CONTACTS
SUBJECTS
CBC Lab WBC VA No Results
2003 -
2003 - ..
2004 - Summary/Objective
2005 -
200501 - Follow up ref SDS 71 0000. ref SDS 69 0000.
200502 -
200503 -
200504 -
200505 -
200506 -
200508 - ..
2006 -
2007 -
2008 - Background
2009 -
200901 - On 131016 1632 submit letter for agenda meeting to review lab results
200902 - scheduled 131017 1000. ref SDS 37 X45G
200904 - ..
200905 - On 140131 0815 ordered another lab - cbc, electrolytes, lipid with NMR
200906 - - from Labcor to get LDL-P. ref SDS 47 X45G
200908 - ..
200909 - On 140201 1159 had full lab with NMR lipid panel drawn at John Muir
200910 - Hospital on Treat, and by Labcorp. ref SDS 48 RP4N
200912 - ..
200913 - On 140203 1147 had partial lab drawn at VA in Martinez. ref SDS 49
200914 - KK9M
200916 - ..
200917 - On 140507 0857 ordered another full lab from Labcorp with NMR lipid
200918 - panel. ref SDS 55 OO5G
200920 - ..
200921 - On 140508 1133 lab blood daw at Labcorp with John Muir Medical Center
200922 - on Treat Blvd in Concord. ref SDS 56 445G
200924 - ..
200925 - On 140514 0950 VA partial lab at Medical Center in San Francisco.
200926 - ref SDS 58 X45G
200928 - ..
200929 - On 140518 0920 letter to VA submits consolidated blood tests from
200930 - Labcorp on 140508 and the VA on 140514, to prepare for the meeting on
200931 - 140519. ref SDS 60 1V6M Advise that VA has not ordered follow up lab
200932 - to check Electrolytes (Chem Profile) requested by Doctor Egan to
200933 - assess previously elevated potassium (K) 5.6, that cause electrical
200934 - problems for the heart. ref SDS 60 DV4M Medication side effects of
200935 - dizziness have subsided. ref SDS 60 DV50 Dry mouth and urination have
200936 - increased. ref SDS 60 DV56 Peripheral neuropathy related to elevated
200937 - bilirubin has recurred. ref SDS 60 DV59
200939 - ..
200940 - On 140518 0920 at 2244 received letter from Doctor Alba notifying not
200941 - to get blood draw at lab prior to meeting with medical team tomorrow
200942 - morning. ref SDS 60 RW7O
200944 - ..
200945 - On 140520 0732 background and planning for getting supplemental labs
200946 - on electrolyte (Chem Profile), and EPC. ref SDS 62 X45G
200948 - ..
200949 - On 140520 0732 at 0743 letter requests VA order electrolyte (Chem
200950 - Profile) lab order today. ref SDS 62 YW4H, and include lab for EPC.
200951 - ref SDS 62 4U46 Doctor Sandhu notified that medical team in San
200952 - Francisco discusses increased urination indicates possible prostate
200953 - issues. ref SDS 62 4U95 During meeting on 140519, decided that mild
200954 - symptoms peripheral neuropathy possibly due to statin treatment does
200955 - not justify ending statin tratement, because treatments have been
200956 - effective managing lipids. ref SDS 62 4U4F
200958 - ..
200959 - On 140520 0732 at 0812 letter from VA advises Doctor Alba will order
200960 - Chem Profile lab when she arrives at the hospital. ref SDS 62 4V5H
200962 - ..
200963 - On 140520 0732 at 1017 VA partial lab at Medical Center in San
200964 - Franciso for electrolyte (Chem) panel that was omitted on lab 140514.
200965 - ref SDS 62 KK9M Glucose, sodium, potassium declined, with potassium
200966 - (K 5.2) still at high end of range for Labcorp and slightly above VA
200967 - range, ref SDS 62 ZG5O; bilirubin declined dramatically. ref SDS 62
200968 - 015M
200970 - ..
