CONTACTS
SUBJECTS
VA Cardiology Examination Cholesterol LDL 240 Increase Hiking Includ
1903 -
1903 - ..
1904 - Summary/Objective
1905 -
190501 - Follow up ref SDS 23 0000. ref SDS 17 0000.
190502 -
190503 - Cholesterol has not declined with increased exercise. Patient doing
190504 - well asymptomatic CAD. ref SDS 0 D95H Consider clinical trial for
190505 - drugs targeted to reduce cholesterol with no side effects. ref SDS 0
190506 - 179N Will increase exercise and weight loss, including hike Half Dome
190507 - and check labs in 5 months. ref SDS 0 FS9M
190508 -
190509 -
190510 -
190511 -
190513 - ..
1906 -
1907 -
1908 - Progress
1909 -
190901 - Cholesterol Elevated Despite Exercise Discuss Clinical Trial
190902 -
190903 - Follow up ref SDS 23 TS7I, ref SDS 17 TS7I.
190904 -
190905 - Reviewed labs on 130529 0818. ref SDS 25 RP4N Results showing
190906 - cholesterol remained high conflict with increased exercise and weight
190907 - loss.
190909 - ..
190910 - Doctor Egan discussed trying Atorvastatin, also called Lipitor, 40 mg
190911 - per day to lower cholesterol that remained high in lab on 130529 0818.
190912 - ref SDS 25 BE6O
190914 - ..
190915 - Reviewed patient history suffering severe side effects taking statin
190916 - medications, reported on 121206 0900. ref SDS 17 I05F
190917 -
190918 - [...below on 130603 0930 Medical Chart Progress Notes show
190919 - Lipitor also called ATORVASTATIN is listed in prescribed
190920 - medications and status is "hold." ref SDS 0 YH7I
190922 - ..
190923 - [On 131121 0930 began 4-week trial taking Atorvastatin
190924 - to evaluate possible clinical trial taking Atorvastatin
190925 - 10 mg with Zetia 10 mg ref SDS 28 2K7F
190926 -
190928 - ..
190929 - Side Effects Atorvastatin
190930 -
190931 - Atorvastatin (Lipitor) side effects were discussed today, following up
190932 - review of Rosuvastatin on 110802 1639. ref SDS 5 AT4J Doctor Egan did
190933 - research on the Internet and found the following list...
190934 -
190935 - [On 131230 began trial taking Atorvastatin 10 mg with
190936 - Ezetimibe 10 mg, shown in case study on 120101 0900.
190937 - ref SDS 8 6A6H
190939 - ..
190940 - [On 140128 1327 letter notifies VA no evident side effects
190941 - taking Atorvastatin 10 mg with Ezetimibe 10 mg. ref SDS 29
190942 - AN7H
190944 - ..
190945 - 1. MedlinePlus
190946 -
190947 - http://www.nlm.nih.gov/medlineplus/druginfo/meds/a600045.html
190949 - ..
190950 - Side Effects...
190951 -
190952 - 1. diarrhea
190953 - 2. constipation
190954 - 3. gas
190955 - 4. headache
190956 - 5. joint pain
190957 - 6. forgetfulness or memory loss
190958 - 7. confusion
190960 - ..
190961 - Serious, but less common - get medical help immediately...
190962 -
190963 - 1. muscle pain, tenderness, or weakness
190964 - 2. lack of energy
190965 - 3. fever
190966 - 4. chest pain
190967 - 5. nausea
190968 - 6. extreme tiredness
190969 - 7. weakness
190970 - 8. bleeding, bruising unusual
190971 - 9. appetite loss
190972 - 10. pain in upper right part of stomach
190973 - 11. flu-like symptoms
190974 - 12. dark colored unine
190975 - 13. yellowing of the skin or eyes
190976 - 14. rash
190977 - 15. hives
190978 - 16. itching
190979 - 17. difficulty breathing or swallowing
190980 - 18. swelling of face, throat, tongue, eyes, hands, feet, ankles or lower legs
190981 - 19. hoareness
190983 - ..
