CONTACTS
SUBJECTS
CBC Lab WBC 12.8 Elevated Blister Big Toe Left Foot VA for Meeting D
2303 -
2303 - ..
2304 - Summary/Objective
2305 -
230501 - Follow up ref SDS 78 0000. ref SDS 77 0000.
230502 -
230503 -
230504 -
230506 - ..
2306 -
2307 -
2308 - Background
2309 -
230901 - On 131016 1632 submit letter for agenda meeting to review lab results
230902 - scheduled 131017 1000. ref SDS 41 X45G
230904 - ..
230905 - On 140131 0815 ordered another lab - cbc, electrolytes, lipid with NMR
230906 - - from Labcor to get LDL-P. ref SDS 50 X45G
230908 - ..
230909 - On 140201 1159 had full lab with NMR lipid panel drawn at John Muir
230910 - Hospital on Treat, and by Labcorp. ref SDS 51 RP4N
230912 - ..
230913 - On 140203 1147 had partial lab drawn at VA in Martinez. ref SDS 52
230914 - KK9M
230916 - ..
230917 - On 140507 0857 ordered another full lab from Labcorp with NMR lipid
230918 - panel. ref SDS 58 OO5G
230920 - ..
230921 - On 140508 1133 lab blood daw at Labcorp with John Muir Medical Center
230922 - on Treat Blvd in Concord. ref SDS 59 445G
230924 - ..
230925 - On 140514 0950 VA partial lab at Medical Center in San Francisco.
230926 - ref SDS 62 X45G
230928 - ..
230929 - On 140814 1530 VA full lab at Clinic in Martinez. ref SDS 68 X45G
230931 - ..
230932 - On 140827 1422 VA partial lab CBC only at Clinic in Martinez re-check
230933 - elevated WBC. ref SDS 72 X45G
230935 - ..
230936 - On 141020 1025 Labcorp partial lab CBC Electrolytes Urinalysis, but
230937 - mistakenly omitted NMP lipid panel. ref SDS 74 X45G
230939 - ..
230940 - On 141021 1009 Labcorp NMR Lipid panel, ref SDS 76 U45J, and
230941 - Homocyst(e)ine. ref SDS 76 CM6J
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230946 - ..
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2311 -
2312 - Progress
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231301 - LDL-C 90 LDL-P 1586 HDL 57 Hike 200 Miles Weight Maintain 180
231302 -
231303 - Follow up ref SDS 78 IM9N, ref SDS 77 IM9N.
231304 -
231305 - 01 S7 Deanna Franke, PhD
231306 - Liposcience Inc
231307 - 2500 Sumner Blvd, Raleigh, NC 27616-3235
231308 - 877 547 6837
231309 -
231310 - customer.service@liposcience.com
231312 - ..
231313 - There was a message on the telephone today from Doctor Deanna Franke
231314 - with Liposcience, responding to the letter to Liposcience asking about
231315 - conflict between LDL-P 1586 and TG/HDL ratio's reported on 141028
231316 - 2038, ref SDS 77 IM9N, and which was followed up with a letter to
231317 - Liposcience later the same day. ref SDS 77 AK6L
231319 - ..
231320 - Doctor Franke related in her telephone message received the letter
231321 - pointing about conflict between LDL-P and TG/HDL ratio. ref SDS 77
231322 - HL61 The doctor advised she has approved another NMR Lipid blood
231323 - test, which aligns with Shannon's call yesterday on 141029 1445,
231324 - ref SDS 78 4O4G, and confirmed in Shannon's letter later that day.
231325 - ref SDS 78 HM7J
231327 - ..
231328 - Submitted letter to Doctor Franke at Liposcience saying...
231329 -
231330 - 1. Subject: Re: LDL-P Conflicting Results Specimen 294-544-7457-0
231331 - Date: 2014-10-31 15:09
231340 - ..
231341 - 2. Thanks for your telephone message yesterday responding to the
231342 - letter on 141028 (shown at ref SDS 77 AK6L), confirming prior
231343 - discussion with Health Testing Centers (HTC) that Liposcience
231344 - will do another NMR Lipid lab. I will get a blood draw next
231345 - week for this. By copy I am thanking Shannon at HTC for
231346 - timely, thorough coordination with Liposcience, and issuing a
231347 - requisition for Labcorp to re-test the NMR lipid panel.
231349 - ..
