CONTACTS
SUBJECTS
VA Doctor Patient Partnership Effective Productive Examination Docto
3403 -
3403 - ..
3404 - Summary/Objective
3405 -
340501 - Follow up ref SDS 29 0000. ref SDS 26 0000.
340502 -
340503 - Good progress with Doctor Patient partnership productive meeting
340504 - relying on agenda. ref SDS 0 D95H Doctor concerned about chronic
340505 - hyperbilirubinemia with T Bilirubin rising 40% above target, reflects
340506 - intollerance for statin drugs to control cholesterol (hyperlipidemia).
340507 - ref SDS 0 KV5G Doctor ordered consult with SF VA Medical Center for
340508 - participation clinical trials using new agents to control cholesterol
340509 - that avoid severe side effects. ref SDS 0 VY6H Patient continuing
340510 - active physically hiking Half Dome and 1200 miles with further weight
340511 - loss past 5 months makes CAD asymptomatic and stable, so no further
340512 - testing required at this time. ref SDS 0 KU9N
340513 -
340514 - [On 131103 1739 received letter from SFVA schedule meeting
340515 - on 131120 1000, to develop clinical trial care for lowering
340516 - cholesterol. ref SDS 34 Q27Z
340518 - ..
340519 - [On 140430 0900 submit agenda to Doctor Egan with copy to
340520 - Doctor Sandhu for follow up meeting. ref SDS 37 HY6O
340521 -
340522 -
340523 -
340524 -
340526 - ..
3406 -
3407 - Progress
3408 -
340801 - Lab Review Shows Elevated T Bilirubin and Cholesterol
340802 - Side Effects Rosuvastatin Persistant Conflict Patient Profile
340803 - Bilirubin Rises 25% Well Above Protocol Range Chronic Hyperbilirubinemia
340804 - Hyperbilirubinemia Chronic Bilirubin Rises 40% Above Protocol Range
340805 -
340806 - Follow up ref SDS 29 D95H, ref SDS 26 TS7I.
340807 -
340808 - Doctor Egan indicated he received the agenda submitted yesterday
340809 - on 131016 1632. ref SDS 32 TW9H During the meeting he was aware of
340810 - issues presented in links provided in the agenda.
340812 - ..
340813 - Reviewed labs on 131015 0724. ref SDS 31 KK9M
340815 - ..
340816 - Discussed Bilirubin increasing 25% to 1.7, 40% above target range,
340817 - shown in the record on 131015 0724, ref SDS 31 015M, rather than
340818 - falling within target range, compared to 1.3 on prior lab 5 months ago
340819 - on 130529 0818. ref SDS 28 1Y9G Since Rosuvastatin was ended on
340820 - 121206 0900, ref SDS 20 OS5L, this record may indicate Rosuvastatin
340821 - did not elevate Bilirubin; or, alternatively, that chronic dysfunction
340822 - of liver has occurred taking Rosuvastatin that cannot be reversabed,
340823 - or that recovery will be long term.
340825 - ..
340826 - [...below on 131017 1000 VA medical chart Progress Notes
340827 - assessment report doctor concerned about chronic
340828 - hyperbilirubinemia. ref SDS 0 PSXT
340830 - ..
340831 - Background on Rosuvastatin causing elevated Total Bilirubin with
340832 - severe side effects is reported in the record on...
340833 -
340834 - 121130............................ ref SDS 19 ER4K
340835 - 121206............................ ref SDS 20 NI9L
340837 - ..
340838 - Doctor Egan seemed to indicate today that elevated T Bilirubin 1.7
340839 - does not signal treatable issue, because symptoms have mostly
340840 - subsided, as reported in the record on 121206 0900. ref SDS 20 I05F
340842 - ..
340843 - The doctor explained that patient history showing continuing
340844 - intermittant and mild peripheral neuropathy, reported in patient
340845 - history since prior meeting at VA on 130603, see case study on 120101
340846 - 0900, ref SDS 10 X14N, suggests intervention is not required at this
340847 - time to improve recovery after ending Rosuvastatin last year on
340848 - 121206. ref SDS 20 OS5L
340849 -
340850 - [...below on 131017 1000 VA medical chart Progress Notes
340851 - assessment report doctor concerned about chronic
340852 - hyperbilirubinemia. ref SDS 0 PSXT
340854 - ..
