CONTACTS
SUBJECTS
VA Cardiology Examination Recover Coronary Artery Bypass Graft CABG
1203 -
1203 - ..
1204 - Summary/Objective
1205 -
120501 - Follow up ref SDS 17 0000. ref SDS 16 0000.
120502 -
120503 -
120505 - ..
1206 -
1207 -
1208 - Progress
1209 -
120901 - Agenda for meeting with Doctor Egan is from prior meeting on 110415
120902 - 0900. ref SDS 10 OF8F
120903 -
120905 - ..
120906 - Hiking Strengthens Coronary Pulmonary System Reduces Blood Pressure
120907 -
120908 -
120909 - 1. Review patient history implementing VA guidance to hike for
120910 - recovering from CABG, reported on 101010 0744. ref SDS 5
120911 - 45SU
120913 - ..
120914 - Doctor Egan asked about patient continuing exercise to recover from
120915 - heart surgery and reducing risk factors for CAD patients.
120916 -
120917 - [On 110818 1051 letter to VA reports excellent meeting with
120918 - Cardiology. ref SDS 19 XA5I
120920 - ..
120921 - Case study on 101010 shows 11 miles yesterday, and on Monday. 101010
120922 - 0744, ref SDS 5 3M3O
120924 - ..
120925 - The doctor said that biking 11 miles a day is excellent cardiovascular
120926 - exercise to reduce risk factors for adverse coronary events.
120928 - ..
120929 - Clarified that case study shows hiking 11 miles a day 3 - 4 times a
120930 - week for the past few months. ref SDS 5 3M3O
120932 - ..
120933 - Explained recent improvement with breathing test reaching nearly 4000
120934 - at the top of the scale.
120936 - ..
120937 - Case study also shows trend toward lower blood pressure and heart
120938 - rate, beginning a few weeks ago on 110801, and listed in case study on
120939 - 101010 0744. ref SDS 5 GG3L
120941 - ..
120942 - Doctor Egan advised that hiking 11 miles several times a week has
120943 - been effective for cardio-pulmonary health.
120944 -
120945 -
120946 -
120947 -
1210 -
SUBJECTS
Default Null Subject Account for Blank Record
1303 -
130401 - ..
130402 - Aspirin Avoid Blood Clots Risk CAD Patients High Platelets
130403 - Platelets High Risk Blood Clots Resolved Aspirin CAD Patients
130404 -
130405 -
130406 - 2. Aspirin advantages for reducing risk factors of adverse
130407 - coronary events, analysed in research following meeting
130408 - with Doctor Sandhu on 101223 1030. ref SDS 7 454F
130410 - ..
130411 - Today, Doctor Egan cited Doctor Lee's report in the Medical Chart
130412 - filed on 110429. and amending the report for meeting with Doctor Egan
130413 - on 110415 0900. to say that taking Omeprazole does not conflict with
130414 - prescribing aspirin. ref SDS 10 OK3G
130416 - ..
130417 - Today, the doctor explained that aspirin thins the blood, and this
130418 - thinning reduces the risk of high platlets making particles stick to
130419 - artery walls, which causes blood clots. Doctor Egan further advised
130420 - that blood clots are a higher threat of death for patients with
130421 - coronary artery disease (CAD).
130423 - ..
130424 - This record indicates that while platlets below the range are harmful,
130425 - high platlets are also a problem for patients with coronary artery
130426 - disease (CAD), by increasing effects of cholesterol that cause blood
130427 - clots which can be fatal from pulmonary embolism and stroke.
130429 - ..
130430 - Doctor Egan advised again that the VA classifies all patients as
130431 - suffering permenant CAD, who have had heart surgery, as occurred in
130432 - this case with quadruple coronary artery bypass graft (CABG 4x),
130433 - reported on 091022 0700. ref SDS 2 PQWU
130435 - ..
130436 - Lab shows platlets (PLT 286) have fallen to mid-range of VA target
130437 - range for good health, reported on 110727 1238. ref SDS 13 SL4F
130438 -
130439 - Collection DT PLT Range
130440 - 07/27/2011 12:58 286 ....130 - 400.. ref SDS 13 SL4F
130441 - 12/07/2010 09:17 310 ............... ref SDS 6 SL4F
130442 - 07/21/2010 08:54 344 ............... ref SDS 4 OT69
130443 - 08/13/2009 15:09 350 ............... ref SDS 1 075H
130445 - ..
130446 - [On 120509 1108 plateletts 288 continues at mid-range,
130447 - which avoids risk of blood clots that require aspirin
130448 - treatment. ref SDS 30 RP4N
130450 - ..
