CONTACTS
SUBJECTS
CBC Lab WBC 12.8 Elevated Blister Big Toe Left Foot VA for Meeting D
2903 -
2903 - ..
2904 - Summary/Objective
2905 -
290501 - Follow up ref SDS 86 0000. ref SDS 85 0000.
290502 -
290503 -
290504 -
290505 -
290506 -
290507 -
290508 -
290510 - ..
2906 -
2907 -
2908 - Background
2909 -
290901 - On 131016 1632 submit letter for agenda meeting to review lab results
290902 - scheduled 131017 1000. ref SDS 41 X45G
290904 - ..
290905 - On 140131 0815 ordered another lab - cbc, electrolytes, lipid with NMR
290906 - - from Labcor to get LDL-P. ref SDS 51 X45G
290908 - ..
290909 - On 140201 1159 had full lab with NMR lipid panel drawn at John Muir
290910 - Hospital on Treat, and by Labcorp. ref SDS 52 RP4N
290912 - ..
290913 - On 140203 1147 had partial lab drawn at VA in Martinez. ref SDS 53
290914 - KK9M
290916 - ..
290917 - On 140507 0857 ordered another full lab from Labcorp with NMR lipid
290918 - panel. ref SDS 59 OO5G
290920 - ..
290921 - On 140508 1133 lab blood daw at Labcorp with John Muir Medical Center
290922 - on Treat Blvd in Concord. ref SDS 60 445G
290924 - ..
290925 - On 140514 0950 VA partial lab at Medical Center in San Francisco.
290926 - ref SDS 63 X45G
290928 - ..
290929 - On 140814 1530 VA full lab at Clinic in Martinez. ref SDS 70 X45G
290931 - ..
290932 - On 140827 1422 VA partial lab CBC only at Clinic in Martinez re-check
290933 - elevated WBC. ref SDS 74 X45G
290935 - ..
290936 - On 141020 1025 Labcorp partial lab CBC Electrolytes Urinalysis, but
290937 - mistakenly omitted NMP lipid panel. ref SDS 75 X45G
290939 - ..
290940 - On 141021 1009 Labcorp NMR Lipid panel, ref SDS 77 U45J, and
290941 - Homocyst(e)ine. ref SDS 77 CM6J
290943 - ..
290944 - On 141201 Health Testing Centers Requisition order # 33541,
290945 - ref SDS 81 FK65, for full panel of blood tests at Labcorp, ref SDS 81
290946 - Q94L - which included NMR Lipid panelto test LDL-P. ref SDS 81 2P5J
290948 - ..
290949 - On 141021 1150 VA labs electrolytes, ref SDS 77 ZG5O, and lipids.
290950 - ref SDS 77 U45J
290952 - ..
290953 - On 150208 Health Testing Centers Requisition order # 34764,
290954 - ref SDS 84 IG6J, for full panel of blood tests at Labcorp, ref SDS 84
290955 - Q94L, which included NMR Lipid panelto test LDL-P. ref SDS 84 2P5J
290957 - ..
290958 - On 150512 0703 Health Testing Centers Requisition order # 36923,
290959 - ref SDS 87 8S7F, for full panel of blood tests at Labcorp, ref SDS 87
290960 - Q94L, which included NMR Lipid panelto test LDL-P. ref SDS 87 2P5J
290961 -
290962 -
290963 -
290965 - ..
2910 -
2911 -
2912 - Progress
2913 -
291301 - See directory structure for medical records on 140320 1125.
291302 - ref SDS 57 4M5I
291303 -
291304 -
291306 - ..
291307 - Blood Tests Evaluate Health 5 Years After CABG x4 Surgery
291308 - CBC WBC 10.6 Elevated at High End of Range Resolve Achalasia Aligns Increased Hiking
291309 -
291310 - Follow up ref SDS 86 RP4N, ref SDS 85 RP4N.
291311 -
291312 - Prior VA CBC on 120509 1108. ref SDS 26 RP4N
291313 - Prior VA CBC on 120831 1524. ref SDS 27 RP4N
291314 - Prior VA CBC on 121130 1001. ref SDS 31 RP4N
291315 - Prior VA CBC on 130529 0818. ref SDS 38 RP4N
291316 - Prior Labcorp CBC on 140201 1159. ref SDS 52 RP4N
291317 - VA did not order CBC for lab on 140203 1147. ref SDS 53 YX8K
291318 - Prior Labcorp CBC on 140508 1149. ref SDS 60 RP4N
291319 - VA did not order CBC for lab on 140514 0950. ref SDS 63 RP4N
291320 - Prior VA CBC on 140814 1530. ref SDS 70 RP4N
291321 - Prior VA CBC on 140827 1413. ref SDS 74 RP4N
291322 - Prior Labcorp CBC on 141020 1025. ref SDS 75 RP4N
291323 - Prior Labcorp CBC on 141201 0850. ref SDS 82 RP4N
291324 - Prior Labcorp CBC on 150208 1438. ref SDS 85 RP4N
291325 - Prior Labcorp CBC on 150512 1239. ref SDS 0 RP4N
291327 - ..
291328 - Labcorp report stored in...
291329 -
291330 - F:\05\00003\SM\CC\AGMJ\20150512-130000\WELCH-ROD.pdf
291332 - ..
291333 - CBC PANEL
291334 - x
291335 - Dates......... 2015 05 12 1300 150208 141201 141020 140827 140814 140514 140508 140203 140201 130529
291336 - Labcorp Labcorp Labcorp Labcorp VA VA VA Labcorp VA Labcorp VA VA Labcorp
291337 - Blood Results Results Results Results Results Results Results Results Results Results Results Units Range Range
291338 - WBC 7.6 10.6 11.2 H 13.3 H 13.8 H 12.8 H 9.5 6.2 7.4 K/cmm 4.8 - 10.8 3.4 - 10.8
291339 - RBC 5.15 5.46 5.24 5.64 5.56 5.44 5.21 5.13 5.09 M/cmm 4.7 - 6.1 4.14 - 5.80
291340 - HGB Hemoglobin 15.1 16.2 15.7 16.5 16.4 16.2 15.1 15.2 15.0 g/dL 14 - 18 12.6 - 17.7
291341 - HCT Hematocrit 45.5 47.7 47.4 50.1 48.8 48.3 47.0 44.2 46.2 % 42 - 52 37.5 - 51.0
291342 - MCV 88.0 87.0 91.0 89.0 87.8 88.7 90.0 86.0 90.7 fL 80 - 99 79.0 - 97.0
291343 - MCH 29.3 29.7 30.0 29.3 29.5 29.8 29.0 29.6 29.5 uug 27 - 34 26.6 - 33.0
291344 - MCHC 33.2 34.0 33.1 32.9 33.6 33.6 32.1 34.4 32.5 gm/dL 32 - 35.2 31.5 - 35.7
291345 - RDW 13.6 13.6 13.9 14.3 13.9 13.9 13.8 13.7 14.4 % 11.5 - 14.5 12.3 - 15.4
291346 - PLT 326.0 321.0 314.0 341.0 322.0 295.0 329 303 279 K/cmm 130 - 400 155.0 - 379.0
291347 - MPV 9.1 8.3 8.8 fL 7 - 10.4
291348 - NEUT % 74.0 76.0 82.0 80.0 74.2 78.1 70 69 69.9 % 40 - 80 40.0 - 74.0
291349 - LYMPH % 19.0 15.0 12.0 13.0 14.9 L 13.6 L 20 21 L 19.7 % 20 - 51 14.0 - 46.0
291350 - MONO % 6.0 7.0 5.0 7.0 9.8 7.6 8 8 7.8 % 2 - 13 4.0 - 12.0
291351 - EOS % 1.0 1.0 1.0 0.0 0.3 L 0.4 L 1 1 1.9 % .5 - 7 0.0 - 5.0
291352 - BASO % 0.0 1.0 0.0 0.9 0.8 0.3 1 1 0.7 % 0 - 2 0.0 - 3.0
291353 - NEUT # 5.5 8.2 H 9.1 H 10.5 H 10.3 H 10.0 H 6.7 4.3 5.2 K/cmm 1.5 - 7.9 1.4 - 7.0
291354 - LYMPH # 1.5 1.6 1.4 1.7 2.1 1.7 1.9 1.3 1.5 K/cmm 1.2 - 3.4 0.7 - 3.1
291355 - MONO # 0.5 0.7 0.6 0.9 1.3 H 1.0 0.7 0.5 0.6 K/cmm .2 - 1.2 0.1 - 0.9
291356 - EOS # 0.1 0.1 0.1 0.0 0.9 L 0.1 0.1 0.1 0.1 K/cmm .1 - .5 0.0 - 0.4
291357 - BASO # 0.0 0.1 0.1 0.0 0.1 0.0 0.1 0.1 0.1 K/cmm 0 - .2 0.0 - 0.2
291358 - ESRmVES mm/hr 0 - 10
291359 - ESRxCYT mm/hr 2 - 10
291360 - RETIC % % .66 - 2.85
291361 - RETIC # k/uL 27.9 - 121.6
291362 - Immature Granulocytes 0.0 0.0 0.0 0.0 0.0 0.0 % 0.0 - 2.0
291363 - Immature Grans (Abs) 0.0 0.0 0.0 0.0 0.0 0.0 % 0.0 - 0.1
291365 - ..
