CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 20 0000. ref SDS 19 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Agenda Submitted for Cardiology Meeting This Morning 0930
040902 -
040903 - Follow up ref SDS 20 D95H, ref SDS 19 D95H.
040904 -
040905 - Background and agenda submitted in the letter yesterday on 131016
040906 - 1632. ref SDS 22 TW9H Agenda cites hike Half Dome in Yosemite on
040907 - 130918 0620. ref SDS 21 0001
040909 - ..
040910 - Discuss Anacetrapib cholesterol treatment reported on 101117 1018,
040911 - ref SDS 3 U75H, and cited in agenda submitted yesterday on 131016
040912 - 1632. ref SDS 22 TG5J
040914 - ..
040915 - ClinicalTrials.gov Identifier.................. NCT01252953
040916 -
040917 - ...for Anacetrapib is shown on Internet at...
040918 -
040919 - http://clinicaltrials.gov/show/NCT01252953
040921 - ..
040922 - VA requirements and procedures for clinical trials is shown at...
040923 -
040924 - http://www.research.va.gov/resources/ord_admin/clinical_trials/#.Ua0zC0A3uAw
040926 - ..
040927 - VA guidance for patients volunteering for clinical trials...
040928 -
040929 - http://www.research.va.gov/programs/csp/participation.cfm#.Ua00M0A3uAw
040930 -
040932 - ..
040933 - Anacetrapib cholesterol treatment does not seem listed on CSP active
040934 - studies...
040935 -
040936 - http://www.research.va.gov/programs/csp/studies.cfm#.Ua01FUA3uAw
040938 - ..
040939 - Amgen and Regeneron are developing medicines that cut cholesterol
040940 - through a new strategy, by blocking a protein called PCSK9, reported
040941 - on 120325 1312. ref SDS 8 GG5I
040942 -
040944 - ..
040945 - Article published by Reuters reported on 131015 new cholesterol drug
040946 - by Regeneron and Sanofi (evidently joint venture project)...
040947 -
040948 - Alirocumab cuts LDL-C by 47.2 pct
040949 -
040950 - Patients taking alirocumab started out with a low 75-milligram
040951 - dose every two weeks, but this was increased to 150 milligrams
040952 - at week 12 if their LDL levels at week eight were above 70.
040953 - Most patients, however, remained on the low dose throughout
040954 - the study because they got their LDL levels below that
040955 - threshold - an aggressive LDL target - by the eighth week.
040957 - ..
040958 - "It shows that a low dose, when used as a monotherapy, can be
040959 - quite effective," Yancopoulos said, noting that no worrisome
040960 - side effects were seen in the study nor in earlier trials.
040962 - ..
040963 - Self-injection bi-weekly, seems better than taking a pill
040964 - everyday.
040965 -
040966 - http://www.reuters.com/article/2013/10/16/us-regeneron-sanofi-cholesterol-idUSBRE99F04220131016
040967 -
040968 -
040969 -
040970 -
040971 -
040972 -
040973 -
040974 -
0410 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
0504 - 0930
050501 - ..
050502 - Meeting Cardiology Followed Agenda Submitted Earlier Today
050503 -
050504 - Follow up ref SDS 20 TS7I, ref SDS 19 TS7I.
050505 -
050506 - Doctor Egan started the meeting OA 0940. He reported having not
050507 - received the letter submitted this morning, per above,
050508 -
050509 - ... and so he was not prepared to discuss associated links relevant to
050510 - issues presented today, including lab review on 130228. 130228 1140,
050511 - ref SDS 18 KK9M
050513 - ..
050514 - The doctor indicated today that unlike the last meeting on 121206
050515 - 0900, ref SDS 15 TS7I, the VA has a new procedure. Correspondence
050516 - sent to the doctor is now diverted to someone, who later transfers the
050517 - letter to the doctor. This sets back progress on patient
050518 - communications, similar to the earlier the meeting a year ago on
050519 - 120216 1000. ref SDS 7 3M4H
050521 - ..
050522 - Following the meeting, this record was transformed into a report on
050523 - discussion and work plans.
050525 - ..
050526 - Reviewed results of lab on 121130. ref SDS 14 RP4N
050527 -
050528 - 121130 120831
050529 - 1. WBC 7.5 10.9 4.8 - 10.8
050530 -
050531 - Reduction of WBC within range aligns with patient history...