200971 - On 140520 0732 at 1028 VA letter Doctor Alba requests clarification of
200972 - scope for EPC lab. ref SDS 62 654J Called to explain scope of EPC
200973 - lab, but encountered poor connection using cell phone. ref SDS 62 U63N
200975 - ..
200976 - On 140520 0732 at 1609 VA letter - Doctor Alba ordered EPC lab, she
200977 - advises EPC lab requires approval by lab staff of doctor's
200978 - justification. ref SDS 62 AF5L
200980 - ..
200981 - On 140520 0732 at 1617 letter to VA submits justification for doctor
200982 - to submit with order for EPC lab that saves lives, time, and money.
200983 - ref SDS 62 JP8O
200985 - ..
200986 - On 140522 1052 letter to Doctor Egan at Martinez submits results of
200987 - labs on Electrolyte Chem Profile showing Potassium, which Doctor Egan
200988 - requested. ref SDS 63 X45G
200990 - ..
200991 - On 140529 0942 letter to Doctor Alba at VA Medical Center in San
200992 - Francisco adise placed order with Release of Information Department to
200993 - submit Progress Notes for meeting on 140519, so no need for Doctor
200994 - Alba so submit. ref SDS 64 X45G Recommend correcting errors in prior
200995 - notes so they are carried forward in Progress Notes for meeting on
200996 - 140519. ref SDS 64 QF6T Recommend Progress Notes cite patient support
200997 - to improve lipid labs past 6 months, ref SDS 64 QF67, referencing the
200998 - lab report on 140514 0950, ref SDS 58 W25L, which also presents
200999 - extended exercise, weight loss, and diet changes. ref SDS 58 I17G
201000 - Asked about progress getting approval for EPC lab. ref SDS 64 QG3U
201001 - Request VA order coronary CT angiography with calcium score to
201002 - evaluate regression of athersclerosis, as a result of good labs from
201003 - medication and extended exercise the past 6 months. ref SDS 64 QG38
201005 - ..
201006 - On 140610 0930 letter asks again about publishing Progress Notes for
201007 - meeting at the VA on 140519. ref SDS 65 X45G Reminds to order EPC and
201008 - coronary CTA tests. ref SDS 65 LJ61 Customer offers to order EPC and
201009 - coronayr CTA tests in order to save time for the VA. ref SDS 65 LJ6L
201010 - Report peripheral neuropathy and urination symptoms have again
201011 - subsided. ref SDS 65 LJ6Y
201013 - ..
201014 - On 140610 0930 at 1115 letter from Doctor Alba advising that Progress
201015 - Notes for meeting on 140519, were completed last week. ref SDS 65 W84I
201017 - ..
201018 - On 140610 0930 at 1114 letter asks Doctor Alba about progress ordering
201019 - EPC lab and coronary CTA with calcium score, ref SDS 65 KH3O, repeating
201020 - request in the letter earlier this morning, ref SDS 65 LJ61, but not
201021 - discussed in Doctor Alba's letter received at 1115. ref SDS 65 W84I
201023 - ..
201024 - On 140612 1048 VA letter notifies refuse order coronary CTA to test
201025 - for level of atherosclerosis because history of CABG surgery on
201026 - 091022, shows coronary artery disease, which VA relies upon to
201027 - speculate plaques remain in arteries, therefore, CT angiography, is
201028 - not going to add any value to your current diagnoses or treatment.
201029 - ref SDS 67 X45G
201031 - ..