291366 - Comments:
291367 -
291368 - a. Test Performed at...
291369 - Health Testing Centers
291370 - 2760 W. OAKLAND PARK BLVD.
291371 - FORT LAUDERDALE FL 33311
291372 -
291374 - ..
291375 - WBC 10.6 High End of Range
291376 -
291377 - Follow up ref SDS 86 EC5L, ref SDS 85 EC5L.
291378 -
291379 - WBC 7.6, declined significantly from persistently elevated WBC > 12
291380 - over past 12 months. ref SDS 0 FK6I,
291382 - ..
291383 - Increased exercise the past 4 months may have stimulated bone marrow
291384 - to produce more new blood cells that maintain WBC elevated at high end
291385 - of range, explained by Doctor Johnson during a meeting at Kaiser on
291386 - 030606. ref SDS 1 JP7G In November hiked over 300 miles and over 100
291387 - miles the last week in November. Similarly, last week in December
291388 - hiked 127 miles. January yielded hiking only 242 miles due to severe
291389 - weather and injuries.
291391 - ..
291392 - WBC elevated at high end of range indicates EPCs may also be elevated
291393 - by increased endurance exercise, e.g., hiking 127 miles the last week
291394 - in December and hiking 11 miles per day for last 14 days in a row.
291395 - Testing for elevated EPC will show likelihood of regression from
291396 - atherosclerosis, based on elevated HDL 66 reported in labs today,
291397 - shown below. ref SDS 85 U45J
291398 -
291399 -
291400 -
291401 -
291402 -
291403 -
291404 -
2915 -
SUBJECTS
Urinalysis Lab VA No Results
4403 -
440401 - ..
440402 - Urinalysis Ketones Trace Abnormal Sp Gravity Above Range
440403 -
440404 - Follow up ref SDS 86 0X72, ref SDS 85 0X72.
440405 -
440406 - Prior Urinalysis test on 101207 0906. ref SDS 15 0X72
440407 - Prior Urinalysis test on 120509 1108. ref SDS 26 0X72
440408 - Prior Urinalysis test on 140201 1159. ref SDS 52 0X72
440409 - VA did not order urinalysis for lab on 140203 1147. ref SDS 53 0X72
440410 - Prior Urinalysis Labcorp test on 140508 1149. ref SDS 60 0X72
440411 - Prior Urinalysis test on 140814 1530. ref SDS 70 0X72
440412 - Prior Urinalysis Labcorp test on 141020 1025. ref SDS 75 0X72
440413 - Prior Urinalysis Labcorp test on 141201 0850. ref SDS 82 0X72
440414 - Prior Urinalysis Labcorp test on 150208 1438. ref SDS 85 0X72
440415 - Prior Urinalysis Labcorp test on 150512 1239. ref SDS 0 0X72
440417 - ..
440418 - URINALYSIS PANEL
440419 - x
440420 - Dates.......... 2015 05 12 1300 150208 141201 141020 140814 140514 140203 140201 120509
440421 - Labcorp Labcorp Labcorp Labcorp VA VA Labcorp VA Labcorp VA VA Labcorp
440422 - Results Results Results Results Results Results Results Results Results Results Units Range Range
440423 - PH 7.0 6.0 5.5 6.0 6.0 5.5 5.5 6.0 5 - 9 5.0 - 7.5
440424 - PROTEIN NEG NEG Trace Trace NEG NEG NEG NEG mg/dL NEG - TRACE NEG - TRACE
440425 - GLUCOSE NEG NEG NEG NEG NEG NEG NEG NEG mg/dL Ref: NEG NEG
440426 - KETONES NEG 1+ Abnormal 1+ Abnormal Trace Abnormal 15 Trace Abnormal NEG NEG mg/dL Ref: NEG NEG
440427 - BILI NEG NEG NEG NEG NEG NEG NEG NEG Ref: NEG NEG
440428 - BILIcnf Ref: NEG
440429 - BLOOD TRACE TRACE TRACE TRACE Ref: NEG
440430 - NITRITE, URINE NEG NEG NEG NEG NEG NEG NEG NEG Ref: NEG NEG
440431 - UROBILI 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2 EU/dL .2 - 1 0.0 - 1.9
440432 - LEU EST NEG NEG Ref: NEG
440433 - SP.GRAV 1.018 1.028 1.035 H 1.030 >=1.030 H 1.036 1.026 1.025 1.003- 1.035 1.005 - 1.030
440434 - COLOR YELLOW YELLOW YELLOW YELLOW YELLOW YELLOW YELLOW YELLOW
440435 - APPEAR CLEAR CLEAR CLEAR CLEAR CLEAR CLEAR CLEAR CLEAR
440436 - WBC 0-5 /hpf 0 - 5
440437 - WBC ESTERASE NEG NEG NEG NEG NEG NEG
440438 - RBC 0-2 /hpf 0 - 2
440439 - OCCULT BLOOD NEG NEG NEG NEG NEG NEG NEG
440440 - HAYALINE CASTS NORM(0-1) per lpf 0 - 1
440441 - GRANULAR CASTS None per lpf Ref: None
440442 - CELLULAR CASTS None per lpf Ref: None
440443 - RBC/HPF NORM(0-3) per lpf 0 - 3
440444 - BACTERIA None seen 0 - 1 None seen / Few
440445 - EPITHELIAL CELLS 0-10 NORM(0-1) /hpf 0 - 10
440446 - RENAL EPITHELIAL CELLS None per lpf Ref: None
440447 - CALCIUM OXILATE CRYST Present Abnormal N/A
440448 - URIC ACID CRYSTALS NORM(0-1) per lpf 0 - 1
440449 - TRIPLE PHOSPHATE CRYST NORM(0-1) per lpf 0 - 1
440450 - AMORPHOUS SEDIMENT None per lpf Ref: None
440451 - MUCOUS No Report Present Present Not Established
440452 - TRICHOMONAS None per lpf Ref: None
440453 - YEAST None per lpf Ref: None
440454 - CULTURE REFLEXED No
440455 - TR EPTH None per lpf Ref: None
440456 - Urobilinogen, Semi-On 0.2 0.2 0.2 0.2
440457 - NITRITE, URINE NEG NEG NEG NEG
440458 - Microscopic Examination
440459 - Microscopic follows if indicated
440461 - ..
440462 - Comments:
440463 -
440464 - a. Test Performed at...
440465 - Health Testing Centers
440466 - 2760 W. OAKLAND PARK BLVD.
440467 - FORT LAUDERDALE FL 33311
440469 - ..
440470 - Ketones trace abnormal signals elevated physical activity. Since it
440471 - is negative in this report appears conflicting with hiking 22 miles 2
440472 - days ago, and 14 miles yesterday in case study on 140101 0600.
440473 - ref SDS 48 UM5L
440474 -
440475 -
440476 -
440477 -
440478 -
4405 -
SUBJECTS
Lab Electrolytes Chem Profile Glucose 97 Sodium NA 144 Potasium K 5.
6103 -
610401 - ..
610402 - T Bili 1.5 Hyperbilirubinemia Improves with Pause Atorvastatin Ezetimibe
610403 - Potasium K 5.3 Elevated Increased Electrical Problems Heart
610404 - Bun/Creatinine Ratio Elevated Slightly
610405 - LDH Elevated and Electrolytes May Correlate Increased Endurance Exercise
610406 -
610407 - Follow up ref SDS 86 KK9M, ref SDS 85 KK9M.