050532 -
050533 - a. Sore throat from Rosuvastatin dehydration causing dry
050534 - mouth and sore throat.
050536 - ..
050537 - Rosuvastatin 10 mg reduced from 20 mg in meeting with
050538 - Doctor Egan at VA on 120906. ref SDS 10 W16H
050540 - ..
050541 - Biopsy on 120925 discovered esophageal infection candida.
050542 - Doctor Lee prescribed Fluconazole, beginning on 121004,
050543 - received from VA, reported in case study on 101010 0744.
050544 - ref SDS 2 1W9L Treatment ended on 121024, also shown in
050545 - case study. ref SDS 2 QQ7K
050547 - ..
050548 - While infection seems resolved shown by WBC dropping witin
050549 - range, slight sore throat recurred, and continues.
050551 - ..
050552 - On 120925 Doctor Lee at VA in Sacramento made referral for
050553 - follow up examination of Heller Myotomy surgery on 091216
050554 - to resolve achalasia, and specifically at this time reflux
050555 - laying on left side, shown in record on 120925 0900,
050556 - ref SDS 11 6J9G On 121013 Doctor Stewart and Doctor Vaughn
050557 - made examination at VA Medical Center in San Francisco
050558 - discovered horse voice disorder. ref SDS 12 AE7K Barrium
050559 - swallow test was ordered and performed on 121113.
050560 - ref SDS 13 4X5H Doctor Stewart made referral for ENT
050561 - examination of voice disorder, scheduled for 121221.
050563 - ..
050564 - b. Blisters under arms from hiking resolved.
050566 - ..
050567 - c. Blisters on lower legs resolved.
050568 -
050569 -
050570 -
050571 - 121130 120831
050572 - ..
050573 - 2. Lymph % 18.5 13.0 20 - 51
050574 -
050575 - Significant increase to near normal.
050577 - ..
050578 - No discussion during meeting today.
050579 -
050580 -
050581 -
0506 -
SUBJECTS
Default Null Subject Account for Blank Record
0603 -
060401 - ..
060402 - Peripheral Neuropathy Recurrence Possible Referral Neurology
060403 - Bilirubin Declines Aligns with Peripheral Neuropathy Less Frequent
060404 - Peripheral Neuropathy Less Frequent Aligns with Bilirubin Declines
060405 -
060406 - Follow up ref SDS 20 NI9L, ref SDS 19 NI9L.
060407 -
060408 - 121130 120831
060409 - 3. T Bilirubin 1.6 2.3 .3 - 1.2 ......... 121130 0846, ref SDS 14 KK9M
060411 - ..
060412 - Sharp decline may reflect reducing Rosuvastatin 10 mg from 20 mg
060413 - ordered by Doctor Egan on 120906, ref SDS 10 C739, and implemented in
060414 - patient history shown in case study on 101010 0744. ref SDS 2 SQ6H
060415 - Lab review on 121130, further correlates lower bilirubin with reduced
060416 - peripheral neuropathy. ref SDS 14 ER4K
060418 - ..
060419 - Peripheral neuropathy recent recurrance, including today, per above,
060420 - ref SDS 15 D95H, indicates continuing challenge taking Rosuvastatin 10
060421 - mg, reported with lab review on 121130 0846, ref SDS 14 XU6I, and
060422 - citing record on 121201 shown in case study on 101010 0744.
060423 - ref SDS 2 ZD5H
060425 - ..
060426 - Doctor Egan advised today that Rosuvastatin 10 mg may not be causing
060427 - peripheral neuropathy, and in particular recent recurrance, including
060428 - today, per above. ref SDS 15 H766 He said that something "internal"
060429 - may be the cause, and asked if Doctor Sandhu has made referral to
060430 - neurology for examination?
060432 - ..
060433 - Referral for neurology may be indicated.
060434 -
060435 - [On 130122 1330 peripheral neuropathy parathesia discussed
060436 - Doctor Stewart in General Surgery at VA Medical Center in
060437 - San Francisco, ref SDS 17 0S3K; preliminary diagnosis
060438 - spinal stenosis, referral made to Neurology Department.
060439 - ref SDS 17 OE6N
060440 -
060441 -
060442 -
0605 -
SUBJECTS
Default Null Subject Account for Blank Record
0703 -
070401 - ..