340855 - Persistant side effects from statin medications present complex
340856 - patient profile for lowering cholesterol.
340857 -
340858 -
340859 -
340860 -
340861 -
3409 -
SUBJECTS
VA Cardiology Examination Cholesterol Hyperlipidemia LDL 248 Despite
7603 -
760401 - ..
760402 - Hyperlipidemia Not Controlled Cholesterol Elevated Despite Exercise
760403 - Cholesterol Elevated Despite Exercise Discuss Clinical Trial
760404 - Clinical Trial Considered Lower Cholesterol Without Statin Drugs
760405 -
760406 - Follow up ref SDS 29 D95H.
760407 -
760408 - Lab on 131015, showing cholesterol remained high, 131015 0724,
760409 - ref SDS 31 BE6O, conflict with increased exercise and weight loss,
760410 - discussed in the letter to the medical team yesterday on 131016 1632.
760411 - ref SDS 32 IW57
760412 -
760413 - [...below on 131017 1000 VA medical chart Progress Notes
760414 - assessment report patient status CAD stable, asymptomatic.
760415 - hyperlipidemia not controlled. ref SDS 0 T24N
760417 - ..
760418 - On 130603 0930 Medical Chart Progress Notes show Lipitor also called
760419 - ATORVASTATIN is listed in prescribed medications and status is "hold."
760420 - ref SDS 29 YH7I This reflects patient history suffering severe side
760421 - effects with statin medications, reported during the meeting 5 months
760422 - ago on 121206 0900. ref SDS 20 I05F
760424 - ..
760425 - Discussed clinical trials again for "targeted" drugs that lower
760426 - cholesterol with less adverse side effects suffered the past year with
760427 - statin technologies.
760428 -
760429 - [On 131103 1739 received letter from SFVA schedule meeting
760430 - on 131120 1000, to develop clinical trial care for lowering
760431 - cholesterol. ref SDS 34 Q27Z
760433 - ..
760434 - Anacetrapib cholesterol treatment reported on 101117 1018. ref SDS 5
760435 - U75H
760437 - ..
760438 - ClinicalTrials.gov Identifier.................. NCT01252953
760439 -
760440 - ...for Anacetrapib is shown on Internet at...
760441 -
760442 - http://clinicaltrials.gov/show/NCT01252953
760444 - ..
760445 - VA requirements and procedures for clinical trials is shown at...
760446 -
760447 - http://www.research.va.gov/resources/ord_admin/clinical_trials/#.Ua0zC0A3uAw
760449 - ..
760450 - VA guidance for patients volunteering for clinical trials...
760451 -
760452 - http://www.research.va.gov/programs/csp/participation.cfm#.Ua00M0A3uAw
760453 -
760455 - ..
760456 - Anacetrapib cholesterol treatment does not seem listed on CSP active
760457 - studies...
760458 -
760459 - http://www.research.va.gov/programs/csp/studies.cfm#.Ua01FUA3uAw
760461 - ..
760462 - Amgen and Regeneron are developing medicines that cut cholesterol
760463 - through a new strategy, by blocking a protein called PCSK9, reported
760464 - on 120325 1312. ref SDS 12 GG5I
760466 - ..
760467 - Article published by Reuters reported on 131015 new cholesterol drug
760468 - by Regeneron and Sanofi (evidently joint venture project)...
760469 -
760470 - Alirocumab cuts LDL-C by 47.2 pct
760471 -
760472 - Patients taking alirocumab started out with a low 75-milligram
760473 - dose every two weeks, but this was increased to 150 milligrams
760474 - at week 12 if their LDL levels at week eight were above 70.
760475 - Most patients, however, remained on the low dose throughout
760476 - the study because they got their LDL levels below that
760477 - threshold - an aggressive LDL target - by the eighth week.
760479 - ..
760480 - "It shows that a low dose, when used as a monotherapy, can be
760481 - quite effective," Yancopoulos said, noting that no worrisome
760482 - side effects were seen in the study nor in earlier trials.