610408 -
610409 - Prior CHEM PROFILE on 120509 1108. ref SDS 26 KK9M
610410 - Prior CHEM PROFILE on 120831 1524. ref SDS 27 KK9M
610411 - Prior CHEM PROFILE on 130228 1140. ref SDS 36 KK9M
610412 - Prior CHEM PROFILE on 130529 0818. ref SDS 38 KK9M
610413 - Prior CHEM PROFILE on 131015 0724. ref SDS 40 KK9M
610414 - Prior CHEM PROFILE Labcorp on 140201 1159. ref SDS 52 KK9M
610415 - Prior CHEM PROFILE on 140203 1147. ref SDS 53 KK9M
610416 - Prior CHEM PROFILE Labcorp on 140508 1149. ref SDS 60 KK9M
610417 - Prior CHEM PROFILE on 140520 0732. ref SDS 66 KK9M
610418 - Prior CHEM PROFILE on 140814 1530. ref SDS 70 KK9M
610419 - Prior CHEM PROFILE Labcorp on 141020 1025. ref SDS 75 KK9M
610420 - Prior CHEM PROFILE on 141021 11150 ref SDS 77 KK9M
610421 - Prior CHEM PROFILE Labcorp on 141201 0840. ref SDS 82 KK9M
610422 - Prior CHEM PROFILE Labcorp on 150208 1438. ref SDS 84 KK9M
610423 - Prior CHEM PROFILE Labcorp on 150208 14380 ref SDS 85 KK9M
610424 - Prior CHEM PROFILE on 150209 10120 ref SDS 86 KK9M
610425 - Prior CHEM PROFILE Labcorp on 150512 1239, ref SDS 0 KK9M
610426 -
610428 - ..
610429 - ELECTROLYTES - CHEM PROFILE
610431 - ..
610432 - Dates..........2015 05 12 1300 150209 150208 141201 141021 141020 140814 140520 140514 140508 140203 140201 131015 130529
610433 - Labcorp VA Labcorp Labcorp VA Labcorp VA VA VA Labcorp VA Labcorp VA VA VA Labcorp
610434 - PLASMA Results Results Results Results Results Results Results Results Results Results Results Results Results Results Units Range Range
610435 - GLUCOSE 99 108 89 104 H 110 H 105 98 98 97 103 98 108 H 120 mg/dL 65 - 115 65.0 - 99.0
610436 - GLUfast mg/dL Ref: <=99
610437 - NA (salt) 141 145 144 147 H 138 144 144 139 144 140 140 139 139 mmol/L 136 - 144 134.0 - 144.0
610438 - K (potassium) 5.0 5.5 H 5.3 H 5.6 H 4.4 4.3 4.3 H 5.2 H 5.6 H 5.4 4.8 4.3 H 4.9 mmol/L 3.4 - 4.8 3.5 - 5.2
610439 - CL 99 109 103 106 103 H 108 H 108 102 105 103 102 105 105 mmol/L 98 - 106 97.0 - 108.0
610440 - CO2 29 28 29 29 29.0 30.0 37.0 30.0 mmol/L 23 - 33
610441 - AGAP 7.0 7.0 8.0 mmol/L 5 - 20
610442 - BUN 17 29 H 26 H 28 H mg/dL 8 - 26 8.0 - 27.0
610443 - * BUN/Creati Ratio 18 26 H 24 H 22 H 28 19 H 23 17 20 24 18 10.0 - 22.0
610444 - CREAT 0.96 0.9 0.99 1.16 0.8 1.13 1.03 0.80 0.97 0.82 0.81 0.83 0.83 mg/dL .5 - 1.1 0.76 - 1.27
610445 - eGFR INA 80 80 77 64 91 66 >60 102 79 >60 91 >60 >60 mL/min Ref: >=60 >59
610446 - eGFR IA 92 89 74 76 92 106 mL/min >59
610447 - CALCIUM 9.5 9.6 10.0 10.0 8.8 9.9 9.1 8.9 9.5 9.3 9.4 9.2 9.2 mg/dL 8.7 - 10.2 8.6 - 10.2
610448 - CA CORR mg/dL 8.7 - 10.2
610449 - PO4 mg/dL 2.4 - 4.5
610450 - MG 85 mg/dL 1.8 - 2.5
610451 - ALK PHO 88 98 96 107 85 86 100 105 84 87 U/L 40 - 125 39.0 - 117.0
610452 - SGOT 27 U/L 5 - 35
610453 - SGPT 28 U/L 7 - 56
610454 - Phosphorous, Serum 3.2 mg/dL 2.5 - 4.5
610456 - ..
610457 - T. BIL 1.2 1.5 H 1.9 H H 2.0 H 2.5 1.2 H 2.2 H 1.3 H 2.1 H 1.6 H 1.7 H 1.3 mg/dL .1 - 1.2 0.0 - 1.2
610458 - D. BILI 0.23 0.31 0.38 0.38 0.3 0.2 0.2 0.32 0.3 0.34 < 0.1 mg/dL .1 - .5 0.00 - 0.40
610459 - Bilirubin, Indir 0.97 H 1.19 H 1.52 H H 1.62 0.98 1.26 H mg/dL 0.10 - 0.80
610460 - AST (SGOT) 17 23 26 31 25 23 26 23 21 20 22 IntUnits/L 8 - 42 0.0 - 40.0
610461 - ALT (SGPT) 17 18 23 30 21 21 17 21 19 17 19 IntUnits/L 5 - 55 0.0 - 44.0
610462 - ALBUMIN 4.5 4.5 4.8 4.7 4.8 4.3 3.9 4.6 4.6 4.1 4.4 3.9 4.0 g/dL 3.3 - 5.2 3.6 - 4.8
610463 - PROTEIN 6.5 6.9 6.6 6.9 7.2 6.5 7.5 6.6 6.7 6.5 7.1 7.2 g/dL 6.0 - 8.5 6.0 - 8.5
610464 - Globulin, Total 2.1 1.9 2.1 2.0 2.1 g/dL 1.4 - 4.5
610465 - A/G Ratio 2.3 2.5 2.3 2.3 2.1 1.1 - 2.5
610466 - LDH 189 240 H 241 H 223 200.0 180.0 IntUnits/L 90 - 208 0.0 - 225.0
610467 - GGT 13 13 11.0 9.0 IU/L 0.0 - 65.0
610468 - Iron, Serum 115 89 101 146 100.0 114.0 ug/dL 40.0 - 155.0
610469 - AMYLASE Units/L 28 - 100
610470 - LIPASE Units/L 7 - 58
610471 - NH3 mcmol/L 15 - 56
610472 - URIC AC 4.9 5.4
610473 - 5.4 5.3 6.9
610474 - 5.6
610475 - mg/dL 4.8 - 8.7 3.7 - 8.6
610476 - ..
610477 - Cholesterol, Total 284 H 167 161 174 164.0 162.0 mg/dL 100.0 - 199.0
610478 - Triglycerides 107 60 66 79 55.0 64.0 mg/dL 0.0 - 149.0
610479 - HDL Cholesterol 57 68 67 61 > 39
610480 - LDL Cholesterol 206 87 81 96 0 - 99
610481 - T Chol/HDL ratio 5.0 2.5 2.4 2.8 0.0 - 5.0
610482 -
610483 - Please Note:
610484 -
610485 - T Chol/HDL Ratio Men Women
610486 -
610487 - 1/2 Avg Risk 3.4 3.3
610488 - Avg Risk 5.0 4.4
610489 - 2x Avg Risk 9.6 7.1
610490 - 3x Avg Risk 23.4 11.0
610492 - ..
610493 - Estimated CHD Risk 1.0 times avg 0.0 - 1.0
610494 -
610495 - T Chol/HDL Ratio Men Women
610496 -
610497 - 1/2 Avg Risk 3.4 3.3
610498 - Avg Risk 5.0 4.4
610499 - 2x Avg Risk 9.6 7.1
610500 - 3x Avg Risk 23.4 11.0
610502 - ..
610503 - The CHD Risk is based on the T Chol/HDL ratio.
610504 - Other factors affect CHD Risk such as hypertension,
610505 - smoking, diabetes, severe obesity, and family history
610506 - of premature CHD.
610508 - ..
610509 - Comments Labcorp test 150208...
610510 -
610511 - a. Test Performed at...
610512 - Jenny Galloway, MD
610513 - LabCorp San Diego
610514 - 13112 Evening Creek Dr So Ste 200, San Diego, CA 92128-4108
610516 - ..
610517 - For inquiries, the physician may contact Branch:
610518 - 800-762-4344 Lab: 858-668-3700
610519 -
610520 -
610521 -
610523 - ..
610524 - Notes on Electrolytes Lab Hyperbilirubinemia Potassium Heart Problems
610525 - Hyperbilirubinemia Potassium Heart Problems Notes on Electrolytes Lab
610526 - Potassium Heart Problems Hyperbilirubinemia Notes on Electrolytes Lab
610527 -
610528 - Follow up ref SDS 86 G34G, ref SDS 85 G34G.
610529 -
610530 - 1. T Bilirubin 1.2...0.3 - 1.2..... ref SDS 0 015M
610532 - ..
