THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com
S U M M A R Y
DIARY: May 9, 2012 11:08 AM Wednesday;
Rod Welch
VA full lab with lipid panel test cholesterol.
1...Summary/Objective
2...Blood Tests Evaluate Health 8 Months After Surgery
3...Total Bilirubin 2.5 Impaired Liver Due to Rosuvastatin
4...Salt Sodium Declines Near Danger Too Low
5...Glucose Declines Again Risk Diabetes Further Reduced
6...LDL 94 Significant Decrease Risk CAD Goal Reduce LDL 70
7...Rosuvastatin Switch from Simvastatin Myopathy Side Effects Decline
8...Simvistatin Side Effects Myopathy Muscle Pain Decline Switch to Rosuvastatin
9...Myopathy Muscle Pain Side Effects Simvistatin Decline Switch to Rosuvastatin
10...Urine Dipstick Laboratory Test Satisfactory Within Range
11...Vitamin D 25 OH Concentration Within Normal Range
..............
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CONTACTS
SUBJECTS
WBC 6.8 Increase 12% CBC Blood Test Lab 120509
1903 -
1903 - ..
1904 - Summary/Objective
1905 -
190501 - Follow up ref SDS 9 0000, ref SDS 8 0000.
190502 -
190503 -
190504 -
190506 - ..
1906 -
1907 -
1908 - Progress
1909 -
190901 - Blood draw today for meeting with Doctor Egan and Doctor Sandhu next
190902 - Monday on 120514, scheduled on 120403 1104. ref SDS 9 X45G
190904 - ..
190905 - Last full lab was on 110727 1238, ref SDS 2 RP4N, and this was to
190906 - prepare for meeting in Primary Care a few weeks later on 110803 1400.
190907 - ref SDS 3 U24I
190909 - ..
190910 - Last partial lab for lipid panel testing cholesterol and for glucose,
190911 - sodium, and total bilirubin was on 120209 1118. ref SDS 6 KK9M
190912 - ref SDS 6 KK9M
190914 - ..
190915 - Last partial lab for lipid panel and other panels for primary care,
190916 - but omitting CBC, was on
190917 -
190918 -
190920 - ..
190921 - Blood Tests Evaluate Health 8 Months After Surgery
190922 -
190923 - Follow up ref SDS 2 RP4N.
190924 -
190925 - Prior CBC on 110727 1238. ref SDS 2 RP4N
190926 -
190927 - CBC.......................... 2012 05 09 1124
190928 - Blood Results Units Range
190929 - WBC +++ 6.8 K/cmm 4.8 - 10.8
190930 - RBC 5.06 M/cmm 4.7 - 6.1
190931 - HGB 15.0 g/dL 14 - 18
190932 - HCT 45.8 % 42 - 52
190933 - MCV 90.7 fL 80 - 99
190934 - MCH 29.7 uug 27 - 34
190935 - MCHC 32.8 gm/dL 32 - 35.2
190936 - RDW 13.6 % 11.5 - 14.5
190937 - PLT --- 288 K/cmm 130 - 400
190938 - MPV 8.7 fL 7 - 10.4
190939 - NEUT % 68.0 % 40 - 80
190940 - LYMPH % 21.3 % 20 - 51
190941 - MONO % 8.0 % 2 - 13
190942 - EOS % --- 2.0 % .5 - 7
190943 - BASO % 0.7 % 0 - 2
190944 - NEUT # +++ 4.6 K/cmm 1.5 - 7.9
190945 - LYMPH # 1.4 K/cmm 1.2 - 3.4
190946 - MONO # 0.5 K/cmm .2 - 1.2
190947 - EOS # 0.1 K/cmm .1 - .5
190948 - BASO # 0.0 K/cmm 0 - .2
190949 - ESRmVES mm/hr 0 - 10
190950 - ESRxCYT mm/hr 2 - 10
190951 - RETIC % % .66 - 2.85
190952 - RETIC # k/uL 27.9 - 121.6
190954 - ..
190955 - Comments:
190956 -
190957 - a. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.
190959 - ..