070402 - Postasium Elevated Health Risk CAD Cause Dehydration Rosuvastatin
070403 - Dehydration Skew Labs Shown by Conflicting Glucose Sodium Potasium
070404 - Retest Electrolytes Ordered Evaluate Lab Skewed by Dehydration
070405 - Labs Skewed Dehydration Retest Ordered Verify Patient Condition
070406 -
070407 - Follow up ref SDS 20 NI5J, ref SDS 19 NI5J.
070408 -
070409 - 121130 120831
070410 - 4. GLUCOSE 115 113 mg/dL 74 - 118....... 121130 0846, ref SDS 14 WJ5H
070411 - 5. NA (salt) 144 141 mmol/L 136 - 144
070412 - 6. K (potasium) H 5.2 3.8 mmol/L 3.4 - 4.8
070414 - ..
070415 - Discussed conflict in lab showing glucose and sodium rising while
070416 - hiking 700 miles in 11,000 minutes past 3 months, shown in lab review
070417 - on 121130 0846. ref SDS 14 868N Explained black coat hiking is covered
070418 - with white salt pouring out of body, and there has been no change in
070419 - diet adding salt nor sugar. While daily consumption of sugar and salt
070420 - may be higher than for most patients, they were decreased over past 3
070421 - months, and have never shown this level of concentration.
070422 - Accordingly, increased hiking would be expected to lower these labs
070423 - rather than cause rising levels.
070425 - ..
070426 - Doctor Egan advised that NA (sodium) may have increased toward high
070427 - end of range rather than significantly decreased, because of
070428 - dehydration caused by Rosuvastatin 10 mg prescribed to lower LDL, per
070429 - below. ref SDS 15 2N4G
070430 -
070431 - [On 121212 0941 follow up, ref SDS 16 KK9M
070433 - ..
070434 - Patient reported today that urinating has increased even without
070435 - increased fluids, i.e., drinking water or anything. For example, last
070436 - night 5 - 6 times, similar to effect of Lasix that causes body to lose
070437 - liquid.
070439 - ..
070440 - Another signal of dehydration is increased cramping in legs and back
070441 - on stretching or turning in odd manner. This normally occurs after
070442 - long hikes, but in past 3 weeks or so problem seems to be continual.
070444 - ..
070445 - The doctor explained Labs measure concentration of elements, like
070446 - glucose, sodium... in the bloodstream, which is mostly water.
070447 - Accordingly, increased urination increases concentration of sodium in
070448 - the blood, and so may account for evident error in electrolytes lab,
070449 - per above. ref SDS 15 NI5J
070451 - ..
070452 - Patient further questioned accuracy of glucose. Hiking 700 miles
070453 - (roughtly 11 miles per day) for past 3 months should have lowered both
070454 - glucose and salt, but lab on 121130 reports rise. ref SDS 15 NI5J
070456 - ..
070457 - Doctor Egan was more concerned about potasium (K) rising above target
070458 - range for good health. He explained this effects electrical signals
070459 - to the heart, and so has significant impact for CAD.
070461 - ..
070462 - This analysis raises prospect that entire lab was skewed by loss of
070463 - liquid through increased urination causing dehydration, a side effect
070464 - of Rosuvastatin, reported on 110802 1639. ref SDS 4 IT9N Rosuvastatin
070465 - was prescribed on 110817 1030, ref SDS 6 DG36, and treatment started
070466 - on 110824, see discussion below. ref SDS 15 OS5L
070468 - ..
070469 - The doctor advised that tomatos and bananas, both prominent in patient
070470 - history, e.g., 121130 shown in case study on 101010 0744, ref SDS 2
070471 - X75H, are rich in potassium. Doctor Egan further explained that
070472 - ordinary diet does not cause increased potasium. He seemed to say
070473 - that medication conflicts can cause potasium lab to rise.
070475 - ..
070476 - Since Omeprazole has been taken with Rosuvastatin for past 18 months,
070477 - beginning on 110824 (see case study on 101010 0744. ref SDS 2 KF8O),
070478 - and since potasium has never been elevated, this seems to support
070479 - analysis today that dehydration explains elevated electrolytes.
070480 -
070481 - [...below on 121206 0900 analysis indicating LDL and HDL
070482 - might be skewed higher by excessive dehydration.
070483 - ref SDS 15 QG6F
070485 - ..
070486 - Doctor Egan ordered retest to verify electrolytes labs.
070488 - ..
070489 - Test will be performed tomorrow.
070491 - ..