190984 - Atorvastatin may cause other side effects.
190986 - ..
190987 - If you experience a serious side effect, you or your doctor
190988 - may send a report to the Food and Drug Administration's (FDA)
190989 - MedWatch Adverse Event Reporting program online [at
190990 - http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].
190991 -
190993 - ..
190994 - 2. Emedicine Health
190995 -
190996 - http://www.emedicinehealth.com/drug-atorvastatin/article_em.htm
190998 - ..
190999 - Stop taking atorvastatin and call your doctor at once if you
191000 - have any of these serious side effects:
191001 -
191002 - 1. unexplained muscle pain, tenderness, or weakness;
191003 - 2. confusion, memory problems;
191004 - 3. fever, unusual tiredness, and dark colored urine;
191005 - 4. swelling, weight gain, urinating less than usual or not at all;
191006 - 5. increased thirst, increased urination, hunger, dry mouth,
191007 - 6. fruity breath odor, drowsiness, dry skin, blurred vision,
191008 - 7. weight loss; or
191009 - 8. nausea, upper stomach pain, itching, loss of appetite, dark
191010 - 9. urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
191012 - ..
191013 - Increased urination occurred previously with Rosuvastatin, reported
191014 - on
191015 -
191017 - ..
191018 - Reviewed objectives to avoid continuing side effects. Patient health
191019 - seems favorable, as a result of increased exercise.
191021 - ..
191022 - Discussed clinical trials for "targeted" drugs that lower cholesterol
191023 - with less adverse side effects suffered the past year with statin
191024 - technologies.
191026 - ..
191027 - Discuss Anacetrapib cholesterol treatment reported on 101117 1018.
191028 - ref SDS 4 U75H
191030 - ..
191031 - ClinicalTrials.gov Identifier.................. NCT01252953
191032 -
191033 - ...for Anacetrapib is shown on Internet at...
191034 -
191035 - http://clinicaltrials.gov/show/NCT01252953
191037 - ..
191038 - VA requirements and procedures for clinical trials is shown at...
191039 -
191040 - http://www.research.va.gov/resources/ord_admin/clinical_trials/#.Ua0zC0A3uAw
191042 - ..
191043 - VA guidance for patients volunteering for clinical trials...
191044 -
191045 - http://www.research.va.gov/programs/csp/participation.cfm#.Ua00M0A3uAw
191046 -
191048 - ..
191049 - Anacetrapib cholesterol treatment does not seem listed on CSP active
191050 - studies...
191051 -
191052 - http://www.research.va.gov/programs/csp/studies.cfm#.Ua01FUA3uAw
191054 - ..
191055 - Doctor Egan will investigate to discuss during next meeting.
191056 -
191058 - ..
191059 - Hiking Increase and Half Dome Lower Cholesterol with Lower Weight
191060 -
191061 - Hiking did not increase according to work plan, shown in case study on
191062 - 120101 0900. ref SDS 8 WQ7I Did 300 miles in May, ref SDS 8 QG3F,
191063 - including 14.2 mile hike on 130601. ref SDS 8 7G6K This recent
191064 - experience increasing daily hike from 11 to 14 miles indicates
191065 - capacity to increase hiking to control cholesterol without statin
191066 - medication.
191068 - ..
191069 - Will increase exercise and lower weight to reduce cholesterol, and to
191070 - train for hiking Half Dome.
191072 - ..
191073 - Report planning to hike Half Dome in Yosemite on 130918, scheduled in
191074 - the record on 121024 0855. ref SDS 14 5W8N
191075 -
191076 - [On 131017 1000 VA medical chart Progress Notes report Half
191077 - Dome hike was challenging, but successful, ref SDS 27 V24N,
191078 - indicating the record climbing Half Dome on 130918 0620,
191079 - ref SDS 26 0001, was reviewed by the doctor.
191081 - ..
191082 - Doctor Egan asked about knee pain going downhill at Half Dome?
191084 - ..