130451 - [On 121130 0846 plateletts 254 fall below mid-range,
130452 - ref SDS 31 RP4N; hiking 700 miles and 20 pound weight loss
130453 - over 3 months avoids risk of blood clots without aspirin
130454 - treatment. ref SDS 31 868N
130456 - ..
130457 - The doctor advised that PT INR does not test this aspect of thinning
130458 - the blood to reduce the stickiness effect of high platlets. He said
130459 - that aspirin is effective to reduce this risk.
130461 - ..
130462 - Seems strange that pulmonary embolism is assessed with PT INR to test
130463 - blood thickness, but this cannot assess similar risks for heart
130464 - patients.
130466 - ..
130467 - Doctor Egan explained that patients taking daily aspirin is cheaper
130468 - than giving patients blood tests once a month or even every 6 months
130469 - to test blood thickness.
130471 - ..
130472 - Research on 101223 indicates...
130473 -
130474 - The risk of a recurrent myocardial infarction decreases with
130475 - strict blood pressure management and lifestyle changes, chiefly
130476 - smoking cessation, regular exercise, a sensible diet for
130477 - patients with heart disease, and limitation of alcohol intake.
130478 - ref SDS 7 4R6L
130480 - ..
130481 - As discussed initially, patient history shows blood pressure has been
130482 - managed through exercise and diet shown in case study on 101010 0744,
130483 - ref SDS 5 45SU, and to meet published guidelines for good cardio
130484 - vascular health, reported in the record on 100305 1000. ref SDS 3
130485 - SU6K
130486 -
130487 -
1305 -
SUBJECTS
Default Null Subject Account for Blank Record
2303 -
230401 - ..
230402 - Cholesterol LDL 102 Slight Increase Past 6 Months Goal LDL < 70
230403 -
230404 -
230405 - 3. Reviewed lab results on 110727 1238, ref SDS 13 RP4N, and
230406 - particularly lipid panel for cholesterol, ref SDS 13 E19L,
230407 - and Doctor Egan's plan to lower LDL < 70, reported during
230408 - meeting on 110309 0900. ref SDS 8 ZM98 A month later on
230409 - 110415, Doctor Egan discussed doubling simvastatin from 40
230410 - mg to 80 mg, in order to reduce LDL below 70. ref SDS 10
230411 - MG3I
230413 - ..
230414 - New England Journal of Medicine June 2011 article reports
230415 - simvastatin only lowers LDL 46% - see research on 110802
230416 - 1639. ref SDS 14 TF9U
230418 - ..
230419 - Simvastatin has already lowered LDL 209 over 50% to LDL 96
230420 - for lab on 101207, ref SDS 6 E19L, and noted by Doctor Egan
230421 - on 110309 0900. ref SDS 8 ZM98
230423 - ..
230424 - New England Journal of Medicine June 2011 article reports
230425 - simvastatin causes myopathy (muscle and joint pain), and
230426 - seems to caution against increasing dose to 80 mg, based on
230427 - FDA study. ref SDS 14 NF5F Further research indicates
230428 - "life threatening" myopathy has become widespread concern
230429 - for some patients taking simvastatin. 110802 1639,
230430 - ref SDS 14 OK9G An example, Doctor Sandhu, Primary Care
230431 - Physician, reported in a meeting at the VA on 110803, that
230432 - he suffered severe adverse effects from simvastatin.
230433 - ref SDS 15 YU4F
230434 -
230435 - [On 110901 0555 Peggy says they wanted to end Bob's
230436 - medication for cholesterol, but his shoulder was hurting
230437 - so badly, he needed surgery. ref SDS 22 VI48
230439 - ..
230440 - Side effects of Rosuvastatin are also listed in the record
230441 - on 110802 1639. ref SDS 14 JH7N
230443 - ..
230444 - Patient history in this case shows myopathy symptoms began
230445 - a few months after increasing simvastatin 20 mg to 40 mg,
230446 - reported on 101126, in case study on 101010. 101010 0744,
230447 - ref SDS 5 6E5I On 101224 had to stop exercise due to
230448 - shoulder pain, and reporting difficulty lifting left arm
230449 - above horizontal in any direction, also in case study on
230450 - 101010 0744, ref SDS 5 554N
230452 - ..
230453 - New England Journal article indicates prescribing
230454 - rosuvastatin (40 mg) may be more effective than simvastatin
230455 - 80 mg, and so may not have same degree of adverse side
230456 - effects, reported on 110802 1639. ref SDS 14 TF9U
230457 -
230458 -
2305 -
SUBJECTS
Resovastatin 10 Mg Replace Simvastatin 40 Mg Reduce Cholesterol LDL
3903 -
390401 - ..