610533 - Collection DT T Bili Range Source
610534 - 05/12/2015 13:00 1.2 ...0.3 - 1.2.. ref SDS 0 015M
610535 - 02/08/2015 14:52 1.5 H...0.3 - 1.2.. ref SDS 85 015M
610536 - 01/12/2014 08:40 1.9 H...0.3 - 1.2.. ref SDS 82 015M
610537 - 20/10/2014 10:60 2.0 H...0.3 - 1.2.. ref SDS 75 015M
610538 - 14/08/2014 15:28 2.5 H...0.3 - 1.2.. ref SDS 70 WJ5H
610539 - 20/05/2014 10:20 1.2 ....0.3 - 1.2.. ref SDS 66 015M
610540 - 08/05/2014 11:49 1.3 H...0.0 - 1.2.. ref SDS 60 015M
610541 - 03/02/2014 09:52 2.1 H...0.3 - 1.2.. ref SDS 53 015M
610542 - 01/02/2014 12:28 1.6 H...0.0 - 1.2.. ref SDS 52 015M
610543 - 15/10/2013 08:25 1.7 H...0.3 - 1.2.. ref SDS 40 015M
610544 - 29/05/2013 08:18 1.3 H...0.3 - 1.2.. ref SDS 38 1Y9G
610545 - 28/02/2013 08:36 1.3 H...0.3 - 1.2.. ref SDS 36 6S4F
610546 - 31/08/2012 15:24 2.3 H...0.3 - 1.2.. ref SDS 27 NV9M
610547 - 09/05/2012 11:24 2.5 H...0.3 - 1.2.. ref SDS 26 O46K
610548 - 09/02/2012 11:18 1.8 H...0.3 - 1.2.. ref SDS 22 KK9M
610549 - 17/11/2011 14:27 1.3 H.............. ref SDS 20 KK9M
610550 - 13/10/2011 14:35 1.3 H.............. ref SDS 19 GM65
610551 - 27/07/2011 12:58 2.0 H.............. ref SDS 16 GM65
610552 - 07/12/2010 09:17 1.0 ............... ref SDS 15 GM65
610553 - 21/07/2010 08:54 1.3 H.............. ref SDS 11 GM65
610554 - 14/12/2009 1.3 H ............. ref DRP 1 DE4O
610555 - 02/11/2009 0.9 ............... ref DRP 1 LG4L
610556 - 13/08/2009 15:09 1.7 H.............. ref SDS 5 VG8R
610558 - ..
610559 - On 131017 1000 VA medical chart Progress Notes assessment
610560 - reports Doctor Egan diagnosed chronic hyperbilirubinemia.
610561 - ref SDS 42 PSXT
610563 - ..
610564 - For some reason VA did not test T Bilirubin for recovery from
610565 - diagnosis of hyperbilirubinemia associated with statin
610566 - medication treating hyperlipidemia.
610568 - ..
610569 - T Bilirubin 1.5 elevated slightly above range shows decline
610570 - from 1.9 in lab 2 months ago on 141201, and dramatic decline
610571 - from Bilirubin 2.5 reported for lab at VA Martinez Clinic
610572 - performed 6 months ago on 140814 1530. ref SDS 70 015M This
610573 - latest result for T Bili in patient history, may demonstrate
610574 - chronic side effects statin medications causing poor liver
610575 - function, as reviewed previously on prior lab on 140514 0950.
610576 - ref SDS 63 G34G Side effects of peripheral neuropathy in right
610577 - foot have ebbed and flowed, reported on 140510, shown in case
610578 - study on 120101 0900. ref SDS 21 TV6I
610580 - ..
610581 - Bilirubin may have declined this cycle because statin treatment
610582 - was reduced by missing treatment for 12 days due to delays
610583 - receiving refills for Ezetimibe, reported to VA in the letter
610584 - on 141218 0359. ref SDS 83 5N3O Effects missing statin
610585 - treatment further evident when prescription was resumed on
610586 - delivery of Ezetimibe. Patient suffered significant
610587 - dehydration for several weeks readjusting to statin treatment,
610588 - shown by frequent urination and feet becoming dry with skin
610589 - cracking and bleeding. The problem was compounded by pausing
610590 - hiking 11 miles per day due to weather and injuries. Several
610591 - weeks after weather improved and injuries were resolved through
610592 - healing and bandaging resuming hiking 11 miles per day further
610593 - resolved dehydration, shown by resolution of cracking and
610594 - bleeding on bottom of both feet.
610596 - ..
610597 - On 140819 0800 during meeting with Doctor Sandhu in Primary
610598 - Care VA Clinic in Martinez, there was no review of chronic
610599 - hyperbilirubinemia, with T Bilirubin 2.5 rising 110% above
610600 - range, ref SDS 72 9K7I, shown in lab ordered by the doctor on
610601 - 140814. ref SDS 70 015M
610603 - ..
610604 - Background on Rosuvastatin causing elevated T Bilirubin with
610605 - associated severe side effects is reported on 121206 0900,
610606 - ref SDS 32 NI9L, and further explained in the record on 121130
610607 - 0846. ref SDS 31 ER4K
610609 - ..
610610 - On 131017 1000 Doctor Egan explained patient history of
610611 - intermittant and mild peripheral neuropathy that correlates
610612 - with persistent elevated T Bilirubin in lab on 131015,
610613 - ref SDS 40 015M, and further reported with vitals, diet and
610614 - exercise since prior meeting at VA on 130603, see case study on
610615 - 120101 0900, ref SDS 21 X14N, suggests intervention is not
610616 - required at this time to improve recovery from side effects
610617 - taking Rosuvastatin. ref SDS 42 LV5J
610618 -
610620 - ..
610621 - 2. Potassium K 5.0 high end of range............ ref SDS 0 ZG5O
610622 -
610623 - Potassium 5.0 in Labcorp lab fell within range at high end may
610624 - reflect increased hiking since last VA test, see history of
610625 - hiking mileage below. ref SDS 86 ZY7M
610627 - ..
610628 - Similarly, dramatic decline in hiking for 6 weeks from June to
610629 - August last year (see again hiking history below, ref SDS 86
610630 - ZY7M), and reported on the agenda for meeting with Doctor
610631 - Sandhu in Primary Care, which was submitted on 140814 2227.
610632 - ref SDS 71 K098, may correlate with potassium falling back
610633 - within range, at that time. This record shows correlation
610634 - between elevated Potassium and extended endurance hiking.
610636 - ..
610637 - Doctor Egan, referring cardiology physician at Martinez VA,
610638 - noted in a letter that meeting at VA Medical Center in San
610639 - Francisco on 140213 0830, ref SDS 56 GT7G, did not address
610640 - elevated potassium in labs performed by Labcorp and VA, shown
610641 - on 140203 1147. ref SDS 53 ZG5O Doctor Egan again notified
610642 - that this condition of elevated potassium represents exposure
610643 - to "electrical problems" with the heart, reported on 140430.
610644 - ref SDS 58 UV5I
610646 - ..
610647 - Doctor Egan was concerned last year about potassium (K) rising
610648 - above range for good health. He explained potassium effects
610649 - electrical signals to the heart, and so has significance for
610650 - CVD, reported during meeting at VA on 121206 0900. ref SDS 32
610651 - 6K56
610653 - ..
610654 - At that time on 121206, the doctor cited medication conflicts
610655 - as possibly causing elevated potassium. ref SDS 32 FI7L Doctor
610656 - Egan further considered dehydration (urination) caused by
610657 - Rosuvastatin may have skewed lab results for electrolytes on
610658 - 121130, and so ordered re-test. ref SDS 32 6K4J
610660 - ..
610661 - On 121212 0941 re-test lab reported Glucose 111, sodium 139,
610662 - and potassium (K) 4.6, all within range, ref SDS 33 KK9M,
610663 - correcting errors noted by Doctor Egan during meeting at VA on
610664 - 121206 0900. ref SDS 32 6K4J
610665 -
610667 - ..
610668 - 3. Glucose 99.......65 - 99.......... ref SDS 0 ZG5O
610669 -
610670 - VA test today showing glucose 108 for range 65-115 appears
610671 - comparable to Labcorp test yesterday showing glucose 89 for
610672 - range 65 - 99, and has remained within VA range, compared to
610673 - prior VA test on 141021. ref SDS 77 ZG5O
610675 - ..
610676 - Diabetes concern from reduced hiking due to metatarsalgia side
610677 - effects, causing weight to increase at times above 180; this
610678 - has subisded the past month, because hiking increased
610679 - significantly, as set out below. ref SDS 86 DC6L
610681 - ..
610682 - On 140814 VA Martinez lab reported HGBA1c 5.6 within range 4 -
610683 - 6, seems to indicate no evident exposure for diabetes.