201032 - On 140626 1652 letter notify VA commend Doctor Alba correcting errors
201033 - in Progress Notes in prior meeting so they are not replicated in
201034 - Progress Notes for meeting on 140519. ref SDS 69 X45G Commend VA
201035 - timely prescription refill on Ezetibime and Atorvastatin. ref SDS 69
201036 - MY9Y Offer to defer lab on EPC to assess prospects for regression of
201037 - atherosclerosis, since EPC should be favorable based on increased
201038 - exercise that has increased WBC 50%. ref SDS 69 MY45 Review VA refusal
201039 - to order coronary CTA aligns with prior experience at Kaiser ordering
201040 - CT testing to evaluate pulmonary embolism. ref SDS 69 MY51 VA grounds
201041 - for refusing CTA testing that results will not aid care for patients
201042 - with CABG surgery, conflicts with the record showing CTA is commonly
201043 - performed to assess recovery from atherosclerosis who have undergone
201044 - CABG surgery. ref SDS 69 MZ33 Request recommendations for 2nd opinions
201045 - on CTA testing. ref SDS 69 MZ82
201047 - ..
201048 - On 140629 1921 report side effects of prescribed care metatasalgia
201049 - causing sore feet. ref SDS 71 UZ64 Efforts to resolve without medical
201050 - care have not been effective. ref SDS 71 U13R Request referral to
201051 - Podiatry for consultation. ref SDS 71 U14H
201053 - ..
201054 - On 140703 1938 letter from Doctor Alba at VA in San Francisco Medical
201055 - Center reports detailed discussion among medical team leading and
201056 - refused to order EPC lab. ref SDS 0 X45G The doctor recommends
201057 - getting 2nd opinion from Doctor Egan at VA Cardiology Clinic in
201058 - Martinez on CTA testing for regression of atherosclerosis. ref SDS 0
201059 - H233 Doctor Alba further recommends requesting from Primary Care at
201060 - VA Clinic in Martinez, referral to Podiatry to resolve metataslagia
201061 - side effects from implementing Plan of care in Progress Notes on
201062 - 140213. ref SDS 0 H240
201064 - ..
201065 - On 140703 1938 at 2023 letter to Doctor Alba at VA in San Francisco
201066 - Medical Center, requests details of discussion among medical team on
201067 - EPC issue. ref SDS 0 6X3V Notify VA customer will pay for cost of EPC
201068 - and CTA testing, request assistance - need doctor to order tests.
201069 - ref SDS 0 6X40 Advise VA Medical Center in San Francisco that during
201070 - a meeting on 140430, Doctor Egan at VA Cardiology Clinin in Martinez,
201071 - was consulted on CTA to evaluate regression of atherosclerosis, and
201072 - seemed to indicate it is impossible. ref SDS 0 6X43 Present research
201073 - showing expert opinion that regression of atherosclerosis occurs under
201074 - conditions of elevated EPC and HDL. ref SDS 0 6X46 Present benefits
201075 - of doing CTA test for regression of atherosclerosis. ref SDS 0 6X5G
201077 - ..
201078 - On 140703 1938 at 2023 letter to Doctor Alba at VA in San Francisco
201079 - Medical Center notfies have been unable to perform Plan of Care for
201080 - continuing physical activity prescribed in Progress Notes on 140213
201081 - 0830, ref SDS 52 E34O, hiking 11 miles per day due to metatarsalgis
201082 - side effects, and will implement recommendation to discuss referral to
201083 - Podiatry with Primary Care at VA Clinic in Martinez. ref SDS 0 6X57
201084 -
201085 -
201086 -
201088 - ..
2011 -
2012 -
2013 - Progress
2014 -
201401 - Letter from Doctor Alba at VA saying...
201402 -
201403 - 1. Subject: RE: Podiatry Referral Resolve Metatarsalgia
201404 - Date: 2014-07-03 15:55
201408 - ..
201409 - 2. Mr Welch
201411 - ..
201412 - 3. Sorry about the Delay.
201414 - ..
201415 - 4. Regarding EPC- discussed with lab medicine- the SF VA does not
201416 - perform EPC, and send out lab is not available at this time.
201417 - We discussed EPC in detail, and there is not justification
201418 - from our point of view to perform EPC.
201420 - ..