760484 - ..
760485 - Self-injection bi-weekly, seems better than taking a pill
760486 - everyday.
760487 -
760488 - http://www.reuters.com/article/2013/10/16/us-regeneron-sanofi-cholesterol-idUSBRE99F04220131016
760490 - ..
760491 - Since cholesterol 321, and LDL 249 are well above targets for LDL 70,
760492 - set in the record on 110309 0900. ref SDS 6 ZM98 Doctor Egan will
760493 - make referral to San Francisco VA Medical Center for evaluating
760494 - patient participation in clinical trial of treatments and medications
760495 - to lower cholesterol with minimal side effects.
760496 -
760497 - [...below on 131017 1000 VA medical chart Progress Notes
760498 - assessment report patient status hyperlipidemia not
760499 - controlled, ref SDS 0 PSXT; Doctor Egan makes referral to
760500 - SF VA Medical Center for consult on participation clinical
760501 - trials, ref SDS 0 EU9F, with experimental agents such as
760502 - AMG 145 and REGN 727 to resolve multiple statin
760503 - intolerances. ref SDS 0 CN4H
760505 - ..
760506 - [On 131121 0930 discussed with San Francisco VA Medical
760507 - Center participating in clinical trial for PCSK9 as
760508 - alternative to statin drug treatment to manage cholesterol
760509 - for reducing CVD risk of atherosclerosis. ref SDS 35 1P5M
760511 - ..
760512 - [On 131121 0930 VA Progress Notes in medical chart report
760513 - consideration for patient to participate in clinical trial
760514 - testing PCSK9 drugs to manage cholesterol for lowering CVD
760515 - risk through regression of atherosclerosis. ref SDS 35 Q17I
760516 -
760517 -
760518 -
760519 -
760520 -
760521 -
7606 -
SUBJECTS
VA Cardiology Examination Patient Active Physically Half Dome Hike 1
AA03 -
AA0401 - ..
AA0402 - Hiking Increase and Half Dome Lower Cholesterol with Lower Weight
AA0403 -
AA0404 - Follow up ref SDS 29 KU9N.
AA0405 -
AA0406 - Doctor Egan was pleased with patient excellent health recovering from
AA0407 - heart surgery on 091022 0700, ref SDS 2 PQWU, through exercise and
AA0408 - weight loss evident recently hiking Half Dome in Yosemite on 130918
AA0409 - 0620, ref SDS 30 0001, and hiking 1200 miles past 5 months, reported
AA0410 - in the letter yesterday on 131016 1632. ref SDS 32 IW4O
AA0412 - ..
AA0413 - Discussed doing another treadmill stress test to evaluate patient
AA0414 - health based on record of exercise in combination with lab showing
AA0415 - elevated cholesterol, reported on 131015 0724. ref SDS 31 BE6O
AA0417 - ..
AA0418 - Doctor Egan noted the treadmill stress ordered by Doctor Lee, and
AA0419 - performed at the VA on 090916, was based on a 5-year period of
AA0420 - routinely experiencing chest pain hiking the first hill at Lafayette
AA0421 - Reservoir 4 - 6 times per week, and finally worsening to continuous
AA0422 - chest pain hiking the entire 3 mile route at the reservoir for 3 days
AA0423 - prior to meeting with Doctor Lee on 090908.
AA0425 - ..
AA0426 - The doctor indicated the situation is different and more favorable
AA0427 - now. At this time, 4 years after heart surgery to correct the
AA0428 - original problem reported on 090908, ref SDS 1 MY4N, the patient has
AA0429 - not suffered chest pain with increased physical activity, most
AA0430 - recently hiking about 1200 miles the past 5 months, and climbing Half
AA0431 - Dome on 130918, presented in the letter to the VA on 131016 1632.
AA0432 - ref SDS 32 IW57
AA0434 - ..
AA0435 - The doctor advised that since the patient is very active physically,
AA0436 - and is asymptomatic, there is no need for further testing despite
AA0437 - elevated cholesterol in the lipid lab test on 131015 0724. ref SDS 31
AA0438 - BE6O
AA0440 - ..