191085 - Explained using Glucosamine Chondroitin to mitigate knee and other
191086 - joint pain, e.g., hip and shoulder.
191088 - ..
191089 - Decided to return for next examination in 5 months, after hiking Half
191090 - Dome.
191091 -
191092 - [...below on 130603 0930 Medical Chart Progress Notes
191093 - report in treatment Plan patient will hike Half Dome.
191094 - ref SDS 0 OX3O
191095 -
191096 -
191097 -
191098 -
191099 -
1911 -
SUBJECTS
VA Cardiology Medical Chart Progress Notes Examination Investigate C
4203 -
420401 - ..
420402 - Medical Chart Progress Notes Meeting 130304
420403 -
420404 - Follow up ref SDS 23 TF5O, ref SDS 17 NS8N.
420405 -
420406 - 1. LOCAL TITLE: Cardiology 10501
420407 - STANDARD TITLE: CARDIOLOGY NOTE
420408 - DATE OF NOTE: JUN 03, 2013@08:30 ENTRY DATE: JUN 03, 2013@08:30:33
420409 - AUTHOR: EGAN,JAMES EXP COSIGNER:
420410 - URGENCY:
420411 - STATUS: COMPLETED
420415 -
420416 - 2. ...68 year old MALE followed in Cardiology Clinic for problems
420417 - including
420418 -
420419 - 1. CAD
420421 - ..
420422 - a) Angina, class II- III 10/2/09
420424 - ..
420425 - b) Abnormal TMST, relatively low work load 9/16/09
420427 - ..
420428 - c) CABGx4v 10/22/09 SFVA (LIMA-->LAD, SVG-->diag,
420429 - SVG-->Ramus,SVG-->PDA).
420431 - ..
420432 - 2. Hyperlipidemia
420434 - ..
420435 - 3. Achalasia, S/P laparoscopic myotomy with fundoplication at
420436 - the San Francisco VA December 2009. Subsequently recurrent
420437 - stricture.
420439 - ..
420440 - 4. PACs with exercise on ETT 4/6/11
420442 - ..
420443 - 3. Background
420444 -
420445 - ...[Doctor Egan enters in Progress for the meeting today,
420446 - assessment and work plan from prior meeting on 121206...]
420448 - ..
420449 - The patient was last seen in clinic on 3/4/13 , A&P as
420450 - follow:
420451 -
420452 - 1. ASSESSMENT
420454 - ..
420455 - 1) CAD. Stable, asymptomatic.
420457 - ..
420458 - 2) Hyperlipidemia. Uncontrolled
420460 - ..
420461 - 3) Achalasia. S/P E dil 1/10/13
420462 -
420464 - ..
420465 - 2. PLAN
420466 -
420467 - 1) Current medications reconciled.
420469 - ..
420470 - 2) Spent the visit discussing lipids, HTN, CAD and
420471 - potential ongoing risk of lipids at current level.
420472 - Discussed use of an alternative statin. On simva 40
420473 - mg in past but developed shoulder weakness and pain
420474 - which he attributed to myopathy, rosuva started at
420475 - that point. Discussed attempt at atorva if NFDR
420476 - approved. Also discussed non-statin lipid therapy.
420477 - Patient prefers to remain off of treatment for
420478 - hyperlipidemia for another three months before making
420479 - a decision on alternative therapy. Is aware of
420480 - potential risk of progressive atherosclerosis at these
420481 - lipid levels.
420483 - ..
420484 - 3) RTC 3 months with lipids, CMP, CBC.
420485 -
420486 -
420487 - 2. /es/ James Egan, MD
420488 - Staff Physician, Cardiology
420489 - Signed: 2013 03 04 1014 PDT
420490 -
420492 - ..
420493 - 4. Current Patient Status on 130304 0930 PDT
420494 -
420495 - Continues in good health, feels great. Did a 14 mile hike over
420496 - the weekend, felt well. No symptoms suggestive of angina.
