CONTACTS
SUBJECTS
VA Prescribe Atorvastin 10 MG Trial 4 Weeks Evaluate Side Effects In
1303 -
1303 - ..
1304 - Summary/Objective
1305 -
130501 - Follow up ref SDS 46 0000. ref SDS 45 0000.
130502 -
130503 -
130504 -
130505 -
130506 -
130508 - ..
1306 -
1307 -
1308 - Background
1309 -
1310 -
131001 - Lab on 131015, showing cholesterol remained high, 131015 0724,
131002 - ref SDS 38 BE6O, conflict with increased exercise and weight loss,
131003 - discussed in the letter to the medical team yesterday on 131016 1632.
131004 - ref SDS 39 IW57
131006 - ..
131007 - On 131017 1000 VA medical chart Progress Notes assessment report
131008 - patient status CAD stable, asymptomatic. hyperlipidemia not
131009 - controlled. ref SDS 40 T24N
131011 - ..
131012 - On 131017 1000 Doctor Egan proposed referring patient for clinical
131013 - trial to reduce cholesterol with new "targeted" drugs. ref SDS 40 179N
131015 - ..
131016 - On 131017 1000 VA medical chart Progress Notes assessment report
131017 - patient status hyperlipidemia not controlled, ref SDS 40 PSXT; Doctor
131018 - Egan makes referral to SF VA Medical Center for consult on
131019 - participation clinical trials, ref SDS 40 EU9F, with experimental
131020 - agents such as AMG 145 and REGN 727 to resolve multiple statin
131021 - intolerances. ref SDS 40 CN4H
131023 - ..
131024 - On 131103 received letter from VA SF Medical Center scheduling meeting
131025 - on 131121 1000, to consider clinical trial for lowering cholesteral.
131026 - ref SDS 41 YT4N
131027 -
131028 - Thursday November 21, 2013 1000 METAB-FELLOW-THRUSDAY Clinic
131030 - ..
131031 - On 131112 New York Times published several articles reporting that the
131032 - day before on 131113, American Heart Association published new
131033 - guidelines for treating CAD patients that expand use of statin
131034 - medication regardless of cholesterol levels, ref SDS 42 0001, and
131035 - further raise the LDL 70 to LDL 190, as a target for cardiovascular
131036 - risk. ref SDS 42 CW6H
131038 - ..
131039 - On 131114 New York Times published several articles reporting that the
131040 - day before on 131113, American Heart Association published new
131041 - guidelines for treating CAD patients. ref SDS 43 SH6G
131043 - ..
131044 - On 131121 1000 meeting with Doctor Diana Alba, Va San Francisco
131045 - Medical Center prescribes Atorvastatin 10 MG 4 weeks. ref SDS 44 HY6O
131047 - ..
131048 - On 131121 1000 at 1125 meeting with Karen and Doctor Shunk, Va San
131049 - Francisco Medical Center seemed to support Doctor Alba's prescription
131050 - for Atorvastatin 10 MG 4 weeks; further suggested trying Chia seeds to
131051 - lower cholesterol without medication. ref SDS 44 MS7G
131053 - ..
131054 - On 131125 0005 letter to Karen submits understandings from meetings at
131055 - VA on 131121 with Doctor Alba, ref SDS 45 UK43, and requests that
131056 - Karen submit to Doctor Alba. ref SDS 45 UK5J Presented patient
131057 - history showing increased exercise lowered cholesterol, but later
131058 - cholesterol rose even while increasing exercise. ref SDS 45 UK6R
131059 - Notified VA taking Atorvastatin 40 mg on 4-week trial. ref SDS 45 UK49
131060 -
131061 -
131062 -
131063 -
131065 - ..
1311 -
1312 -
1313 - Progress
1314 -
131401 - Hyperlipidemia Not Controlled Cholesterol Elevated Despite Exercise
131402 - Cholesterol Elevated Despite Exercise Discuss Clinical Trial
131403 - Clinical Trial Considered Lower Cholesterol Without Statin Drugs
131404 -
131405 - Follow up ref SDS 46 HY6O, ref SDS 26 HY6O.
131406 -
131407 - Need to add subjects for past few records since 131121.
131409 - ..
131410 - Sent letter to Doctor Alba saying...
131411 -
131412 -
131413 - 1. Subject: Pending Issues VA Meeting 19 Dec 0930, Clinical Trials Non-statin Solutions
131414 - Date: 2013-12-16 02:26
131423 - ..