AA0441 - [...below on 131017 1000 VA medical chart Progress Notes
AA0442 - report patient completed Half Dome hike and remains active
AA0443 - physically, ref SDS 0 TX4G, assessment report patient
AA0444 - status CAD stable, asymptomatic. ref SDS 0 T24N
AA0446 - ..
AA0447 - Scheduled next meeting in 6 months.
AA0448 -
AA0449 -
AA0450 -
AA0451 -
AA0452 -
AA0453 -
AA0454 -
AA05 -
SUBJECTS
VA Cardiology Medical Chart Progress Notes Examination Investigate C
B703 -
B70401 - ..
B70402 - Medical Chart Progress Notes Meeting 130304
B70403 -
B70404 - Follow up ref SDS 29 TF5O, ref SDS 26 TF5O.
B70405 -
B70406 - 1. LOCAL TITLE: Cardiology 10501
B70407 - STANDARD TITLE: CARDIOLOGY NOTE
B70408 - DATE OF NOTE: OCT 17, 2013@08:44 ENTRY DATE: OCT 17, 2013@08:44:02
B70409 - AUTHOR: EGAN,JAMES EXP COSIGNER:
B70410 - URGENCY:
B70411 - STATUS: COMPLETED
B70415 -
B70416 - 2. ...68 year old MALE followed in Cardiology Clinic for problems
B70417 - including
B70418 -
B70419 - 1. CAD
B70421 - ..
B70422 - a) Angina, class II- III 10/2/09
B70424 - ..
B70425 - b) Abnormal TMST, relatively low work load 9/16/09
B70427 - ..
B70428 - c) CABGx4v 10/22/09 SFVA (LIMA-->LAD, SVG-->diag,
B70429 - SVG-->Ramus,SVG-->PDA).
B70431 - ..
B70432 - 2. Hyperlipidemia intolerant simvastatin, atorvastatin,
B70433 - rosuvastatin.
B70435 - ..
B70436 - 3. Achalasia, S/P laparoscopic myotomy with fundoplication at
B70437 - the San Francisco VA December 2009. Subsequently recurrent
B70438 - stricture.
B70440 - ..
B70441 - 4. PACs with exercise on ETT 4/6/11
B70443 - ..
B70444 - 3. Background
B70445 -
B70446 - ...[Doctor Egan enters in Progress for the meeting today,
B70447 - assessment and work plan from prior meeting on 121206...]
B70449 - ..
B70450 - The patient was last seen in clinic on 6/3/13 , A&P as
B70451 - follow:
B70452 -
B70453 - 1. ASSESSMENT
B70455 - ..
B70456 - 1) CAD. Stable, asymptomatic.
B70458 - ..
B70459 - 2) Hyperlipidemia. not in control
B70461 - ..
B70462 - 3) PACs with exercise on ETT 4/6/11
B70464 - ..
B70465 - 2. PLAN
B70466 -
B70467 - 1) Current medications reconciled.
B70468 -
B70469 - 2) Prolonged discussion of appropriate approach to his
B70470 - hyperlipidemia. Given past left should pain
B70471 - attributed to simvastatin and possible lightheadedness
B70472 - and paresthesias with rosuvastatin, atorvastatin seems
B70473 - a reasonable choice. Discussed potential interaction
B70474 - with omeprazole and increased risk of myopathy.
B70475 - Prefers to make an attempt with atorva and failing
B70476 - that research participation in clinical trials of
B70477 - newer agents.
B70479 - ..
B70480 - 3) Rx atorvastatin 40 mg daily
B70482 - ..
B70483 - 4) CMP, Lipids in early October following climb of Half Dome.
B70484 -
B70485 - 2. /es/ James Egan, MD
B70486 - Staff Physician, Cardiology
B70487 - Signed: 2013 06 03 1022 PDT
B70488 -
B70490 - ..
B70491 - 4. Current Patient Status on 131017 1000 PDT
B70492 -
B70493 - Eventually discontinued atorvastatin, felt it was limiting his
B70494 - exercise capability. Completed his Half Dome hike 9/28/13.