610684 - ref SDS 77 H66G
610686 - ..
610687 - On 140514 0950 VA lab for HGBA1c 5.4 within range 4 - 6, seems
610688 - to indicate no evident exposure for diabetes. ref SDS 63 H66G
610689 -
610691 - ..
610692 - 4. Salt NA 145..................... ref SDS 86 WJ5H
610693 -
610694 - NA salt 145 increased from prior level 138 on VA test performed
610695 - 141021, but still within range.
610697 - ..
610698 - 5. LDH 240......................... ref SDS 85 015M
610699 -
610700 - For some reason LDH was not tested in VA lab today, despite
610701 - recent history of elevated results. LDH 240 in Labcorp test
610702 - yesterday, showing slight decline may reflect reduced hiking
610703 - compared to prior test on 141201, but since hiking overall
610704 - increased to 300 miles per month LDH remains elevated above
610705 - range.
610706 -
610707 -
610708 -
610709 -
610710 -
610711 -
610712 -
610713 -
6108 -
SUBJECTS
VA Lab Lipid Cholesterol 164 with Medication Hiking 1000 Miles Weigh
8103 -
810401 - ..
810402 - LDL-C 79 LDL-P 656 HDL 63 Hike 250 Miles in 3 Weeks
810403 -
810404 - Follow up ref SDS 86 IM9N, ref SDS 85 IM9N.
810405 -
810406 - Improved LDL-P declined 33% and HDL increased 20% nominally represent
810407 - significantly lower CVD risk.
810409 - ..
810410 - Prior LIPID PANEL 120509 1108. ref SDS 26 IM9N
810411 - Prior LIPID PANEL 120831 1525. ref SDS 27 IM9N
810412 - Prior LIPID PANEL 130228 1140. ref SDS 36 IM9N
810413 - Prior LIPID PANEL 130529 0818. ref SDS 38 IM9N
810414 - Prior LIPID PANEL 131015 0724, ref SDS 40 IM9N
810415 - Prior LIPID PANEL Labcorp, 140201 1159, ref SDS 52 IM9N
810416 - Prior LIPID PANEL, 140203 1147, ref SDS 53 IM9N
810417 - Prior LIPID PANEL Labcorp, 140508 1149. ref SDS 60 IM9N
810418 - Prior LIPID PANEL, 140814 1530, ref SDS 70 IM9N
810419 - Prior LIPID PANEL Labcorp, 141021 1009. ref SDS 76 IM9N
810420 - Prior LIPID PANEL, 141021 1150, ref SDS 77 IM9N
810421 - Prior LIPID PANEL Labcorp, 141106 0630, ref SDS 79 IM9N
810422 - Prior LIPID PANEL Labcorp, 141201 0852, ref SDS 82 IM9N
810423 - Prior LIPID PANEL Labcorp, 150208 1438, ref SDS 85 IM9N
810424 - Prior LIPID PANEL VA Medical Center San Francisco, 150209 1012, ref SDS 86 IM9N
810425 - Prior LIPID PANEL Labcorp, 150512 1239, ref SDS 0 IM9N
810427 - ..
810428 - LIPID PANEL
810429 - ..
810430 - x
810431 - Dates..........2015 05 12 1300 150209 150208 141201 141106 0714 141021 1148 141021 1021 140814 140514 140508 140203 140201 131015 130529
810432 - Labcorp VA Labcorp Labcorp Labcorp VA Labcorp VA VA Labcorp VA Labcorp VA VA VA Labcorp
810433 - NMR LipoProfile Results Results Results Results Results Results Results Results Results Results Results Results Results Results Units Range Range
810434 - LDL Particle Number
810435 - LDL P 2537 H 709 656 997 H 1586 851 861 nmol/L Low < 1000
810436 - Moderate 1000 - 1299
810437 - Borderline High 1300 - 1599
810438 - High 1600 - 2000
810439 - Very High > 2000
810441 - ..
810442 - Lipids
810443 - CHOL 282 H 161 162 157 137 159 157 161 (a) 164 162 160 156 321 H 307 mg/dL 100 - 240 < 200
810444 - (b) 169
810445 - TRIGLYC 108 50 66 73 85 65 80 72 (a) 58 59 47 68 109 85 mg/dL 10 - 190 < 150
810446 - (b) 59
810447 - HDL-C 56 70 66 63 53 57 55 55 (a) 66 67 58 61 50 50 mg/dL Ref: >=35 >= 40
810448 - (b) 67
810449 - LDL-C 204 H 81 83 79 67 90 86 92 (a) 87 83 93 81 249 H 240 mg/dL Ref: <=131 < 160
810450 - (b) 90
810451 - ** LDL Dir 93 mg/dL 0 - 130
810452 - TRIG NF mg/dL Ref: <=150
810454 - ..
810455 - TG/HDL ratio 1.16 1.16 1.60 1.14 1.46 1.31 (a) 0.88 0.88 0.81 1.11 < 2.0
810456 - TC/HDL ratio 2.49 2.49 2.58 2.79 2.85 2.93 2.48 2.42 2.76 2.56
810458 - ..
810459 - LDL and HDL Particles s s s s
810460 - HDL-P (Total) 34.3 39.5 38.9 35.2 36.4 38.1 31.4 umol/L >= 30.5
810461 - Small LDL-P 1141 H 153 310 387 H 1277.0 < 90.0 < 90.0 umol/L <=527.0
810462 - LDL Size 20.8 21.0 20.4 Low 20.8 L 19.7 21.2 21.3 nm > 20.5
810464 - ..
810465 - --------------------------------------------------------
810466 - ** INTERPRETATIVE INFORMATION**
810467 - PARTICLE CONCENTRATION AND SIZE
810469 - ..
810470 - LDL AND HDL PARTICLES Percentile in Reference Population
810471 - HDL-P (total) High 75th 50th 25th Low
810472 - >34.9 34.9 30.5 26.7 <25.7
810473 - ..
810474 - Small LDL-P Low 25th 50th 75th High
810475 - <117 117 527 839 >839
810477 - ..
810478 - LDL Size <- Large (Pattern A)-> <- (Pattern B) ->
810479 - 23.0 20.6 20.5 19.0
810481 - ..
810482 - --------------------------------------------------------
810483 - Insulin Resistance/Diab. Risk
810484 - Large VLDL-P < 0.8 nmol/L <= 2.7
810485 - Small LDL-P < 90.0 nmol/L < 527
810486 - Large HDL-P 9.4 umol/L >= 4.8
810488 - ..
810489 - VLDL Size NOTES
810490 -
810491 - VLDL concentration too low to allow determination of VLDL
810492 - Size. Low VLDL concentration contributes minimally to the
810493 - LP-IR score.
810495 - ..
810496 - LDL Size 21.2 >= 20.8
810497 - HDL Size 9.8 >= 9.2
810498 -
810499 - Small LDL-P, LDL Particle Size, Large HDL-P VLDL Size, HDL
810500 - Size, HDL Particle, and LP-IR Score have been validated by
810501 - LipoScience but not cleared by US FDA; the clinical
810502 - utility of these tests has not been fully established.
810504 - ..
810505 - Insulin Resistance Score
810506 - LP-IR Score 45 < 25 H 46.0 < 25.0 < 25.0 <= 45.0
810508 - ..
810509 - LP-IR Score is inaccurate if patient is non-fasting. The
810510 - LP-IR Score combines the information from Large VLDL-P,
810511 - Small LDL-P, Large HDL-P, VLDL Size, LDL Size and HDL Size
810512 - to give improved assessment of insulin resistance and
810513 - diabetes risk.
810515 - ..
810516 - INSULIN RESISTANCE MARKER
810517 -
810518 - <--Insulin Sensitive Insulin Resistant-->
810519 - Percentile in Reference Population
810520 -
810521 - Large VLDL-P Low 25th 50th 75th High
810522 - <0.9 0.9 2.7 6.9 >6.9
810524 - ..
810525 - Small LDL-P Low 25th 50th 75th High
810526 - <117 117 527 839 >839
810528 - ..
810529 - Large HDL-P High 75th 50th 25th Low
810530 - >7.3 7.3 4.8 3.1 <3.1
810532 - ..
810533 - VLDL Size Small 25th 50th 75th Large
810534 - <42.4 42.4 46.6 52.5 >52.5
810536 - ..
810537 - LDL Size Large 75th 50th 25th Small
810538 - >21.2 21.2 20.8 20.4 <20.4
810540 - ..
810541 - HDL Size Large 75th 50th 25th Small
810542 - > 9.6 9.6 9.2 8.9 < 8.9
810544 - ..
810545 - Insulin Resistance Score
810546 - LP-IR Score Low 25th 50th 75th High
810547 - <27 27 45 63 >63
810549 - ..