420497 - Most of visit spent discussing therapy for lipids. Prior feet
420498 - paresthesias have essentially resolved, as has lightheadedness
420499 - and left shoulder pain. Is interested in participating in a
420500 - clinical trial utilizing a non-statin antilipemic.
420502 - ..
420503 - This aligns with the record meeting with the doctor earlier today,
420504 - above. ref SDS 0 179N
420506 - ..
420507 - Progress Notes continue...
420508 -
420509 - 5. PAST MEDICAL HISTORY:
420510 -
420511 - Computerized Problem List is the source for the following:
420512 -
420513 - 1. Dizziness * (ICD-9-CM 780.4) 09/06/12 Egan, James
420515 - ..
420516 - 2. Paresthesia * (ICD-9-CM 782.0) 09/06/12 Egan, James
420518 - ..
420519 - 3. Vitamin D Deficiency 08/03/11 Sandhu, Harkesh
420521 - ..
420522 - 4. Postsurgical Aortocoronary Bypass Status (ICD-9-CM
420523 - V45.81) 03/09/11 Egan, James
420525 - ..
420526 - 5. Esophageal Stricture 03/05/10 LEE,RANDALL E.......
420528 - ..
420529 - 6. Screening for Malignant Neoplasms of colon 02/02/10
420530 - LEE,RANDALL E (ICD-9-CM V76.51)
420532 - ..
420533 - 7. Coronary Atherosclerosis (unspecified type 02/02/10
420534 - LEE,RANDALL E vessel, native or graft) (ICD-9-CM 41
420536 - ..
420537 - 8. Coronary Artery Bypass using Venous and 01/04/10
420538 - SANDHU,HARKESH Arterial Grafts (Single Vein Graft),
420539 - Onset 10/00/09 done at vasf
420541 - ..
420542 - CABG was performed at VA San Francisco Medical Center on 091022.
420543 - ref SDS 13 PQWU
420545 - ..
420546 - VA medical chart continues...
420547 -
420548 - 9. Surgical Thoracoscopy with Esophagomyotomy 01/04/10
420549 - SANDHU,HARKESH (Heller Type), Onset 12/16/09 at vasf
420551 - ..
420552 - 10. Hyperlipidemia * (ICD-9-CM 272.4) 10/02/09 EGAN,JAMES
420554 - ..
420555 - 11. Inflamed Seborrheic Keratosis (ICD-9-CM 702.11)
420556 - 03/12/07 LIN,BERTHA
420558 - ..
420559 - 12. Rosacea * (ICD-9-CM 695.3) 03/12/07 LIN,BERTHA
420561 - ..
420562 - 13. Dermatitis * (ICD-9-CM 692.9) 03/12/07 LIN,BERTHA
420564 - ..
420565 - 14. Tinea Unguium * (ICD-9-CM 110.1) 03/12/07 LIN,BERTHA
420567 - ..
420568 - 15. Tinea * (ICD-9-CM 110.9) 03/12/07 LIN,BERTHA
420570 - ..
420571 - 16. Rosacea conjunctivitis (ICD-9-CM 372.31) 03/02/07
420572 - MARGULIES,LINDA
420574 - ..
420575 - 17. Rosacea * (ICD-9-CM 695.3) 03/02/07 MARGULIES,LINDA
420577 - ..
420578 - 18. Blepharitis NOS 02/21/07 MARGULIES,LINDA
420580 - ..
420581 - 19. Achalasia * (ICD-9-CM 530.0) 12/22/05 SANDHU,HARKESH
420583 - ..
420584 - 20. Abn. LFT's 08/16/05 SANDHU,HARKESH
420586 - ..
420587 - 21. Obesity 06/29/05 SANDHU,HARKESH
420589 - ..
420590 - 22. Rosacea 06/29/05 SANDHU,HARKESH
420592 - ..
420593 - 23. Tinea Unguium 06/29/05 SANDHU,HARKESH
420595 - ..
420596 - Patient has answered NKA (no known allergies)
420598 - ..