B70495 - Now hiking 11 miles in 160 minutes, 1200 miles over the last 5
B70496 - months.
B70498 - ..
B70499 - Lipitor (atorvastatin) deferred due to adverse side effects aligns
B70500 - with report to medical team on submitted yesterday on 131016 1632.
B70501 - ref SDS 32 IW5J
B70503 - ..
B70504 - Exercise increase and weight loss with concomitant improved health
B70505 - aligns with report to medical team submitted yesterday on 131016 1632,
B70506 - ref SDS 32 IW57, and discussed during the meeting, above. ref SDS 0
B70507 - KU9N
B70509 - ..
B70510 - Reference to Half Dome relates to report today hiking Half Dome on
B70511 - 130918 0620. ref SDS 30 0001 The doctor entered 130928, which is off
B70512 - by 10 days, but there was a lot discussed during the meeting.
B70514 - ..
B70515 - Progress Notes continue...
B70516 -
B70517 - Seen today with Kathy, as prior.
B70519 - ..
B70520 - Feeling well in every respect, Half Dome hike was challenging
B70521 - but successful.
B70523 - ..
B70524 - Aligns with the record hiking Half Dome on 130918 0620, ref SDS 30
B70525 - QE4L, submitted with the agenda yesterday on 131016 1632, ref SDS 32
B70526 - IW4O, and discussed during the meeting. ref SDS 0 KU9N
B70528 - ..
B70529 - Progress Notes continue...
B70530 -
B70531 - No symptoms suggestive of angina, remains very active
B70532 - physically.
B70534 - ..
B70535 - Concerned with ongoing elevation in LDL, has been researching
B70536 - experimental agents such as AMG 145 and REGN 727 and would be
B70537 - interested in participating in a clinical trial if one were
B70538 - available to him, given multiple statin intolerances.
B70540 - ..
B70541 - Progress Notes report multiple statin intolerances, above, ref SDS 0
B70542 - JM5L, and aligns with discussion during the meeting, above.
B70543 - ref SDS 0 179N
B70544 -
B70545 - [...below on 131017 1000 VA medical chart Progress Notes
B70546 - assessment report patient status hyperlipidemia not
B70547 - controlled, ref SDS 0 PSXT; Doctor Egan makes referral to
B70548 - SF VA Medical Center for consult on participation clinical
B70549 - trials, ref SDS 0 EU9F, with experimental agents such as
B70550 - AMG 145 and REGN 727 to resolve multiple statin
B70551 - intolerances. ref SDS 0 CN4H
B70553 - ..
B70554 - [On 131103 1739 received letter from SFVA schedule meeting
B70555 - on 131120 1000, to develop clinical trial care for lowering
B70556 - cholesterol. ref SDS 34 Q27Z
B70558 - ..
B70559 - Progress Notes continue...
B70560 -
B70561 - No history of dizziness, lightheadedness or syncope.
B70562 - Occasional mild paresthesias of right foot. No palpitations.
B70564 - ..
B70565 - 5. PAST MEDICAL HISTORY:
B70566 -
B70567 - Computerized Problem List is the source for the following:
B70568 -
B70569 - 1. Dizziness * (ICD-9-CM 780.4) 09/06/12 Egan, James
B70571 - ..
B70572 - 2. Paresthesia * (ICD-9-CM 782.0) 09/06/12 Egan, James
B70574 - ..
B70575 - 3. Vitamin D Deficiency 08/03/11 Sandhu, Harkesh
B70577 - ..
B70578 - 4. Postsurgical Aortocoronary Bypass Status (ICD-9-CM
B70579 - V45.81) 03/09/11 Egan, James
B70581 - ..
B70582 - 5. Esophageal Stricture 03/05/10 LEE,RANDALL E.......
B70584 - ..
B70585 - 6. Screening for Malignant Neoplasms of colon 02/02/10
B70586 - LEE,RANDALL E (ICD-9-CM V76.51)
B70588 - ..
B70589 - 7. Coronary Atherosclerosis (unspecified type 02/02/10
B70590 - LEE,RANDALL E vessel, native or graft) (ICD-9-CM 41
B70592 - ..