810550 - Final Report
810552 - ..
810553 - Date Issued: 05/14/15 1727 ET
810555 - ..
810556 - This document contains private and confidential health
810557 - information protected by state and federal law.
810558 - If you have received this document in error, please call
810559 - 858-668-3700
810560 -
810561 - 1995-2014 Laboratory Corporation of America® Holdings
810562 - All Rights Reserved - Enterprise Report Version 1.00
810564 - ..
810565 - 01 SO Jenny Galloway, MD
810566 - Labcorp San Diego
810567 - 13112 Evening Creek Dr So Ste 200 San Diego, CA
810568 - 92128-4108
810570 - ..
810571 - 02 BN William F Hancock, MD
810572 - Labcorp Burlington
810573 - 1447 York Court, Burlington, NC 27215-3361
810574 - 877 547 6837
810575 - 800-762-4344 Lab: 858-668-3700
810576 - Bianca
810577 - duranb3@labcorp.com
810579 - ..
810580 - This representation indicates Labcorp performed the NMR lipid test
810581 - internally, and did not contract for NMR lipid testing as done on
810582 - prior labs, e.g., on 150208 1438. ref SDS 85 IM9N
810584 - ..
810585 - For inquiries, the physician may contact Branch: 800 762 4344
810586 - Lab: 858 668 3700
810587 -
810588 -
810590 - ..
810591 - Prior labs contact for NMR Lipids...
810592 -
810593 - 02 BN Deanna Franke, PhD
810594 - Liposcience Inc
810595 - 2500 Sumner Blvd, Raleigh, NC 27616-3235
810596 - 877 547 6837
810597 - 800-762-4344 Lab: 858-668-3700
810598 - customer.service@liposcience.com
810599 -
810600 -
810602 - ..
810603 - Lipid History Trend Analysis
810604 -
810605 - Follow up ref SDS 86 W25L, ref SDS 85 W25L.
810606 -
810607 - There are currently 3 tests for cholesterol performed for an
810608 - examination cycle: (1) VA, (2) Liposcience NMR lipids, and (3)
810609 - Labcorp lipids. Confidence in lab results is high when these labs are
810610 - in close proximity...
810611 -
810612 - Small LDL LP-IR
810613 - Collection DT CHOL TRIGL HDL LDL-C LDL-P HDL-P LDL-P SIZE SCORE LDL-D Miles Minutes Min/Mile Weight
810614 - error 05/12/2015 13:00 ?? 282 108 56 204 H .2537....34.3..1141...20.8......45....... ref SDS 0 BE6O 11 167 15.18 178
810615 - 02/09/2015 11:21 161 50 70 81 ......................................... ref SDS 86 BE6O 11 167 15.18 178
810616 - 02/08/2015 14:52 162 66 66 83 ..709....39.5...153...21.0....< 25....... ref SDS 85 BE6O 611 9553 15.64 177
810617 - 02/08/2015 14:52 167 60 68 87 ......................................... ref SDS 85 BE6O - - -
810618 - 12/01/2014 08:40 157 73 63 79 ..656....38.9...310...20.4....< 25....... ref SDS 82 BE6O 269 4124 15.33 173
810619 - 12/01/2014 08:40 161 66 67 81 ......................................... ref SDS 82 1O6N - - -
810620 - 11/06/2014 07:14 137 85 53 67 ..997....35.2...387...20.8......30....... ref SDS 79 BE6O 147 2363 16.07 175
810621 - error 10/21/2014 10:21 157 80 55 86 .1586....36.4..1277...19.7......46....... ref SDS 76 BE6O Error
810622 - 10/21/2014 11:48 159 65 57 90 ......................................... ref SDS 77 BE6O 0 0 0.00
810623 - 10/20/2014 10:50 174 79 61 96 ......................................... ref SDS 75 IN5N 307 5758 18.76 177
810624 - 08/14/2014 15:28 161 72 55 92 ......................................... ref SDS 70 BE6O 429 7042 16.41 178
810625 - 05/14/2014 10:16 164 58 66 87 .................................... 93.. ref SDS 63 BE6O 67 1074 16.03 167
810626 - 05/08/2014 11:49 162 59 67 83 851 38.1 < 90 21.2 < 25 ..... ref SDS 60 BE6O 881 13952 15.84 170
810627 - 02/03/2014 12:28 160 47 58 93 ......................................... ref SDS 53 BE6O 25 407 16.28 175
810628 - 02/01/2014 12:31 156 68 61 81 861 31.4 < 90 21.3 < 25 ..... ref SDS 52 BE6O 935 14712 15.73 172
810629 - 10/15/2013 08:25 321 H 109 50 249 H ......................................... ref SDS 40 BE6O 1008 16771 16.64 167
810630 - 05/29/2013 08:18 307 H 85 50 240 H ......................................... ref SDS 36 BE6O 507 8171 16.12 180
810631 - 02/28/2013 08:39 310 H 73 47 248 H ......................................... ref SDS 36 BE6O 464 7154 15.42 183
810632 - 11/30/2012 10:01 173 53 57 105 ......................................... ref SDS 31 BE6O 680 10803 15.89 176
810633 - 08/31/2012 15:25 176 94 47 110 ......................................... ref SDS 27 U89N 308 5256 17.06 Not Reported
810634 - 05/09/2012 11:24 158 76 49 94 ......................................... ref SDS 26 U89N 127 2181 17.17
810635 - 02/09/2012 11:18 285 82 41 228 H ......................................... ref SDS 22 2A4G 347 5671 16.34
810636 - 11/17/2011 14:27 260 84 43 200 H ......................................... ref SDS 20 2A4G 397 6914 17.42
810637 - 07/27/2011 12:58 163 81 45 102 ......................................... ref SDS 16 E19L 500 8348 16.70
810638 - 12/07/2010 09:17 151 41 47 96 ......................................... ref SDS 15 E19L 106 1762 16.62
810639 - 07/21/2010 08:54 261 H 87 35 L 209 H ......................................... ref SDS 11 E19L 100 1762 16.60 Estimates
810640 - 06/10/2010 10:33 217 H 83 36 L 164 H ......................................... ref SDS 10 QV4F 400 6680 16.70 Estimates
810641 - * 12/14/2009 11:10 241 H 136 44 170 H ......................................... 100928 0706, ref SDS 12 VW6J 220 3675 16.70 Estimates
810642 - 08/13/2009 15:09 233 H 118 30 L 179 H ......................................... 100610 1046, ref SDS 10 U45G 2700 45100 16.70 Estimates
810643 - 06/16/2006 10:59 238 H 68 32 L 192 H ......................................... 091002 0900, ref SDS 6 LJ5H
810644 -
810645 - * Lab at VA San Francisco Medical Center reported on 100928 0706.
810646 - ref SDS 12 VW6J
810648 - ..
810649 - Research on cholesterol reported on 091002 0900. ref SDS 6 2F8K
810651 - ..
810652 - On 131125 0005 research found ezetimibe (zetia) mg added to
810653 - Atorvastatin 20 mg yielded after 6 weeks significantly greater changes
810654 - to lipids than taking Atorvastatin in higher doses, e.g., 20 or 40 mg.
810655 - ref SDS 46 CO56
810657 - ..
810658 - On 131125 0005 research found discordance LDL-P low and LDL-C high
810659 - lipid panel HDL 65 TG 77 healthy patient profile with LDL 246.
810660 - ref SDS 46 MN98 Discordance with LDL-P low and LDL-C high is lowest
810661 - risk for CVD, arterialsclorosis. ref SDS 46 FI3G
810663 - ..
810664 - Analysis....
810665 -
810666 - 1. VA results today HDL 70 and Triglycerides 50 are approximately
810667 - 20% better than Labcorp HDL 66 and TG 66, reported the day
810668 - before on 150208, ref SDS 86 U45J, indicating effects on lipid
810669 - labs from endurance exercise hiking 11 miles in 167 minutes,
810670 - i.e., 15 minute miles, for 1 more day.
810672 - ..
810673 - LDL-P 600 estimated from VA results for HDL and TG on 150809,
810674 - based on Liposcience NMR LDL-P 709 reported in lipid test the
810675 - day before on 150208, ref SDS 86 U45J, and indicating continued
810676 - improvement reported for prior lab finding LDL-P 656 on 141201
810677 - 0850. ref SDS 82 U45J These results confirm resolution of
810678 - evident erroneous lab reporting LDL-P 1586, reported by
810679 - Liposcience on 141021 1009. ref SDS 76 U45J
810681 - ..