190960 - Plateletts 288 continue mid-range 130 - 400, presenting no risk of
190961 - blood clots caused by high platletts that require treatment with
190962 - aspirin, reported in the meeting on 110817 1030. ref SDS 4 CZ5L
190963 -
190964 - [On 140430 0900 discussed concern hiking 11 miles causing
190965 - blood clots due to dehydration; plateletts 303 at
190966 - mid-range, blood pressure and heart rate below normal.
190967 - ref SDS 11 7J7L
190968 -
190969 -
190970 -
190971 -
190972 -
190973 -
1910 -
SUBJECTS
Chem Profile Glucose 108 Range 74-118 Lab Blood Test Below Diabetes
5403 -
540401 - ..
540402 - Total Bilirubin 2.5 Impaired Liver Due to Rosuvastatin
540403 - Salt Sodium Declines Near Danger Too Low
540404 - Glucose Declines Again Risk Diabetes Further Reduced
540405 -
540406 - Follow up ref SDS 6 KK9M, ref SDS 5 KK9M.
540407 -
540408 - Prior Chem Profile on 120209 1118. ref SDS 6 KK9M
540410 - ..
540411 - Electrolytes
540413 - ..
540414 - CHEM PROFILE........... 2012 05 09 1124
540415 - PLASMA Results Units Range
540416 - GLUCOSE 108 mg/dL 74 - 118
540417 - GLUfast mg/dL Ref: <=99
540418 - NA (salt) 138 mmol/L 136 - 144
540419 - K 4.2 mmol/L 3.4 - 4.8
540420 - CL 105 mmol/L 98 - 106
540421 - CO2 27 mmol/L 23 - 33
540422 - BUN 17 mg/dL 8 - 26
540423 - CREAT 0.95 mg/dL .5 - 1.1
540424 - eGFR >60 mL/min Ref: >=60
540425 - CALCIUM 8.7 mg/dL 8.7 - 10.2
540426 - CA CORR mg/dL 8.7 - 10.2
540427 - PO4 mg/dL 2.4 - 4.5
540428 - MG mg/dL 1.8 - 2.5
540429 - ALK PHO 86 IntUnits/L 37 - 107
540430 - T. BIL +5 2.5 H mg/dL .3 - 1.2
540431 - D. BILI 0.3 mg/dL .1 - .4
540432 - AST 25 IntUnits/L 8 - 42
540433 - ALT 21 IntUnits/L 5 - 55
540434 - ALBUMIN 4.1 g/dL 3.3 - 4.8
540435 - PROTEIN 7.1 g/dL 6.5 - 8.1
540436 - LDH IntUnits/L 90 - 208
540437 - AMYLASE Units/L 28 - 100
540438 - LIPASE Units/L 7 - 58
540439 - NH3 mcmol/L 15 - 56
540440 - URIC AC mg/dL 4.8 - 8.7
540441 - Comments: a
540443 - ..
540444 - a. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.
540446 - ..
540447 - b. Evaluation for CREAT:
540448 -
540449 - Effective 7/2/08, new standardized method for
540450 - creatinine in place. Note reference range change.
540451 - Previous range 0.5-1.2 mg/dL.
540453 - ..
540454 - c. Evaluation for ALK PHO:
540455 -
540456 - The normal range is for an adult population less than
540457 - 50 years old. Alk Phos increases with age over 50 to
540458 - about 60% higher values by ages greater than 75 years
540459 - old.
540461 - ..
540462 - d. Evaluation for eGFR:
540463 -
540464 - eGFR Units = mL/min/1.73 square meters
540465 -
540467 - ..
540468 - Total Bilirubin 2.5 increased from 1.8 - 70% compared to prior lab on
540469 - 120209 1118. ref SDS 6 KK9M This is now more than 100% above
540470 - published range, and associated with increasing Rosuvastatin 20 mg
540471 - from 10 mg, prescribed on 120216 1000. ref SDS 7 DG36
540472 -
540473 -
540474 -
540475 -
5405 -
SUBJECTS
Default Null Subject Account for Blank Record
5503 -
550401 - ..
550402 - LDL 94 Significant Decrease Risk CAD Goal Reduce LDL < 70
550403 -
550404 - Follow up ref SDS 6 IM9N, ref SDS 5 IM9N.