B70593 - 8. Coronary Artery Bypass using Venous and 01/04/10
B70594 - SANDHU,HARKESH Arterial Grafts (Single Vein Graft),
B70595 - Onset 10/00/09 done at vasf
B70597 - ..
B70598 - CABG was performed at VA San Francisco Medical Center on 091022.
B70599 - ref SDS 16 PQWU
B70601 - ..
B70602 - Progress Notes continue...
B70603 -
B70604 - 9. Surgical Thoracoscopy with Esophagomyotomy 01/04/10
B70605 - SANDHU,HARKESH (Heller Type), Onset 12/16/09 at vasf
B70607 - ..
B70608 - 10. Hyperlipidemia * (ICD-9-CM 272.4) 10/02/09 EGAN,JAMES
B70610 - ..
B70611 - 11. Inflamed Seborrheic Keratosis (ICD-9-CM 702.11)
B70612 - 03/12/07 LIN,BERTHA
B70614 - ..
B70615 - 12. Rosacea * (ICD-9-CM 695.3) 03/12/07 LIN,BERTHA
B70617 - ..
B70618 - 13. Dermatitis * (ICD-9-CM 692.9) 03/12/07 LIN,BERTHA
B70620 - ..
B70621 - 14. Tinea Unguium * (ICD-9-CM 110.1) 03/12/07 LIN,BERTHA
B70623 - ..
B70624 - 15. Tinea * (ICD-9-CM 110.9) 03/12/07 LIN,BERTHA
B70626 - ..
B70627 - 16. Rosacea conjunctivitis (ICD-9-CM 372.31) 03/02/07
B70628 - MARGULIES,LINDA
B70630 - ..
B70631 - 17. Rosacea * (ICD-9-CM 695.3) 03/02/07 MARGULIES,LINDA
B70633 - ..
B70634 - 18. Blepharitis NOS 02/21/07 MARGULIES,LINDA
B70636 - ..
B70637 - 19. Achalasia * (ICD-9-CM 530.0) 12/22/05 SANDHU,HARKESH
B70639 - ..
B70640 - 20. Abn. LFT's 08/16/05 SANDHU,HARKESH
B70642 - ..
B70643 - 21. Obesity 06/29/05 SANDHU,HARKESH
B70645 - ..
B70646 - 22. Rosacea 06/29/05 SANDHU,HARKESH
B70648 - ..
B70649 - 23. Tinea Unguium 06/29/05 SANDHU,HARKESH
B70651 - ..
B70652 - Patient has answered NKA (no known allergies)
B70654 - ..
B70655 - 6. Active Outpatient Medications (including Supplies):
B70656 -
B70657 - 1. ATORVASTATIN CALCIUM 40MG TAB TAKE ONE TABLET BY MOUTH ONCE
B70658 - DAILY TO LOWER CHOLESTEROL. (REPLACES ROSUVASTATIN)
B70659 -
B70660 - Active
B70662 - ..
B70663 - Atorvastatin is Lipitore discussed as being deferred due to statin
B70664 - intollerance, above. ref SDS 0 UU7J
B70666 - ..
B70667 - Progress Notes continue...
B70668 -
B70669 - 2. OMEPRAZOLE 20MG EC CAP TAKE ONE CAPSULE BY MOUTH TWICE A
B70670 - HOLD DAY 15 MINUTES BEFORE A MEAL FOR SEVERE ACID REFLUX
B70671 - AND ESOPHAGEAL NARROWING.
B70673 - ..
B70674 - Active
B70675 -
B70677 - ..
B70678 - Progress Notes continue...
B70679 -
B70680 - 7. PHYSICAL EXAM - Date: 131017 0948
B70681 -
B70682 - T....................... 97.7 F (36.5 C)
B70683 - P....................... 61
B70684 - R....................... 20
B70685 - B/P..................... 129/64
B70686 - Wt...................... 179.5 (81.59 KG) (ACTUAL STANDING WEIGHT)
B70687 - Body Mass Index......... 29*
B70688 - Pulse Oximetry.......... 99%
B70689 - Pain.................... 0 - No pain
B70691 - ..
