVES mm/hr 0 - 10
340536 - ESRxCYT mm/hr 2 - 10
340537 - RETIC % % .66 - 2.85
340538 - RETIC # k/uL 27.9 - 121.6
340540 - ..
340541 - Comments:
340542 -
340543 - a. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.
340545 - ..
340546 - WBC 7.5 increasing from 6.7 for test on 101207, and 7.3 for test on
340547 - ref SDS 43 OT69, 100721, reverses decline over the past year from WBC
340548 - 12.0 for lab on 091117, reported on 091119 1000. ref SDS 21 9S5V, and
340549 - WBC 7.5 remains within target range of 4.8 - 10.8, indicating
340550 - satisfactory immunity strength.
340552 - ..
340553 - Extensive patient history on WBC labs shown in records from VA for
340554 - heart surgery, and later the operation for achalasia, received in the
340555 - record on 100928 0706. ref SDS 46 PG5M
340557 - ..
340558 - WBC may have ticked up to fight infection from blisters on 110723,
340559 - caused by increased hiking the past month, shown in patient history in
340560 - case study on 101010. 101010 0744, ref SDS 47 N44N
340561 -
340562 -
340563 -
340564 -
340565 -
340566 -
3406 -
SUBJECTS
Chem Profile Glucose 102 Range 74-118 Lab Blood Test Below Diabetes
5403 -
540401 - ..
540402 - Total Bilirubin 2.0 Possible Impaired Liver with Simvastatin
540403 - Salt Sodium Near Danger Too Low
540404 - Glucose Declines Risk Diabetes Substantially Reduced
540405 -
540406 - Follow up ref SDS 54 GM65, ref SDS 43 GM65
540407 -
540408 - CHEM PROFILE........... 2011 07 27 1258
540409 - PLASMA Results Units Range
540410 - GLUCOSE 102 mg/dL 74 - 118
540411 - GLUfast mg/dL Ref: <=99
540412 - NA (salt) 138 mmol/L 136 - 144
540413 - K 3.9 mmol/L 3.4 - 4.8
540414 - CL 104 mmol/L 98 - 106
540415 - CO2 26 mmol/L 23 - 33
540416 - BUN 10 mg/dL 8 - 26
540417 - CREAT 0.89 mg/dL .5 - 1.1
540418 - eGFR >60 mL/min Ref: >=60
540419 - CALCIUM 8.9 mg/dL 8.7 - 10.2
540420 - CA CORR mg/dL 8.7 - 10.2
540421 - PO4 mg/dL 2.4 - 4.5
540422 - MG mg/dL 1.8 - 2.5
540423 - ALK PHO 81 IntUnits/L 37 - 107
540424 - ** T. BIL 2.0 H mg/dL .3 - 1.2
540425 - D. BILI 0.2 mg/dL .1 - .4
540426 - AST 24 IntUnits/L 8 - 42
540427 - ALT 21 IntUnits/L 5 - 55
540428 - ALBUMIN 4.2 g/dL 3.3 - 4.8
540429 - PROTEIN 7.4 g/dL 6.5 - 8.1
540430 - LDH IntUnits/L 90 - 208
540431 - AMYLASE Units/L 28 - 100
540432 - LIPASE Units/L 7 - 58
540433 - NH3 mcmol/L 15 - 56
540434 - URIC AC mg/dL 4.8 - 8.7
540435 - Comments: a
540437 - ..
540438 - a. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.
540440 - ..
540441 - b. Evaluation for CREAT:
540442 -
540443 - Effective 7/2/08, new standardized method for
540444 - creatinine in place. Note reference range change.
540445 - Previous range 0.5-1.2 mg/dL.
540447 - ..
540448 - c. Evaluation for ALK PHO:
540449 -
540450 - The normal range is for an adult population less than
540451 - 50 years old. Alk Phos increases with age over 50 to
540452 - about 60% higher values by ages greater than 75 years
540453 - old.
540455 - ..
540456 - d. Evaluation for eGFR:
540457 -
540458 - eGFR Units = mL/min/1.73 square meters
540460 - ..
540461 - Total Bilirubin 2.0 *******
540462 -
540463 - [On 111013 1404 interim lab shows Total Bilirubin 1.3,
540464 - ref SDS 71 557J, declines sharply from 2.0 after ending
540465 - simvastitin, indicating reduced risk of impaired liver
540466 - function caused by simvistatin, based on Internet research.
540467 - ref SDS 71 LC8J
540469 - ..
540470 - [On 111117 1415 follow up lab shows no further improvement
540471 - in total bilirubin 1.3, still slightly high from prior
540472 - regimen taking simvastatin. ref SDS 72 ZW6J
540474 - ..
540475 - Disappointing glucose 102 did not continue dropping after falling 6
540476 - months ago on 101207 to 102 from 117 6 months earlier in July.
540477 - While Glucose remains below danger level for diabetes, need to see
540478 - it decline below 90.
540479 -
540480 - [On 111013 1404 interim lab evaluating effects switching
540481 - from simvastatin to Rosuvastatin, shows glucose declining
540482 - significantly toward goal below 90. ref SDS 71 GM65
540484 - ..
540485 - Salt (NA 138) rises above danger of being too low. Maintaining
540486 - adequate salt level is critical to life was researched on 091104 0718.
540487 - ref SDS 19 D58G Salt issue was discussed briefly with Doctor Beatty
540488 - prior to heart surgery on 091021 0716. ref SDS 12 HA92
540490 - ..
540491 - On 110314 1022 Ross letter asks again about feedback from the doctor
540492 - on correlations between salting food and swallowing problems.