550405 -
550406 - Work plan changed simvastatin 40 mg to rosuvastatin 10 mg on 110817
550407 - 1030. ref SDS 4 DG36 Increase rosuvastatin to 20 mg following lab on
550408 - 111117 1415. ref SDS 5 IM9N, was not effective reducing cholesterol
550409 - LDL < 70, planned in meeting on 110817 1030, ref SDS 4 JQ54
550411 - ..
550412 - On 120214 decided to continue Rosuvastatin 20 mg. ref SDS 7 DG36
550414 - ..
550415 - Prior Chem Profile on 120209 1118. ref SDS 6 IM9N
550417 - ..
550418 - Results today show strong response to treatment.
550420 - ..
550421 - LIPID PANEL............ 2012 05 09 1124
550422 - PLASMA Results Units Range
550423 - CHOL 158 mg/dL Ref: <=200
550424 - TRIGLYC 76 mg/dL Ref: <=150
550425 - HDL 49 mg/dL Ref: >=40
550426 - LDL 94 mg/dL Ref: <=160
550427 - LDL Dir mg/dL Ref: <=160
550428 - TRIG NF mg/dL Ref: <=150
550429 - Comments: a
550431 - ..
550432 - a. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.
550434 - ..
550435 - b. Evaluation for LDL-CHO:
550436 -
550437 - RISK CATEGORY LDL GOAL
550438 - CHD and CHD risk equivalents <100 mg/dL
550439 - Multiple (2+) risk factors <130 mg/dL
550440 - 0-1 risk factor <160 mg/dL
550442 - ..
550443 - HDL Chol. greater than/equal to 60 mg/dL counts as "negative" risk
550444 - factor; its presence removes 1 risk factor from the total count.
550446 - ..
550447 - Ref: Adult Treatment Panel III (ATP III) JAMA 5/16/01 Vol. 285 #19.
550449 - ..
550450 - LDL dropped from 228 to 94 = 134
550451 -
550452 - [On 120831 1400 LDL 110 lab increased from 94, rather than
550453 - continue to decline. ref SDS 10 IM9N
550454 -
550455 -
550456 -
550457 -
550458 -
5505 -
SUBJECTS
Default Null Subject Account for Blank Record
5603 -
560401 - ..
560402 - Rosuvastatin Switch from Simvastatin Myopathy Side Effects Decline
560403 - Simvistatin Side Effects Myopathy Muscle Pain Decline Switch to Rosuvastatin
560404 - Myopathy Muscle Pain Side Effects Simvistatin Decline Switch to Rosuvastatin
560405 -
560406 - Follow up ref SDS 6 D26G, ref SDS 5 D26G.
560407 -
560408 - Prior Cardiac Enzymes Profile on 120209 1118. ref SDS 6 D26G
560409 -
560410 - CARDIAC ENZYMES........ 2012 02 09 1124
560411 - PLASMA Results Units Range
560412 - CK 152 IntUnits/L 36 - 340
560413 - TRPONIN ng/ml 0 - 0.07
560414 - CK-MB ng/ml 0.6 - 3.5
560415 - MYOGLOB ng/ml 20 - 82
560417 - ..
560418 - a. TEST PERFORMED BY VAMC SACRAMENTO, 10535 HOSPITAL WAY,
560419 - MATHER CA.
560420 -
560421 -
560422 -
560423 -
560424 -
560425 -
560426 -
5605 -
SUBJECTS
Default Null Subject Account for Blank Record
5703 -
570401 - ..
570402 - Urine Dipstick Laboratory Test Satisfactory Within Range
570403 -
570404 - Follow up ref SDS 1 0X72.
570405 -
570406 - Prior Urine Dipstick test on 101207 0906. ref SDS 1 0X72
570407 -
570408 - URINE DIPSTICK............ 2012 05 09 1124
570409 - URINE Results Units Range
570410 - PH 6.0 5 - 9
570411 - PROTEIN NEG mg/dL NEG - TRACE
570412 - GLUCOSE NEG mg/dL Ref: NEG
570413 - KETONES NEG mg/dL Ref: NEG
570414 - BILI NEG Ref: NEG
570415 - BILIcnf Ref: NEG
570416 - BLOOD TRACE Ref: NEG
570417 - NITRITE NEG Ref: NEG
570418 - UROBILI 0.2 EU/dL .2 - 1
570419 - LEU EST NEG Ref: NEG
570420 - SP.GRAV 1.025 1.003- 1.035
570421 - COLOR YELLOW
570422 - APPEAR CLEAR
570423 - Comments: a
570425 - ..