070492 - Might delay test until Monday on 121210, to allow time for reduced
070493 - urination after ending Rosuvastatin (ordered today, per below.
070494 - ref SDS 15 OS5L This might restore normal concentration levels in the
070495 - blood, unless something else is driving dehydration.
070496 -
070497 -
070498 -
0705 -
SUBJECTS
Default Null Subject Account for Blank Record
0803 -
080401 - ..
080402 - Clinical Trial Phase I Exercise Weight Lower Cholesterol Reduce Drugs 50%
080403 - Dehydration Skewed Cholesterol Labs LDL < 70 Remains Goal
080404 - LDL Cholesterol Lab Mixed Results Possibly Skewed by Dehydration
080405 -
080406 - Follow up ref SDS 20 2N4G, ref SDS 19 2N4G.
080407 -
080408 - 121130 120831
080409 - ..
080410 - 7. LDL 105 110 <= 160 ........... 121130 0846, ref SDS 14 BE6O
080411 - HDL 57 47 >= 140
080413 - ..
080414 - On 120906 LDL cholesterol increased slightly. At that time 3 months
080415 - ago, decided to reduce Rosuvastatin 10 mg by 50% from 20 mg, and test
080416 - lowering LDL cholesterol and increasing HDL through exercise and
080417 - weight loss. ref SDS 10 C739
080419 - ..
080420 - Doctor Egan indicated during the meeting that he reviewed analysis
080421 - hiking 700 miles and weight loss past 3 months shown with the record
080422 - for the recent lab on 121130 0846. ref SDS 14 868N
080424 - ..
080425 - These lab results may justify ending Rosuvastatin to avoid side
080426 - effects of peripheral neuropathy and dehydration, per discussion on
080427 - skewed labs for electrolytes, above, ref SDS 15 NI5J, while continuing
080428 - to reduce LDL and increase HDL cholesterol to manage CAD.
080430 - ..
080431 - Continuing level of effort hiking 700 miles over next 3 months will be
080432 - challenged by winter weather and by injuries to shoulder and hip,
080433 - cited in lab review on 121130 0846. ref SDS 14 SY4L
080434 -
080435 -
080436 -
080437 -
0805 -
SUBJECTS
Default Null Subject Account for Blank Record
0903 -
090401 - ..
090402 - Phase II Clinical Trial Cholesterol Manage with Exercise Weight Loss
090403 - LDL Lower Without Drugs Clinical Trial 3 Months Hiking Weight Loss
090404 - Rosuvastatin End Rely on Hiking Weight Loss Lower LDL cholesterol
090405 -
090406 - Follow up ref SDS 20 OS5L, ref SDS 19 OS5L.
090407 -
090408 - Today, Doctor Egan prescribed ending Rosuvastatin ordered previously
090409 - during the meeting at the VA on 110817, ref SDS 6 DG36, to replace
090410 - Simvastatin and begun on 110824, as shown in case study on 101010
090411 - 0744. ref SDS 2 KF8O The doctor ordered another lab in 3 months to
090412 - test lowering LDL cholesterol without drug medications, and continuing
090413 - hiking exercise and weight loss, as shown in record reviewing the
090414 - recent lab on 121130. ref SDS 14 868N
090416 - ..
090417 - Doctor Egan emphasized objective for CAD patient to reduce LDL < 70
090418 - after having heart surgery (CABG 4x) on 091022 0700. ref SDS 1 PQWU
090419 - The doctor indicated that increasing HDL 57 was likely due to
090420 - increased exercise, and was very positive and in some respects reduces
090421 - risks of LDL > 70, found in the recent lab.
090423 - ..
090424 - [On 101010 0744 patient history medication, diet, exercise
090425 - and vitals reports ending Rosuvastatin today. ref SDS 2
090426 - GC6N
090428 - ..
090429 - Explanation today of dehydration through frequent urination caused by
090430 - Rosuvastatin affecting concentrations of labs for Bilirubin,
090431 - ref SDS 15 NI9L, Glucose and sodium, possibly potassium, might also
090432 - affect LDL and HDL, i.e., LDL and HDL might both be lower, per above
090433 - discussion. ref SDS 15 NI5J
090434 -
090435 -
090436 -
090437 -
0905 -
SUBJECTS
Default Null Subject Account for Blank Record
1003 -
100401 - ..