540493 - ref SDS 59 NT3V
540494 -
540495 -
540496 -
540497 -
540498 -
5405 -
SUBJECTS
Lipid Cholesterol 163 Range <200 Lab 40% Decline LDL 102 Range <1 74
7303 -
730401 - ..
730402 - Cholesterol Rises 5% Heart Disease Risk Stable Coronary Arterial Disease
730403 -
730404 - Follow up ref SDS 54 E19L, ref SDS 43 E19L.
730405 -
730406 - LIPID PANEL............ 2011 07 27 1258
730407 - PLASMA Results Units Range
730408 - CHOL 163 mg/dL Ref: <=200
730409 - TRIGLYC 81 mg/dL Ref: <=150
730410 - HDL 45 mg/dL Ref: >=40
730411 - LDL 102 mg/dL Ref: <=160
730412 - LDL Dir mg/dL Ref: <=160
730413 - TRIG NF mg/dL Ref: <=150
730414 - Comments: a
730415 -
730416 - [On 111128 0202 follow up, ref SDS 73 EA4V
730418 - ..
730419 - a. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.
730421 - ..
730422 - b. Evaluation for LDL-CHO:
730423 -
730424 - RISK CATEGORY LDL GOAL
730425 - CHD and CHD risk equivalents <100 mg/dL
730426 - Multiple (2+) risk factors <130 mg/dL
730427 - 0-1 risk factor <160 mg/dL
730429 - ..
730430 - HDL Chol. greater than/equal to 60 mg/dL counts as "negative" risk
730431 - factor; its presence removes 1 risk factor from the total count.
730433 - ..
730434 - Ref: Adult Treatment Panel III (ATP III) JAMA 5/16/01 Vol. 285 #19.
730435 -
730437 - ..
7305 -
7306 -
7307 - Analysis
7308 -
730801 - LDL 102 rising from 96 indicates Simvastatin 40 mg may no
730802 - longer be effective reducing LDL < 70.
730804 - ..
730805 - Rreport of harmful cholesterol 163 disappointing, especially
730806 - ldl 102 rising from 96 relative to goal of falling below 90;
730807 - indicates substantial improvement from test a year ago on
730808 - 100721 0800. ref SDS 43 E19L, reverses long-term risk of
730809 - arterial coronary disease from elevated cholesterol for past 5
730810 - years. Reduced risk of heart attack aligns with Doctor Sandhu
730811 - increasing Simvistatin from 20 to 40 mg during the meeting at
730812 - the VA on 100721 0800. ref SDS 43 RP4F During this period diet
730813 - continued stable, and exercise declined to hiking 20 - 30 miles
730814 - per week shown by case study on 101010 0744, ref SDS 47 QJ5I,
730815 - down from 30 - 35, reported previously on 100721 0800.
730816 - ref SDS 43 PTPP
730818 - ..
730819 - On 101223 1030 Doctor Sandhu pleased prescription to increase
730820 - Simvistatin yielded very favorable results; for the first time
730821 - in many years cholesterol well below level safe from arterial
730822 - coronary disease and heart attack. Goal to lower ldl 96 to
730823 - below 90. ref SDS 56 415H
730825 - ..
730826 - On 110309 0900 Doctor Egan in Cardiology Department VA Martinez
730827 - set target for LDL 70, now at 96, and well below 160 shown in
730828 - VA labs for LDL target range. ref SDS 58 ZM98 A month later,
730829 - the doctor again discussed goal to lower ldl below 70.
730830 -
730831 - [On 110802 1005 Richard reported recent findings that high
730832 - dose statin drugs 80 mg to reduce cholesterol have proven
730833 - problematic, causing death of some patients. ref SDS 68
730834 - II9F
730836 - ..
730837 - [On 110802 1539 research Harvard Medical School article
730838 - published Nov 2004, cites studies showing LDL below 70
730839 - reduces risk significantly of adverse coronary events.
730840 - ref SDS 69 E98Y
730842 - ..
730843 - [On 110817 1030 VA end treatment with Simvastatin, which
730844 - reduced LDL by 50% but LDL 102 on lab 110727, ref SDS 0
730845 - E19L, well above LDL < 70 planned by VA, and Simvastatin
730846 - even if increased to 80 mg cannot further lower LDL, and
730847 - Simvastatin 80 mg has adverse side effects of debilitating
730848 - myopathy; so Doctor Egan prescribed rosuvastatin 10 mg to
730849 - replace Simvastatin, which is more potent and so has the
730850 - chance to reach medical goal LDL < 70. ref SDS 70 DG36
730851 -
730852 -
730853 -
730854 -
7309 -
SUBJECTS
Tumor Markers PSA 1.16 Range 0-40 Low End Scale Signal Negative Labo
9303 -
930401 - ..
930402 - PSA Negative Cancer Markers
930403 -
930404 - Follow up ref SDS 54 ER6N, ref SDS 43 ER6N.
930405 -
930406 - TUMOR MARKERS.............. 2011 07 27 1258
930407 - SERUM Results Units Range
930408 - AFP TM ng/mL 0 - 8
930409 - CEA ng/mL 0 - 3
930410 - PSA 1.16 ng/ml 0 - 4
930411 - CA 125 Units/mL 0 - 34
930412 - CA 15-3 Units/mL 0 - 25
930413 - CA 19-9 Units/mL 0 - 37
930414 - Comments: a
930416 - ..
930417 - a. Test performed by VA NCHCS Martinez, 150 Muir Road,
930418 - Martinez
930420 - ..
930421 - Decrease in PSA 1.16 from 1.50 for test for test on 101207, reverses
930422 - Slight increase PSA 1.50 from 1.25 for prior test 5 months ago on
930423 - 100721.
930424 -
930425 -
930426 -
930427 -
930428 -
9305 -