231350 - 3. Today, I called the number you provided (919 256 1098) and
231351 - requested call back on mathematical correlation between LDL-P
231352 - and TG/HDL ratio. Seems like it should fall with a range, such
231353 - that if LDL-P is reported outside the range, then another lab
231354 - should be done to check all 3 elements that could have tested
231355 - incorrectly for myriad reasons.
231357 - ..
231358 - 4. In this case, as you know, Liposcience reported LDL-P 1586 -
231359 - nearly doubled, i.e., increased 100%. But also reported TG 80,
231360 - which is substantially higher than the VA Medical Center in San
231361 - Francisco reported TG 65; Liposcience reported HDL 55, similar
231362 - to the VA test HDL 57. However Labcorp reported HDL 61
231363 - included with an HTC panel for electrolytes. Your HDL 55 and
231364 - Labcorp HDL 61 came from the same blood draw, and VA HDL 57 was
231365 - a 2nd blood draw an hour later all on 141021. None of these
231366 - tests changed by the order of magnitude reflected in LDL-P.
231367 - Rather the ratios seem to indicate LDL-P 1000+/-, based on
231368 - mathematical correlations from prior Liposcience NMR Lipid labs
231369 - reporting LDL-P 851 on May 8, and LDL-P 861 on Jan 31.
231371 - ..
231372 - 5. Besides discontinuity with prior labs, Shannon at Health
231373 - Testing Centers noted that receiving NMR Lipid results on
231374 - 141023, 2 days after the blood draw could indicate possible
231375 - issues, since HTC guidance says this report takes 5-7 days. I
231376 - was grateful getting results in time for meeting with VA the
231377 - next day on 141024. But, seeing LDL-P increase 100% had
231378 - everyone perplexed, saying: "Rod - you've got to cut back on
231379 - ice cream, milk, bacon, eggs, ham and cheese sandwiches, apple
231380 - fritters - everything!!"
231382 - ..
231383 - 6. I particularly noticed discordance between high LDL-P 1586 and
231384 - low LDL-C 86, because research indicates this condition is the
231385 - most dangerous (highest) CVD risk, reported on 131125 (see line
231386 - NT0722. ref SDS 46 FI3G
231388 - ..
231389 - 7. Concern is placated by TG/HDL ratio possible conflict with
231390 - elevated LDL-P. Accordingly, Liposcience proposal to do
231391 - another lab is greatly appreciated. Copying the medical team
231392 - for notice that results of retest will be submitted for the
231393 - record.
231395 - ..
231396 - 8. LDL-P was expected to increase, because hiking since June,
231397 - dropped 60% from 300 miles per month to about 130, due to
231398 - injuries. Since TG and HDL track physical activity, and cannot
231399 - be moved much with drugs, reduction in hiking likely reduced
231400 - HDL and increased TG causing LDL-P to rise. Additionally,
231401 - maintaining consumption of orange juice may have prevented HDL
231402 - from sliding further - see again research on 131125 - line
231403 - NV0448. ref SDS 46 R48K
231405 - ..
231406 - 9. We do lab tests to find out how the numbers changed; in effect,
231407 - answering the question: "Gosh, if I skip hiking today, how
231408 - much is CVD risk increased?" It's an incentive to balance
231409 - against the risk of hiking injuries.
231411 - ..
231412 - 10. Can you please reference published guidance for this type of
231413 - analysis?
231415 - ..
231416 - 11. The VA has done terrific work increasing HDL 30 in October
231417 - 2009, when I had CABG+4, to HDL 67 this past May. The VA does
231418 - not report LDL-P, so Liposcience was hired through Health
231419 - Testing Centers to run the numbers. The UCSF/VA team maintains
231420 - LDL-P has a stronger association with CVD risk than LDL-C, and
231421 - further says LDL-P can be "assumed" from TG/HDL ratio. How is
231422 - the mathematical "assumption" calculated? Is there is a paper
231423 - on this?
231425 - ..
231426 - 12. I will be out the next 3 hours hiking in the rain (Yes -- rain
231427 - at last in California!!), and so returning OA 1800 PDT, which
231428 - will be 2100 EDT, where you are in North Carolina. If you can
231429 - call this evening, fine (I'm available 24/7); otherwise, please
231430 - call anytime at your convenience. As well, please submit
231431 - citations to published sources by replying to this letter.
231433 - ..
231434 - 13. Thanks again very much for calling yesterday.
231443 - ..
231444 - 16. PS. Have to hurry and do the hike to avoid getting entangled
231445 - with Trick or Treaters
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