B70692 - VITALS: 06/03/2013 09:31 BP:129/70 HR:65 Wt:185.7 lb [84.4 kg
B70694 - ..
B70695 - Head atraumatic, PERRL.
B70696 - Carotid upstrokes normal, no bruits noted
B70697 - Thyroid normal to palpation.
B70698 - JVP wnl.
B70699 - Cor: Regular, no ectopy, no sig mrg.
B70700 - Lungs clear of rales, ronchi and wheezes.
B70701 - Extremities without cyanosis, clubbing or edema.
B70703 - ..
B70704 - 8. LAB Review
B70705 -
B70706 - ...[Doctor Egan lists results for lab performed on 131015 0724.
B70707 - ref SDS 31 BE6O
B70709 - ..
B70710 - 9. ASSESSMENT
B70711 -
B70712 - 1. CAD. Stable, asymptomatic. No diagnostic testing
B70713 - currently indicated.
B70715 - ..
B70716 - 2. Hyperlipidemia. uncontrolled. Multiple statin
B70717 - intolerances. Discussed potential use of colestipol but
B70718 - there is little chance that this agent would allow us to
B70719 - achieve LDL goal of < 100 mg/dl and I am concerned with his
B70720 - chronic hyperbilirubinemia. Ezetemibe might be of some
B70721 - value but would not achieve goal and may or may not prevent
B70722 - atherogenesis.
B70724 - ..
B70725 - Concern for hyperlipidemia and chronic hyperbilirubinemia caused by
B70726 - statin agents to lower cholesterol, reflects discussion during the
B70727 - meeting, above. ref SDS 0 LV5J and ref SDS 0 VY6H
B70728 -
B70729 - [...below on 131017 1000 VA medical chart Progress Notes
B70730 - Doctor Egan makes referral to SF VA Medical Center for
B70731 - consult on participation clinical trials, ref SDS 0 EU9F,
B70732 - with experimental agents such as AMG 145 and REGN 727 to
B70733 - resolve multiple statin intolerances. ref SDS 0 CN4H
B70735 - ..
B70736 - [On 131103 1739 received letter from SFVA schedule meeting
B70737 - on 131120 1000, to develop clinical trial care for lowering
B70738 - cholesterol. ref SDS 34 Q27Z
B70740 - ..
B70741 - [On 140203 0830 lab reports T Bilirubin increased to 2.1,
B70742 - nearly 100% above healthy range. ref SDS 36 015M
B70744 - ..
B70745 - [On 140814 1530 lab reports T Bilirubin increased 2.5;
B70746 - patient history shows chronic hyperbilirubinemia
B70747 - ref SDS 38 G34G
B70749 - ..
B70750 - Progress Notes continue...
B70751 -
B70752 - 10. PLAN:
B70753 -
B70754 - 1. Current medications reconciled, no changes made.
B70756 - ..
B70757 - 2. After thorough discussion we have elected to ask the help
B70758 - of Endocrine at SFVA in managing his hyperlipidemia,
B70759 - consult submitted.
B70761 - ..
B70762 - Plan to resolve chronic hyperlipidemia with participation in clinical
B70763 - trials of agents that avoid side effects of statins, reflects
B70764 - discussion during the meeting, above. ref SDS 0 8B3M
B70765 -
B70766 - [On 131103 1739 received letter from SFVA schedule meeting
B70767 - on 131120 1000, to develop clinical trial care for lowering
B70768 - cholesterol. ref SDS 34 Q27Z
B70770 - ..
B70771 - 3. RTC 6 months, will f/u Dr Sandhu next month.
B70772 -
B70773 - [On 140430 0900 submit agenda to Doctor Egan with copy to
B70774 - Doctor Sandhu for follow up meeting. ref SDS 37 HY6O
B70775 -
B70776 - 11. /es/ James Egan, MD
B70777 - Staff Physician, Cardiology
B70778 - Signed: 2013 10 17 1040 PDT
B70779 -
B70780 -
B70781 -
B70782 -
B70783 -
B70784 -
B70785 -
B70786 -
B70787 -
B70788 -
B70789 -
B70790 -
B70791 -
B70792 -
B70793 -
B70794 -
B708 -