201421 - This relates to ordering a lab on the amount of EPC blood elements to
201422 - evaluate prospects for regression of atherosclerosos, and discussed in
201423 - the letter on 140626 1652. ref SDS 69 MY45
201424 -
201425 - [...below on 140703 1938 at 2023 respond to Doctor Alba's
201426 - letter received today, ref SDS 0 RV5L; request details of
201427 - discussion among medical team on ordering EPC labs.
201428 - ref SDS 0 6X3V
201430 - ..
201431 - [...below on 140703 1938 at 2023 letter to Doctor Alba
201432 - notifies VA patient will pay for EPC and CTA tests to
201433 - evaluate regression of atherosclerosis plaquese - need
201434 - doctor to order tests paid for by customer. ref SDS 0 6X40
201436 - ..
201437 - Background on EPC issue....
201438 -
201439 - Request progress ordering EPC lab.............. 140626 1652, ref SDS 69 MY45
201440 - VA still pending answer on order EPC lab....... 140612 1048, ref SDS 66 Y68L
201441 - Follow up on ordering EPC lab.................. 140610 0903, ref SDS 65 LJ61
201442 - Follow up on ordering EPC lab.................. 140529 0942, ref SDS 64 QG3U
201443 - Doctor Alba responds........................... 140520 0732, ref SDS 62 AF5L
201444 - Follow up letter............................... 140520 0732, ref SDS 62 4U46
201445 - Confirm request in meeting on 140529........... 140520 0732, ref SDS 62 4U46
201446 - Request EPC lab................................ 140515 2043, ref SDS 59 YM61
201447 - Original research on........................... 131125 0005, ref SDS 43 6O9M
201449 - ..
201450 - Need details on EPC discussed by the team at the VA, noted in Doctor
201451 - Alba's letter today, per above. ref SDS 0 H167
201453 - ..
201454 - The letter to the VA on 140626, offered to defer ordering EPC lab, if
201455 - this is politically difficult at this time. ref SDS 69 MY48
201457 - ..
201458 - VA letter on 140703 continues...
201459 -
201460 - 5. Regarding CTA- if you would like a second opinion, I think
201461 - discussing this with your cardiologist Dr Egan would be your
201462 - best option. He knows you well and has follow you for a while
201463 - now. From endocrinology- Dr Feingold is the expert on lipids
201464 - and you have already spoke with him.
201466 - ..
201467 - VA recommendation to contact Doctor Egan at Cardiology VA in Martinez,
201468 - responds to the request for source to get 2nd opinion on ordering CTA
201469 - to determine regression of atherosclerosis, in the letter to the VA on
201470 - 140626 1652. ref SDS 69 MZ82
201471 -
201472 - [...below on 140703 1938 at 2023 letter to Doctor Alba
201473 - notifies VA patient will pay for EPC and CTA tests to
201474 - evaluate regression of atherosclerosis plaquese - need
201475 - doctor to order tests paid for by customer. ref SDS 0 6X40
201477 - ..
201478 - [...below on 140703 1938 at 2023 letter notifies Doctor
201479 - Egan was consulted on ordering CTA to evaluate regression
201480 - of atherosclerosis, and was not responsive, seeming to
201481 - indicate common position in cardiology that atherosclerosis
201482 - cannot regress. ref SDS 0 6X43
201484 - ..
201485 - [...below on 140703 1938 at 2023 letter reviews research
201486 - indicating elevated EPC and HDL can regress
201487 - atherosclerosis, and since customer's HDL increased from 30
201488 - to 67 since CABG on 091022, these intervening events
201489 - justify testing for regression of athersclerosis.
201490 - ref SDS 0 6X46
201492 - ..
201493 - Doctor Alba responds to the letter requesting coronary CTA with
201494 - calcium score, presented in prior correspondence on...