131424 - 2. Thanks for your letter received on 131210 (shown below),
131425 - requesting pending issues for meeting in your office scheduled
131426 - on the 19th. ref SDS 46 HY6O
131428 - ..
131429 - 3. You can bookmark to follow daily exercise, vitals, medications,
131430 - and diet shown in case study on 120101. ref SDS 14 LJ6H
131432 - ..
131433 - 4. Medications show daily use and cumulative to date. Exercise
131434 - shows daily and cum per week. Vitals show left and right side
131435 - with differentials, generally after exercise, sometimes before
131436 - and after.
131438 - ..
131439 - 5. Progress Notes for meeting on 131121, seem accurate and
131440 - comprehensive. Comments are available for review, if time
131441 - permits (see line 500402. ref SDS 44 NV6H
131443 - ..
131444 - 6. Pending issues...
131445 -
131446 - 1. VA guidance to adjust diet, exercise and medications, e.g.,
131447 - reduce Atorvastatin to 10 mg and add Zetia; or, switch to
131448 - non-statin clinical trial like Alirocumab presented in the
131449 - letter on 131125. ref SDS 45 YU5X
131451 - ..
131452 - Some authorities list orange juice and cranberry juice for
131453 - increasing HDL. Can lemon and grape juice substitute for
131454 - raising HDL?
131456 - ..
131457 - 2. Review VA record investigating non-statin clinical trials
131458 - for lowering cholesterol. Who was contacted; what follow
131459 - up is pending, e.g., Doctor Bikle, other VA venues,
131460 - implementing work plan on 131121.
131462 - ..
131463 - 3. Since 2010, ratio TG/HDL has tracked < 2, on 10 labs until
131464 - recently. The last lab on 131015, TG suddenly increased to
131465 - 109, i.e., above 100, while hiking increased over past 6
131466 - months by orders of magnitude, averaging 11 miles and 3
131467 - hours per day. [...cited in prior letter to VA on 131125
131468 - 0005, ref SDS 45 UK7K, shown in case study on 120101 0900.
131469 - beginning on 130427. ref SDS 14 F35N...]. That's a lot of
131470 - effort. Since diet is unchanged, shown in case study on
131471 - 120101, what caused HDL to fall, instead of rise? Is this
131472 - an aging process, or have we broken something? Can it be
131473 - fixed, so that HDL tracks exercise?
131475 - ..
131476 - 4. Discordant LDL-C and LDL-P issue is complex. [...shown in
131477 - research on 131125 0005. ref SDS 45 PQ74...]. Authorities
131478 - say measuring LDL-P is expensive, 131125 0005, ref SDS 45
131479 - G45J...], but maintaining TG/HDL ratio below 2 indicates
131480 - low LDL-P (< 1000), that signals low risk for CVD. [...
131481 - shown on 131125 0005, ref SDS 45 EH9J, and, ref SDS 45
131482 - QS9F...]. VA guidance is appreciated.
131484 - ..
131485 - 5. Side effects taking Atorvastatin 40 mg have been minimal.
131486 - Accordingly, trial with Ezetimibe (Zetia) 10 mg added to
131487 - Atorvastatin 10 mg seems feasible and promising shown by
131488 - research on 131125 (see line 132063. ref SDS 45 WL7I
131490 - ..
131491 - 7. Peripheral neuropathy seems nearly totally resolved, a year
131492 - after ending Rosuvastatin on 121206. There has been no
131493 - resumption after 4-weeks taking Atorvastatin 40 mg. As well,
131494 - there has been no evident myopathy that occurred with
131495 - Simvastatin 2 years ago.
131497 - ..
131498 - 8. Prior chronic pain in hips, back, neck, etc., has been fully
131499 - resolved with increased hiking the past year, as shown in the
131500 - case study. Very grateful to VA for supporting patient hiking
131501 - protocol.
131503 - ..
131504 - 9. Chia seeds have proven easy to incorporate into daily diet, and
131505 - preliminarily seem to increase energy, while reducing appetite
131506 - that supports weight loss.
131508 - ..
131509 - 10. Anxious to see effects on the next lipid panel working with VA
131510 - on new drugs combined with diet and exercise.
131512 - ..
131513 - 11. Grateful as well for strong doctor/patient partnership shown by
131514 - your letter yesterday asking for pending issues.
131516 - ..
131517 - 12. Looking forward to seeing the team on Thursday.
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