390402 - Resovastatin 10 Mg Replace Simvastatin 40 Mg Achieve Goal LDL < 70
390403 - Myopathy Caused Simvastatin 40 Mg Prescribe Rosuvastatin 10 Mg
390404 -
390405 - Doctor Egan prescribed rosuvastatin 10 mg, implementing above
390406 - analysis, ref SDS 0 FE4H, to replace simvastatin 40 mg, and replaces
390407 - work plan to prescribe simvastatin 80 mg in order to reach goals for
390408 - reducing LDL < 70, discussed during meeting on 110415 0900.
390409 - ref SDS 10 MG3I
390411 - ..
390412 - Side effects of Rosuvastatin are listed in the record on 110802 1639.
390413 - ref SDS 14 JH7N
390415 - ..
390416 - Equally, CAD patient risk of recurrance can be managed by increasing
390417 - HDL cholesterol.
390418 -
390419 - [On 110823 1312 received in US mail prescription 90 days
390420 - rosuvastating 10 mg. ref SDS 20 UY5G
390422 - ..
390423 - [On 110826 1338 myopathy shoulder pain due to high dose
390424 - simvastatin 40 mg and after switching to rosuvastatin 10 mg
390425 - seems less playing golf for first time in over a year.
390426 - ref SDS 21 QG7G
390428 - ..
390429 - [On 110901 0555 Peggy says they wanted to end Bob's
390430 - medication for cholesterol, but his shoulder was hurting so
390431 - badly, he needed surgery. ref SDS 22 VI48
390433 - ..
390434 - [On 111018 0800 reported to Doctor Sandhu significant
390435 - improvement recovering from myopathy after ending
390436 - simvastatin, and starting rosuvastatin. ref SDS 24 FO5M
390438 - ..
390439 - [On 111117 1415 lab reports cholesterol LDL 200 increased
390440 - from 102, rather than decrease to LDL < 70. ref SDS 25 IM9N
390442 - ..
390443 - [On 111117 1415 lipid cholesterol tests unreliable since
390444 - 1988, ref SDS 25 PUPU; article published in 2011 by the
390445 - National Health Institute warns testing for LDL cholesterol
390446 - is still "fraught with error." ref SDS 25 N29Y
390448 - ..
390449 - [On 111125 2028 CNN television broadcast analysis saying
390450 - measuring LDL cholesterol is not effective for
390451 - evaluating coronary health risks, ref SDS 26 LJ7F,
390452 - recommends measuring small particle LDL cholesterol
390453 - using coronary calcium san techology. ref SDS 26 LW75
390455 - ..
390456 - [On 111128 0202 letter to medical team cites lab on 111117,
390457 - reporting LDL 200, ref SDS 27 EA4V; asks about increasing
390458 - medication to rosuvastatin 20 mg or trying some other line
390459 - of care to reduce cholesterol LDL < 70, ref SDS 27 EB3U,
390460 - according to the VA work plan on 110817 1030. ref SDS 18
390461 - DG36
390463 - ..
390464 - [On 111128 2038 increased medication to rosuvastatin 20 mg,
390465 - shown in case study on patient history on 101010 0744.
390466 - ref SDS 5 NV7I
390468 - ..
390469 - [On 120325 1950 over past few days noticed slight numbness,
390470 - tingling in lower legs and feet, and dry mouth, possible
390471 - neuropathy. ref SDS 29 Z45I
390472 -
390473 -
390475 - ..
390476 - The doctor seemed to indicate, during the meeting today, that
390477 - rosuvastatin 10 mg is more effective for lowering LDL cholesterol, and
390478 - increasing HDL cholesterol, than switching from simvastatin 40 mg to
390479 - simvastatin 80 mg.
390480 -
390481 - [On 110818 1051 letter to VA reports excellent meeting with
390482 - Cardiology. ref SDS 19 XA5I
390483 -
390484 -
390485 -
3905 -
SUBJECTS
Default Null Subject Account for Blank Record
4003 -
400401 - ..
400402 - Test Ordered 6 Weeks Assess Prescription Rosuvastatin
400403 - Cholesterol Lab 3 Months Evaluate Rosuvastatin Replace Simvastatin
400404 -
400405 - Doctor Egan will order a test in 6 weeks to assess effects of taking
400406 - rosuvastatin.
400407 -
400408 - [On 111013 1404 went to VA for blood draw to perform lab
400409 - accomplishing 6 - 8 week test on switching from simvastatin
400410 - to Rosuvastatin. ref SDS 23 NP5G
400412 - ..