201495 -
201496 - Request referral for 2nd opinion on CTA........ 140626 1652, ref SDS 69 MY51
201497 - No grounds refuse CTA assess atherosclerosis... 140626 1652, ref SDS 69 MZ33
201498 - CTA for CABG common assess atherosclerosis..... 140626 1652, ref SDS 69 MZ54
201499 - VA no grounds failure order CTA assess plaques. 140612 1048, ref SDS 66 Y68L
201500 - Follow up on ordering CTA atherosclerosis...... 140610 0903, ref SDS 65 LJ61
201501 - Request CTA assess atherosclerosis plaques..... 140529 0942, ref SDS 64 QG38
201502 - Justification coronary CTA order............... 140520 0732, ref SDS 62 VQ48
201503 - Request EPC lab predicate to CTA............... 140515 2043, ref SDS 59 YM61
201504 - Original research on........................... 131125 0005, ref SDS 43 N73K
201506 - ..
201507 - VA letter on 140703 continues...
201508 -
201509 - 6. Please request referral for podiatry from your primary care
201510 - doctor.
201512 - ..
201513 - This responds to request for referral to podiatry in the letter on
201514 - 140629 1921. ref SDS 71 U14H
201515 -
201516 - [...below on 140703 1938 at 2023 letter notifies VA have
201517 - not been able to hike since 140624, due to metatarsalgia
201518 - side effects. Present record attempting to resolve medical
201519 - maladies that prevent prescribed care in Progress Notes on
201520 - 140213, ref SDS 52 E34O; plan to request Primary Care make
201521 - referral to Podiatry during meeting next month. ref SDS 0
201522 - 6X57
201524 - ..
201525 - [On 140710 1348 sent VA letter from Medical Center in San
201526 - Francisco to Doctor Sandhu Primary Care VA Clinic in
201527 - Martinez on making referral to Podiatry to resolve
201528 - metatasalgia problem. ref SDS 74 CM68
201530 - ..
201531 - VA letter on 140703 continues...
201532 -
201533 - 7. Great working you!
201534 -
201543 -
201544 -
201545 -
201547 - ..
2016 -
2017 -
2018 - 2023
2019 -
201901 - Sent letter to Doctor Alba at VA saying...
201902 -
201903 - 1. Subject: Podiatry Resolve Metatarsalgia to Prepare for CTA
201904 - Date: 2014-07-03 21:12
201913 - ..
201914 - 2. You have certainly gone the "extra mile" on this case. Thanks
201915 - very much for helpful guidance in your letter today (shown
201916 - below) on Podiatry referral, EPC, and CTA testing.
201918 - ..
201919 - Respond to Doctor Alba's letter at VA San Francisco Medical Center,
201920 - received earlier today, shown above. ref SDS 0 X45G
201922 - ..
201923 - Letter to VA continues...
201924 -
201925 - 3. Very grateful the team took the time to discuss "EPC in detail"
201926 - as set out in your letter. ref SDS 0 X45G Is this analysis in
201927 - Progress Notes amending notes for the meeting on 140519, or in
201928 - a new note?
201930 - ..
201931 - 4. I will pay for EPC and CTA tests. Just need a doctor to order
201932 - it. Would like to have results online at the VA, but will
201933 - submit for consideration, as we do with NMR lipid tests. Not
201934 - sure if VA will order outside tests, for which the customer
201935 - pays the cost. This was not required for NMR lipid tests. I
201936 - just paid the lab bill online - very simple. So, for EPC and
201937 - CTA, do we submit the name of the labs to the VA, and you file
201938 - an order directing the lab to bill the customer? That would be
201939 - simple.
201940 -
201941 - [On 140710 1348 letter from Doctor Alba offers to inquire
201942 - about getting doctor order EPC and CTA tests with customer
201943 - billed for cost. ref SDS 73 X45G
201945 - ..
201946 - [On 140731 1048 Doctor Alba explains reluctance to order
201947 - EPC and CTA tests on grounds of not understanding utility,
201948 - ref SDS 75 0V75; seems to conflict with patient intent to
201949 - pay for the tests. ref SDS 75 FS9G
201951 - ..