420599 - 6. Active Outpatient Medications (including Supplies):
420600 -
420601 - 1. OMEPRAZOLE 20MG EC CAP TAKE ONE CAPSULE BY MOUTH TWICE A
420602 - HOLD DAY 15 MINUTES BEFORE A MEAL FOR SEVERE ACID REFLUX
420603 - AND ESOPHAGEAL NARROWING.
420605 - ..
420606 - 2. ATORVASTATIN CALCIUM 40MG TAB TAKE ONE TABLET BY MOUTH ONCE
420607 - DAILY TO LOWER CHOLESTEROL. (REPLACES ROSUVASTATIN) HOLD
420609 - ..
420610 - Atorvastatin is Lipitore discussed as possible medication to lower
420611 - cholesterol during the meeting, per above. ref SDS 0 VQ9I
420613 - ..
420614 - VA medical chart continues...
420615 -
420616 - 7. PHYSICAL EXAM - Date: 130304 0940
420617 -
420618 - T....................... 96.7 F (35.9 C)
420619 - P....................... 65
420620 - R....................... 16
420621 - B/P..................... 129/70
420622 - Wt...................... 185.7 (84.41 KG) (ACTUAL STANDING WEIGHT)
420623 - Body Mass Index......... 30*
420624 - Pulse Oximetry.......... 96%
420625 - Pain.................... 0 - No pain
420627 - ..
420628 - VITALS: 04/16/2013 10:08 BP:132/78 HR:61 Wt:193 lb [87.7 kg]
420630 - ..
420631 - This last report on vitals reflects meeting with Doctor Lee for EGD
420632 - Dilation at VA in Sacramento on 130416 1100. ref SDS 24 K37G
420634 - ..
420635 - VA medical chart continues...
420636 -
420637 - 8. LAB Review
420638 -
420639 - ...[Doctor Egan lists results for lab performed on 130529 0818.
420640 - ref SDS 25 BE6O
420642 - ..
420643 - 9. ASSESSMENT
420644 -
420645 - 1. CAD. Stable, asymptomatic.
420647 - ..
420648 - 2. Hyperlipidemia. not in control.
420650 - ..
420651 - 3. PACs with exercise on ETT 4/6/11
420653 - ..
420654 - 10. PLAN:
420655 -
420656 - 1. Current medications reconciled with patient.
420657 -
420658 - 2. Prolonged discussion of appropriate approach to his
420659 - hyperlipidemia. Given past left should pain attributed to
420660 - simvastatin and possible lightheadedness and paresthesias
420661 - with rosuvastatin, atorvastatin seems a reasonable choice.
420662 - Discussed potential interaction with omeprazole and
420663 - increased risk of myopathy. Prefers to make an attempt
420664 - with atorva and failing that research participation in
420665 - clinical trials of newer agents.
420667 - ..
420668 - 3. Rx atorvastatin 40 mg daily
420669 -
420670 - [On 131121 0930 began 4-week trial taking Atorvastatin
420671 - to evaluate possible clinical trial taking Atorvastatin
420672 - 10 mg with Zetia 10 mg ref SDS 28 2K7F
420674 - ..
420675 - 4. CMP, Lipids in early October following climb of Half Dome.
420677 - ..
420678 - Nice for doctor to note in the record patient will attempt to hike
420679 - Half Dome, discussed during the meeting today, per above. ref SDS 0
420680 - 2Z5G
420681 -
420682 - [On 131017 1000 VA medical chart Progress Notes report Half
420683 - Dome hike was challenging, but successful, ref SDS 27 V24N,
420684 - indicating the record climbing Half Dome on 130918 0620,
420685 - ref SDS 26 0001, was reviewed by the doctor.
420686 -
420687 -
420688 - 11. /es/ James Egan, MD
420689 - Staff Physician, Cardiology
420690 - Signed: 2013 06 03 1022 PDT
420691 -
420692 -
420693 -
420694 -
420695 -
420696 -
420697 -
420698 -
420699 -
420700 -
420701 -
420702 -
420703 -
420704 -
420705 -
420706 -
4208 -