810682 - The test today shows high levels of physical activity in
810683 - relation to patient history, hiking 11 miles in < 170 minutes
810684 - for 21 days in a row, including the best time ever, 158
810685 - minutes. This is a breakthrough in conditioning that exceeds
810686 - prior levels, since the longest period hiking < 170 minutes for
810687 - 11 miles was only 6 days in a row. Conditioning deteriorated
810688 - to doing 11 miles in 192 minutes on 141011, shown in case study
810689 - on 120101 0900. ref SDS 21 PUWT Now 2 tests 2+ months apart
810690 - yield comparable results, with slightly higher LDL-P this cycle
810691 - reflecting reduced hiking due to inclement weather and
810692 - injuries.
810694 - ..
810695 - 2. Research indicates healthiest cardiovascular condition occurs
810696 - with lowest risk for CVD, when lipids are discordant, with
810697 - LDL-P low and LDL-C high. However, greatest risk for CVD is
810698 - LDL-P high and LDL-C low, shown in the record on 131125 0005.
810699 - ref SDS 46 FI3G
810701 - ..
810702 - VA published goal LDL-C <= 131; Labcorp published goal LCL-C <
810703 - 100. ref SDS 63 5C7M New AHA guidelines show LDL-C < 190,
810704 - reported on 131112 1422. ref SDS 44 HT87
810706 - ..
810707 - VA lowering goal to HDL > 35, per above, ref SDS 85 5C7M, from >
810708 - 40 seems conflicting with patient history of CABG +4 on 091022
810709 - 0700. ref SDS 7 PQWU Since HDL 30 was found at that time (see
810710 - Lipid history below, ref SDS 63 W25L, setting the bar at HDL 35
810711 - has little tolerance for genetic variation to avoid and repair
810712 - endothelium lesions causing atheriosclerotic plaque.
810714 - ..
810715 - 3. Resting heart rate getting up in the mornings has dropped below
810716 - 50. Blood pressure averages about 127 68; however, systolic
810717 - often drops below 120, and diastolic often falls below 60.
810718 - After 11 mile hikes blood pressure drops to about 105 55.
810719 - Systolic on occassion falls below 90. Dystalic has fallen
810720 - below 50 - e.g., see Saturday, 141018, reported in case study
810721 - on 120101 0900, ref SDS 21 V83O Heart rate now recovers well
810722 - after strenuous exercise, often falling back below 60 within 20
810723 - minutes or so.
810725 - ..
810726 - 4. Cholesterol................... 161................ ref SDS 86 U45J
810728 - ..
810729 - 2 unit increase of cholesterol from prior test 4 months ago on
810730 - 141021, aligns with patient history showing Cholesterol has
810731 - been steady taking Atorvastatin 10 mg and Ezetimibe 10 mg for
810732 - 12 months, varying between 157 - 174. ref SDS 79 W25L This
810733 - increase may reflect 12 day pause taking Atorvastatin 10 mg and
810734 - Ezetimibe 10 mg due to delay receiving refills, reported to VA
810735 - in a letter on 141218 0359. ref SDS 83 5N3O
810737 - ..
810738 - LDL-C......................... 81................ ref SDS 86 U45J
810740 - ..
810741 - 9 unit decline of LDL-C from prior test on 141021, aligns
810742 - testing with patient history consistently 10 - 20 units above
810743 - VA goal to lower LDL-C < 70 reported in Progress Notes on
810744 - 140519 0800. ref SDS 65 OW3K LDL-C is calculated and so can be
810745 - "assumed" from the Friedwald equation...Cholesterol - HDL -
810746 - TG/5 (reported on 140213 0830. ref SDS 56 Z37L).
810748 - ..
810749 - 5. Improved HDL and TG lipids reflect...
810751 - ..
810752 - a. Physical activity prescribed by the VA on 140213,
810753 - ref SDS 56 E34O, has recovered after a pause of 5 months to
810754 - recover from side effects, and now continues from prior
810755 - levels hiking 300+ miles per month, and supplemented with
810756 - 750 ml orange juice per day (explained below, ref SDS 86
810757 - LO4J)...
810759 - ..
810760 - Mileage 2014 and Beginning 2015 Since Prior Lab
810761 -
810762 - Follow up ref SDS 86 ZY7M, ref SDS 85 ZY7M.
810763 -
810764 - 131103....Oct................. 373 5757 ...... ref SDS 21 6F9N
810765 - 131201....Nov................. 172 2899 ...... ref SDS 21 XRPV
810766 - 131229....Dec................. 234 3324 ...... ref SDS 21 XXQY
810767 - 140202....Jan................. 347 5393 ...... ref SDS 48 YWST
810768 - 140302....Feb................. 234 3681 ...... ref SDS 48 PYWS
810769 - 140330....Mar................. 207 3313 ...... ref SDS 48 RXPR
810770 - 140427....Apr................. 310 4402 ...... ref SDS 48 RXVV
810771 - 140601....May................. 322 5338 ...... ref SDS 48 SXWV
810772 - 140629....Jun................. 156 2337 ...... ref SDS 48 ZW4N
810773 - 140803....Jul................. 81 1023 ...... ref SDS 48 I37G
810774 - 140831....Aug................. 140 1998 ...... ref SDS 48 236I
810775 - 140928....Sep................. 136 2855 ...... ref SDS 48 XWUY
810776 - 141102....Oct................. 215 3540 ...... ref SDS 48 F56L
810777 - 141130....Nov................. 319 4840 ...... ref SDS 48 ST5L
810778 - 141228....Dec................. 284 4533 ...... ref SDS 48 SRTP
810779 - 150201....Jan................. 242 3687 ...... ref SDS 48 TSYW
810780 - 150208....Feb only 1 week..... 74 1122 ...... ref SDS 48 736O
810781 -
810783 - ..
810784 - b. Weight - 177 on date of lab 150208 (see case study on
810785 - 140101 0600, ref SDS 48 736O, increased from 173 on 141201,
810786 - ref SDS 48 1N4I; yet, declined from 186 on 141011,
810787 - ref SDS 21 PUWT, but still above 163 on 140513, shown in
810788 - case study on 120101 0900. ref SDS 21 ZU5G Hiking has a
810789 - positive effect on weight consuming calories and
810790 - triglycerides, and also reducing time and interest for
810791 - eating. Lower weight tends to reduce tryglycerides, which
810792 - tends to increase LDL-P size = 21.0, as shown in current
810793 - lab, per above. ref SDS 85 5C86 Evidence indicates weight
810794 - is highly sensitive to eating and exercise, and directly
810795 - correlated to CVD risk.
810797 - ..
810798 - Week ending 121130, hiked 106 miles the most in patient
810799 - history for 1 week. ref SDS 21 ST5L
810801 - ..
810802 - On 141123 hiked 11 miles in 158 minutes, fastest pace in
810803 - patient history. ref SDS 48 OI6N
810805 - ..
810806 - Hiked 11 miles per day in < 170 minutes for 20 days in a
810807 - row; hiking 14 - 15 minute miles every day reflects order
810808 - of magnitude improvement in body condition; previous best
810809 - was only 6 days in a row. This change in body condition
810810 - may reconcile 33% decline in LDL-P 656, and 20% better than
810811 - prior best lipid report before side effect injuries that
810812 - caused hiking to decline 70%, leading to poor Lipids.
810814 - ..
810815 - The last week in December hiked 127 miles, all below 170
810816 - minutes per 11 mile lap, i.e., 15 minute miles, shown in
810817 - case study. ref SDS 48 KU6F
810819 - ..
810820 - January hiking distance declined and speed increased
810821 - slightly because of severe cold weather and also due to
810822 - injuries. This decline in endurance exercise may have
810823 - caused LDL-P to rise slightly from 656 to 709 in the
810824 - current lab on 150208, see above. ref SDS 85 U45J
810825 -
810827 - ..
810828 - c. Low-carbohydrate diet works best in this case with
810829 - elevated physical activity, because exhaustion from hiking
810830 - reduces desire/energy for eating.
810832 - ..
810833 - d. Chia seeds added to diet on 131125, reported in case study
810834 - on 120101 0900, ref SDS 21 746M, and recommended for
810835 - sustained energy hiking by Karen at VA on 131121 0930.
810836 - ref SDS 45 NQ37
810838 - ..
810839 - e. Orange juice may have increased slightly this cycle, likely
810840 - contributing to HDL 70 rising 27%, ref SDS 86 U45J, from HDL
810841 - 55 on 141021, and supplementing increased physical
810842 - activity, and as explained in the prior lab analysis on
810843 - 140514 0950. ref SDS 63 LO4J
810845 - ..
810846 - f. Atorvastatin 10 mg with Ezetimibe 10 begun on 131230,
810847 - reported in case study on 120101, ref SDS 21 6A6H, and
810848 - continued through current cycle.