201952 - 5. Would love to work with Doctor Egan on ordering EPC and CTA,
201953 - called out in your letter today, shown above. ref SDS 0 H233
201954 - He has been outstanding in every way. Doctor Egan along with
201955 - Doctor Lee, saved my life in 2009, sending me to the Medical
201956 - Center, and correctly anticipating multi-vessel stenosis [...
201957 - reported in VA Progress Notes on 091002 0900. ref SDS 3
201958 - 7S8M...]. EPC and CTA was discussed with Doctor Egan during
201959 - the meeting on 140430. He seemed dubious that meaningful
201960 - regression of atherosclerotic plaques can be achieved. [...
201961 - ref SDS 54 2F6O...] Research indicates this is a common and
201962 - respected view in cardiology. Actually, every cardiologist
201963 - contacted on this matter seems to hold the same view, i.e.,
201964 - that regression is a Quixotic quest. One doctor said - Just
201965 - get a treadmill stress test."
201967 - ..
201968 - 6. There is an another view (continuing debate) that elevated EPC
201969 - along with HDL can rapidly regress atherosclerotic plaques,
201970 - including post-CABG patients - see research on 131125 (line
201971 - 0D0402. ref SDS 43 8X4N
201973 - ..
201974 - 7. Having "walked the extra mile" (actually over 6,000 miles)
201975 - since CABG +4, now 5 years ago, to increase HDL from 30 to 67,
201976 - we are positioned to test the theory of plaque regression with
201977 - CTA testing. If CTA is inconclusive due to "anatomy changes"
201978 - from heart surgery 5 years ago, (see your Progress Notes on
201979 - 140519), such that a viable calcium score cannot be rendered,
201980 - as some voices maintain, then care will continue focused on
201981 - lipid labs, as currently being done. If CTA proves viable in
201982 - this case and calcium score is "low," this supports the VA's
201983 - line of care, and might justify reducing level of effort. An
201984 - elevated calcium score sounds the alert to increase effort on
201985 - lowering the score, as we have done with LDL; or, at worst to
201986 - abandon prodigious efforts toward regression of
201987 - atherosclerosis, as beyond reach.
201989 - ..
201990 - 8. These prospective findings may understandably be de minimus to
201991 - the VA, i.e., insufficient justification; but, are useful
201992 - enough for me to pay for the tests. I just need help to place
201993 - the order.
201995 - ..
201996 - 9. Have not been able to hike for over a week, since 140624, due
201997 - to painful side effects. I am scheduled to see Doctor Sandhu
201998 - in Primary Care next month. Was scheduled to receive today,
201999 - shoes specially resoled to prevent Metatarsalgia. However,
202000 - shipment was delayed. Hopefully, will receive on Saturday or
202001 - Monday and can resume hiking to test resolution of
202002 - Metatarsalgia. If this is another failure (we've tried 3
202003 - designs to solve the problem), will ask PCP for referral to
202004 - Podiatry, as recommended in your letter, so that hiking can
202005 - resume to get a good faith test on regression of
202006 - atherosclerosis, as presented in the letter on 140629,
202007 - discussing orthotics (shown below).
202009 - ..
202010 - Responds to Doctor Alba's letter saying to request referral to
202011 - Podiatry from Primary Care doctor for resolution of matatarsalgia
202012 - required for VA Plan of Care in Progress Notes on 140213, ref SDS 52
202013 - E34O, for continuing physical activity. ref SDS 0 H240
202014 -
202015 - [On 140710 1348 sent VA letter from Medical Center in San
202016 - Francisco to Doctor Sandhu Primary Care VA Clinin in
202017 - Martinez on making referral to Podiatry to resolve
202018 - metatasalgia problem. ref SDS 74 CM68
202020 - ..
202021 - Letter to VA continues...
202022 -
202023 - 10. In any case need a solution soon on Metatarsalgia to prepare
202024 - for Half Dome scheduled for September 17th.
202025 -
202034 -
202035 -
202036 -
202037 -
202038 -
202039 -
202040 -
202041 -
202042 -
202043 -
2021 -