400413 - [On 111013 1404 results seem to show cardiac enzymes are
400414 - within published range. ref SDS 23 DO5O
400416 - ..
400417 - Doctor Egan further ordered another lab in 3 months to evaluate and
400418 - adjust rosuvastatin 10 mg, as required for lowering LDL < 70.
400419 -
400420 - [On 110818 1051 letter to VA confirms work plan to test
400421 - results switching to Rosuvastitin in 6 - 8 weeks, and order
400422 - lab in 3 months to assess progress reaching goals for
400423 - lowering LDL < 70. LDL. ref SDS 19 4P8U
400425 - ..
400426 - [On 111013 1404 interim lab scheduled on 111117 to assess
400427 - cholesterol LDL falling below 70 after switching medication
400428 - from simvastatin to Rosuvastatin. ref SDS 23 EO7O
400430 - ..
400431 - [On 111117 1415 lab reports cholesterol LDL 200 increased
400432 - from 102, rather than decrease to LDL < 70. ref SDS 25 IM9N
400434 - ..
400435 - [On 111117 1415 lipid cholesterol tests unreliable since
400436 - 1988, ref SDS 25 PUPU; article published in 2011 by the
400437 - National Health Institute warns testing for LDL cholesterol
400438 - is still "fraught with error." ref SDS 25 N29Y
400440 - ..
400441 - [On 111125 2028 CNN television broadcast analysis saying
400442 - measuring LDL cholesterol is not effective for
400443 - evaluating coronary health risks, ref SDS 26 LJ7F,
400444 - recommends measuring small particle LDL cholesterol
400445 - using coronary calcium san techology. ref SDS 26 LW75
400447 - ..
400448 - [On 111128 0202 letter to medical team cites lab on 111117,
400449 - reporting LDL 200, ref SDS 27 EA4V; asks about increasing
400450 - medication to rosuvastatin 20 mg or trying some other line
400451 - of care to reduce cholesterol LDL < 70, ref SDS 27 EB3U,
400452 - according to the VA work plan on 110817 1030. ref SDS 18
400453 - DG36
400455 - ..
400456 - [On 111128 2038 increased medication to rosuvastatin 20 mg,
400457 - shown in case study on patient history on 101010 0744.
400458 - ref SDS 5 NV7I
400459 -
400460 -
4005 -
SUBJECTS
Default Null Subject Account for Blank Record
4103 -
410401 - ..
410402 - Agenda meeting continues...
410403 -
410404 - 4. Myoview study pending from stress test on 110406, cited in
410405 - medical chart on 110415 0900. ref SDS 10 PYYP
410407 - ..
410408 - Doctor Egan explained there was no "myview" study done in this case,
410409 - and so the note in the medical report was a mistake. Someone used a
410410 - standard form, and did not remove the "myview" field to correlate with
410411 - patient profile. The doctor seemed to say that a "Myview" study
410412 - injects dye into the circulatory system to monitor distribution rate
410413 - during and/or following exercise. He asked if this was done for the
410414 - stress test on 110406?
410416 - ..
410417 - We reviewed the record showing no indication of an injection, reported
410418 - on 110406 1230. ref SDS 9 OF8F
410420 - ..
410421 - As a result, there is no "Myview" test report pending, as shown in
410422 - medical chart for the meeting on 110415 0900. ref SDS 10 PYYP
410424 - ..
410425 - Correction was entered in patient history.
410426 -
410427 -
4105 -
SUBJECTS
Default Null Subject Account for Blank Record
4203 -
420401 - ..
420402 - Mercury Lab Order Changed by Someone at VA
420403 -
420404 -
420405 - 5. Mercury lab ordered by Doctor Egan on 110415 0900,
420406 - ref SDS 10 YE7M, and which was mysteriously later removed
420407 - from the lab, reported on 110727 1238. ref SDS 13 PP8W
420409 - ..
420410 - The doctor recalled discussing risks of mercury from concentrating
420411 - diet with tuna, and in order to facilitate swallowing, and to reduce
420412 - cholesterol which reduces risk of CAD, reported on 110415. 110415
420413 - 0900, ref SDS 10 JE6O, and as a result the doctor added a test for
420414 - mercury to the next lab, reported during the meeting on 110415 0900.
420415 - ref SDS 10 YE7M
420417 - ..
420418 - The doctor was frustrated about someone changing his order adding a
420419 - test for mercury to the lab. He said Doctor Sandhu should be
420420 - consulted, and noted that he does not have time today for wading
420421 - through his medical chart to see what was done in this matter.
420422 -
420423 -
420424 -
420425 -
420426 -
420427 -
420428 -
420429 -
420430 -
4205 -