810850 - ..
810851 - Cholesterol 161 remained comparable to prior level 157 on
810852 - 141021, per above, ref SDS 86 5C7M, indicating minimal
810853 - effects pausing Atorvastatin 10 mg and Ezetimibe 10 mg for
810854 - 12 days due to delays in refill processing, cited in the
810855 - letter to the VA on 141218 0359. ref SDS 83 5N3O
810857 - ..
810858 - Research studies report Atorvastatin 10 mg + Ezetimibe 10
810859 - mg achieves LDL < 70, and favorably changes triglycerides
810860 - and HDL by 5%, reported on 131125 0005. ref SDS 46 CO45
810861 - While low LDL < 70 conflicts with goal of "discordance"
810862 - that lowers health risk for arterialsclorosis and CVD when
810863 - LDL-P low and LDL-C high, shown in research on 131125 0005,
810864 - ref SDS 46 FI3G, even "concordant" results today are good
810865 - news.
810866 -
810867 -
810869 - ..
810870 - Coronary CTA or IVUS Test Athereosclerosis Plaque 4 Years After CABG
810871 - Athereosclerosis Plaque 4 Years After CABG Coronary CTA or IVUS Test
810872 -
810873 - Follow up ref SDS 86 QA4M, ref SDS 85 QA4M.
810874 -
810875 - On 131125 0005 research further found radiology imaging tests can
810876 - evaluate level of plaque build up resulting from elevated cholesterol.
810877 - ref SDS 46 N73K Radiology imaging technologies are Coronary CT
810878 - angiography - CTA - and Intravascular ultrasound - IVUS. ref SDS 46
810879 - KZ8O
810881 - ..
810882 - Lipid history and particularly the past 3 months with HDL > 60 and
810883 - Triglycerides < 100, ref SDS 86 5C7M, indicates body chemestry may be
810884 - sufficient again to cause rapid regression of atherosclerosis plaque,
810885 - cited in research on 131125 0005. ref SDS 46 RA7K Research indicates
810886 - that favorable lipid profile, weight loss, and production of EPC in
810887 - the bone marrow, all stimulated by exercise, drives regression of
810888 - plaque. ref SDS 46 XY7L
810890 - ..
810891 - The next step monitoring results of medical, diet, and exercise
810892 - interventions the past 4 years, since CABG +4 on 091022 0700,
810893 - ref SDS 7 PQWU, is to perform radiology testing with coronary CT
810894 - angiography or IVUS to assess regression of atherosclerosis plaque,
810895 - which previously required major surgery to fix.
810897 - ..
810898 - This step is supported by patient history using CT radiology imaging
810899 - to assess regression of esophageal bubble after 4 years of medical
810900 - interventions, reported favorable by Doctor Stewart, Chief General
810901 - Surgery at VA on 130122 1330. ref SDS 34 03H6 CT radiology with
810902 - calcium score is commonly used to assess response to treatment for
810903 - regression of athersclerosis, reported during the meeting at the VA on
810904 - 140519 0800. ref SDS 65 OF7N
810905 -
810906 -
810907 -
810908 -
810909 -
810910 -
810911 -
810912 -
810913 -
810914 -
810915 -
8110 -
SUBJECTS
VA Lab Cardiac Enzymnes Creatine Kinase CK also CPK Creatine Phospho
8903 -
890401 - ..
890402 - Myopathy Muscle Pain Side Effects Simvistatin Decline
890403 -
890404 - Follow up ref SDS 86 D26G, ref SDS 85 D26G.
890405 -
890406 - Prior Cardiac Enzymes Profile on 120209 1118. ref SDS 22 D26G
890407 - Prior Cardiac Enzymes Profile on 120509 1108. ref SDS 26 D26G
890408 - Prior Cardiac Enzymes, 131015 0724, ref SDS 40 D26G
890409 - Prior Cardiac Enzymes Profile VA on 140203 1147. ref SDS 53 NX6G
890411 - ..
890412 - This test not performed by Labcorp with blood draw on 150208, nor by
890413 - the VA with blood draw today. Most recent testing showed...
890414 -
890415 - CARDIAC ENZYMES
890416 -
890417 - Dates 2014 05 14 1016 140508 140203 131015 120509
890418 - VA Labcorp VA VA VA
890419 - PLASMA Results Results Results Results Results Units Range
890420 - CPK (CK) 192 149 110 152 U/L 30 - 235
890421 - TRPONIN ng/ml 0 - 0.07
890422 - CK-MB ng/ml 0.6 - 3.5
890423 - MYOGLOB ng/ml 20 - 82
890425 - ..
890426 - a. CPK/CK test not performed by Labcorp
890428 - ..
890429 - b. SLIGHTLY ICTERIC SPECIMEN /HN
890431 - ..
890432 - c. Ordering Provider: Diana Alba
890433 - Report Released..: May 14, 2014@11:29
890434 - Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]
890435 - 4150 CLEMENT STREET
890436 - SAN FRANCISCO, CA 94121-1545
890437 - Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]
890439 - ..
890440 - CKP and CK are the same thing - creatine phosphokinase (CPK) also
890441 - called creatine kinase (CK).
890442 -
890443 - http://www.scai.org/SecondsCount/Resources/Detail.aspx?cid=ed385473-d4e8-491e-9ce0-a7c984fe6f8e#.U3b_BfldWi8
890445 - ..
890446 - Research on 111013 explains Creatine Kinase CK, relates to muscle
890447 - disorders caused by cholesterol medications with statins. 111013 1404,
890448 - ref SDS 19 J54K
890450 - ..
890451 - CK lab may align with reduced side effects of muscle pain in left
890452 - shoulder.
890453 -
890454 -
890455 -
890456 -
890457 -
890458 -
8905 -
SUBJECTS
HGBA1C 5.4 Range 4.0-6.0 Diabetes Negative Laboratory Blood Test Cro
A603 -
A60401 - ..
A60402 - HGBA1c Diabetes Blood Test A1c
A60403 - A1c Diabetes Blood Test HGBA1c
A60404 - Diabetes HGBA1c A1c Blood Test
A60405 -
A60406 - Follow up ref SDS 86 9F4O, ref SDS 85 9F4O.
A60407 -
A60408 - Prior HGBA1c Profile on 100721 0800. ref SDS 11 IL4N
A60409 - Prior HGBA1c Profile on 101207 0906. ref SDS 15 IL4N
A60410 - Prior HGBA1c Profile on 131015 0724. ref SDS 40 9F4O
A60411 - Prior HGBA1c Profile on 140203 1147. ref SDS 53 9F4O
A60413 - ..
A60414 - This test not performed by Labcorp with blood draw on 150208, nor by
A60415 - the VA with blood draw today. Most recent testing showed...
A60417 - ..
A60418 - Endocrine IV - HGBA1c - A1c
A60419 -
A60420 - Dates..........2014 08 14 1528 140514 140508 140203 131015 101207
A60421 - VA VA Labcorp VA VA VA
A60422 - BLOOD Results Results Results Results Results Results Units Range
A60423 - HGBA1c 5.6 5.4 5.5 5.5 5.7 % 4.0 - 6.0
A60424 - eAG 114 111 111 mg/dL 74.0 - 118
A60426 - ..
A60427 - Comments:
A60428 -
A60429 - a. Labcorp did not perform HGBA1c lab
A60430 -
A60431 - b. Ordering Provider: Diana Alba
A60432 - Report Released..: May 14, 2014@11:29
A60433 - Reporting Lab....: SAN FRANCISCO VAMC [CLIA# 05D0988226]
A60434 - 4150 CLEMENT STREET
A60435 - SAN FRANCISCO, CA 94121-1545
A60436 - Performing Lab...: SAN FRANCISCO VAMC [CLIA# 05D0988226]
A60438 - ..
A60439 - This test for diabetes was ordered by Doctor Abrams during a meeting
A60440 - at the San Francisco VA Medical Center on 130227 0930. ref SDS 35 8T5L
A60441 - However, it is not reported for the lab performed the next day on
A60442 - 130228 1140, ref SDS 36 RP4N, nor in the follow up lab 3 months later
A60443 - on 130529 0818. ref SDS 38 RP4N
A60445 - ..
A60446 - HGBA1c was performed previously on 101207 0906, ref SDS 15 IL4N, and 5
A60447 - months earlier on 100721 0800. ref SDS 11 IL4N
A60449 - ..
A60450 - Labcorp test showing LP-IR Score < 25.0, indicating very low risk of
A60451 - diabetes. ref SDS 82 TU6L
A60452 -
A60453 -
A60454 -
A60455 -
A60456 -
A60457 -
A60458 -
A60459 -
A60460 -
A60461 -
A605 -