570426 - a. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ
570427 - CA.
570428 -
570430 - ..
570431 - URINE MICROSCOPIC......... 2012 02 09 1124
570432 - URINE HY.CAST GR.CAST WBC/HPF RBC/HPF
570433 - Ref range low 0 None 0 0
570434 - Ref range high 1 5 5
570435 -
570436 - per lpf per lpf per hpf per hpf
570437 -
570439 - ..
570440 - a 05/09/2012 11:24 Normal (0-1) None Normal (0-5) Normal (0-5)
570441 - ===============================================================================
570443 - ..
570444 - URINE EPI CEL YEAST BACT MUCOUS
570445 - Ref range low 0 none 0
570446 - Ref range high 1 1
570447 - per hpf per hpf per hpf
570449 - ..
570450 - a 05/09/2012 11:24 Normal (0-1) None Normal (0-1) Present
570451 - ===============================================================================
570453 - ..
570454 - URINE AMR SED CRYSTAL
570455 - Ref range low 0
570456 - Ref range high 1
570457 - CRYS/LPF
570459 - ..
570460 - a 05/09/2012 11:24 None
570462 - ..
570463 - a. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ
570464 - CA.
570465 -
570466 -
570468 - ..
570469 - MISCELLANEOUS TESTS....... 2012 02 09 1124
570471 - ..
570472 - DATE TIME SPECIMEN TEST VALUE Ref ranges
570473 -
570474 - 05/09/2012 11:24 URINE TrichUR None per hpf Ref: None
570475 - 05/09/2012 11:24 URINE CultRfx No
570476 - 05/09/2012 11:24 URINE CelCast None per lpf Ref: None
570477 - 05/09/2012 11:24 URINE RenalEp None per hpf Ref: None
570478 - 05/09/2012 11:24 URINE Calc/Ox Norm(0-1) per hpf0 - 1
570479 - 05/09/2012 11:24 URINE UrACrys Norm(0-1) per hpf0 - 1
570480 - 05/09/2012 11:24 URINE TriPhos Norm(0-1) per hpf0 - 1
570481 -
570482 - a. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ
570483 - CA.
570484 -
570485 -
5705 -
SUBJECTS
Default Null Subject Account for Blank Record
5803 -
580401 - ..
580402 - Vitamin D 25 OH Concentration Within Normal Range
580403 -
580404 - Follow up ref SDS 3 N63O.
580405 -
580406 - 05/09/2012 11:24 SERUM 25-OH-D 33.0 ng/mL 30 - 100
580408 - ..
580409 - Interpretation:
580410 - Deficiency: <10ng/mL
580411 - Insufficiency: 10-30ng/mL
580412 - Sufficiency: 30-100ng/mL
580413 - Toxicity: >100 ng/mL
580415 - ..
580416 - The role of vitamin D in bone and mineral metabolism was
580417 - recognized from its first identification as a factor that could
580418 - cure rickets. However, vitamin D is now recognized as a
580419 - prohormone which has multiple roles in maintaining optimal
580420 - health. Vitamin D (D3, D2 and metabolites) is converted to
580421 - 25-hydroxyvitamin D in the liver. The measurement of 25-OH
580422 - vitamin D concentration in the serum or plasma is the best
580423 - indicator of vitamin D nutritional status. Test performed at
580424 - VA Lexington, 1101 Veterans Dr, Lex, KY 40502
580426 - ..
580427 - On 110803 Doctor Sandhu considered prescribing vitamin D treatment to
580428 - recover from, 110803 1400, ref SDS 3 PE6O
580429 -
580430 -
580431 -
580432 -
580433 -
580434 -
580435 -
580436 -
580437 -
580438 -
580439 -
580440 -
580441 -
580442 -
580443 -
580444 -
5805 -