100402 - Peripheral Neuropathy Parathesia Reduced Dizziness Resolved
100403 - Rosuvastatin Side Effects Subsided After Reducing Dose
100404 -
100405 - Follow up ref SDS 20 I05F, ref SDS 19 I05F.
100406 -
100407 - 1. Dizziness
100408 -
100409 - Completely resolved and so ending major disorder reported
100410 - during meeting at VA on 120906 1100. ref SDS 10 5L6H
100412 - ..
100413 - 2. Periperhal neuropathy follow up report at prior meeting on
100414 - 120906 1100, ref SDS 10 2I4G, and originally reported to the VA
100415 - on 120514 1300. ref SDS 9 6I70
100417 - ..
100418 - Mostly resolved for several months with increased hiking to 700
100419 - miles past 3 months, per above, ref SDS 15 0R3L, but recent
100420 - moderate recurrance while waiting to get blood draw at VA on
100421 - 121130 0846. ref SDS 14 PH3M, and again today while waiting to
100422 - meet with Doctor Egan, per above, ref SDS 15 H766, indicates
100423 - continuing challenges, reported on 121201 and shown in case
100424 - study on 101010 0744. ref SDS 2 ZD5H
100426 - ..
100427 - Doctor Egan advised today discussing correlation with taking
100428 - Rosuvastatin 10 mg to manage cholesterol may not be causing peripheral
100429 - neuropathy, ref SDS 15 VL3F, and in particular recent recurrance,
100430 - including today, also above. ref SDS 15 H766 He said that something
100431 - "internal" may be the cause, and asked if Doctor Sandhu has made
100432 - referral to neurology for examination?
100434 - ..
100435 - Referral for neurology may be indicated.
100436 -
100437 - [On 130122 1330 peripheral neuropathy parathesia discussed
100438 - Doctor Stewart in General Surgery at VA Medical Center in
100439 - San Francisco, ref SDS 17 0S3K; preliminary diagnosis
100440 - spinal stenosis, referral made to Neurology Department.
100441 - ref SDS 17 OE6N
100443 - ..
100444 - 3. Sore throat due to dehydration
100445 -
100446 - Horse voice will be examined by ENT on 121221. Doctor Lee has
100447 - advanced next EGD dilation from April to 130110 (January 10).
100448 -
100449 -
100450 -
1005 -
SUBJECTS
Default Null Subject Account for Blank Record
1103 -
110401 - ..
110402 - Left Shoulder Pain Swinging Arm Hiking Long Distance Not Myopathy
110403 -
110404 - Follow up ref SDS 20 OE9I, ref SDS 19 OE9I.
110405 -
110406 - Left shoulder pain is markedly different from myopathy pain caused by
110407 - Simvastatin, and which contributed to switching to Rosuvastatin in the
110408 - meeting at the VA on 110817 1030. ref SDS 6 DG36
110410 - ..
110411 - In the prior case last year, left shoulder hurt to lift the arm in any
110412 - direction above horizontal, reported during meeting at VA on 110817
110413 - 1030, ref SDS 5 QF6W, and citing daily report on 101224 in case study
110414 - on 101010 0744. ref SDS 2 554N This seemed like a muscle issue caused
110415 - by side effects taking Simvastatin, and discussed with Doctor Sandhu
110416 - on 110803 1400. ref SDS 14 RP4F
110418 - ..
110419 - Painful left shoulder in this case beginning 2 weeks ago OA 121126,
110420 - shown in case study on 101010 0744, ref SDS 2 9X4L, seems to occur
110421 - from swinging the arm hiking long distances. There is no pain lifting
110422 - the arm above horizontal nor placing left hand behind head, as
110423 - occurred with Simvastatin.
110424 -
110425 -
110426 -
110427 -
1105 -
SUBJECTS
Default Null Subject Account for Blank Record
1203 -
120401 - ..
120402 - Rosacia Recurrance Past 2 Weeks
120403 -
120404 - Follow up ref SDS 20 SU6F, ref SDS 19 SU6F.
120405 -
120406 - Doctor Egan will report in Progress Notes rosacia recurrence evident
120407 - above right eye. May be caused by increased perspiration from
120408 - hiking, and/or some exposure to sun on a few days when hiking without
120409 - a hat because of cloud cover.
120410 -
120411 -
120412 -
120413 -
120414 -
120415 -
120416 -
120417 -
120418 -
120419 -
120420 -
120421 -
1205 -