CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 15 0000. ref SDS 14 0000.
040502 -
040503 -
040504 -
040505 - [On 180201 1842 received letter from Lauren explaining
040506 - sources report that taking acetaminophen causes blood tests
040507 - to falsley show HDL is lowered, but that it is actually
040508 - lowered. ref SDS 25 KO5H
040510 - ..
040511 - [On 180202 1322 letter to Lauren concurs with her analysis
040512 - finding taking acetaminophen does not lower HDLl, but does
040513 - cause false lab reports on HDL, which can be remedied by
040514 - pausing acetaminophen a few days before a lab. ref SDS 26
040515 - KO5H
040516 -
040517 -
040518 -
040519 -
040521 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - On 171011, received in US mail notice of meeting scheduled to visit
040902 - primary care provider, Lauren Rettberg on 180102 0930.
040904 - ..
040905 - Previously, met with Lauren on 170911 1000. ref SDS 15 KO5H
040907 - ..
040908 - At that time reviewed continuing medical issues from vehicle collision
040909 - on 170905 2230. ref SDS 10 0001 Lauren ordered hydrocodone and
040910 - acetaminaphen to manage pain. ref SDS 15 IA4L She also ordered a lab
040911 - to follow up on CBC and Electrolytes (Chem Profile Metabolic...) that
040912 - were high and low on tests at San Joaquinn General Hospital on 170906.
040914 - ..
040915 - Telecon meeting today with Lauren Rettberg, NP acting Primary Care
040916 - Physician...
040917 -
040918 - [On 180411 1700 followed up, ref SDS 27 KO5H
040920 - ..
040921 - Agenda...
040922 -
040923 - 1. Generally very healthy.
040924 -
040925 - No sickness past years.
040926 -
040927 - 2. Medical issues from vehicle collision on 170906...
040928 -
040929 - 1. Three (3) fractured ribs healed, no complications
040930 -
040932 - ..
040933 - 2. BPPV dizziness resolved by Doctor Bethany Wiseman after 3
040934 - treatments ending on 171201 1300. ref SDS 19 GG5I
040936 - ..
040937 - There have been no further dizziness spells.
040939 - ..
040940 - Bethany did excellent work consulting with outside experts
040941 - to eventually apply a procedure that worked.
040942 -
040944 - ..
040945 - 3. Head pain concussion.
040946 -
040947 - 99% resolved - no issues.
040949 - ..
040950 - There is no longer pain touching the back of the head on
040951 - the left side.
040952 -
040954 - ..
040955 - 4. Neck and back pain
040956 -
040957 - 75% resolved.
040959 - ..
040960 - When working for 2+ hours, pain begins rising along a line
040961 - from the right tendon supporting the head doen the right
040962 - side of the neck, and along the right edge of the
040963 - vertebra.
040965 - ..
040966 - Research on "neck strain" and "pulled neck muscles" show
040967 - "splenius" may be involved.
040968 -
040969 - https://www.google.ca/search?q=anatomy+head+support+neck+tendons&lr=&as_qdr=all&tbm=isch&source=iu&ictx=1&fir=rFOImWF0DuBKXM%253A%252CLA5rdtBT2bFPmM%252C_&usg=__N3IVGYWufISf-O8mu4IGeB6BB_4%3D&sa=X&ved=0ahUKEwjJseGO7rzYAhWpgVQKHebjD8UQ9QEIPTAH#imgrc=_
040971 - ..
040972 - After the accident on 170905 and until about 3 weeks ago,
040973 - after hiking for 2 hours or so, when the head was turned
040974 - left or right, there was a feeling that some cord-like
040975 - structure as pulled from a protective shield. This caused
040976 - very severe pain level 10+. When the head was restored to
040977 - normal straight ahead position, the cord-like element
040978 - slipped back into place, and pain subsided.
040980 - ..
040981 - Over the past 3 weeks, this problem no longer occurs
040982 - hiking.
040984 - ..
040985 - Severe pain still occurs when twisting the upper body to
040986 - lift a computer keyboard from a side table to working
040987 - position, although lately this does not occur now
040988 - everytime.
040989 -
040991 - ..
040992 - 5. Hematoma injury lower left leg
040993 -
040994 - Mostly healed. Lana did a good job in Wound Care working
040995 - with Doctor Stewart in General Surgery. They both agreed
040996 - treatment could end on 171107 1505. ref SDS 17 KO5H
040997 -
040999 - ..
041000 - 3. Orthopedics... feet and knees
041001 -
041002 - MRI on feet and knees performed 171229, ordered by Doctor
041003 - Thuillier in Orthotpedics.
041005 - ..
041006 - Evaluate regeneration cartilage in feet and left knee following
041007 - PRP injection treatments on 170726, and on 170816.
041009 - ..
041010 - Lauren seemed aware of MRI testing on both knees last Friday on 171229
041011 - 0745, ref SDS 20 FZ5L; and, also, on both feet on 171229 0900.
041012 - ref SDS 21 JG7N
041014 - ..
041015 - Lauren is familiar with PRP - she has patients who got the treatment
041016 - after returning from duty in the Middle East.
041018 - ..
041019 - Her experience indicates PRP works for 50% of patients.
041021 - ..
041022 - Partial report seen last night seems to show analyst finds no
041023 - change in condition of left knee minsicus, still totally
041024 - deteriorated.
041026 - ..
041027 - Need to review analysts full report.
041029 - ..
041030 - What accounts for significant clinical improvement, e.g., pain
041031 - free hiking since date of treatment on 170726?
041033 - ..
041034 - Will schedule meeting with Doctor Thuillier. He is following
041035 - PRP line of care in this case.
041036 -
041038 - ..
041039 - 4. Carpel Tunnel Syndrome
041040 -
041041 - This was severe in right wrist last year. Using auxillary
041042 - table to support right arm from elbow to wrist, eventually
041043 - resolved the pain.
041045 - ..
041046 - New issue developed 4 months ago, with right elbow becoming
041047 - painful using mouse. This has improved with changed
041048 - ergonomics ensuring right elbow is fully supported when using
041049 - computer mouse.
041050 -
041052 - ..
041053 - 5. Achalasia
041054 -
041055 - Significant recovery from severe condition beginning November
041056 - 2016, reported on 160816 0800. ref SDS 5 5H5J
041058 - ..
041059 - Required weekly EGD dilation treatments and increased PPI
041060 - (proton pump inhibitor), because fundoplication began failing
041061 - in November 2014.
041063 - ..
041064 - This caused increased reflux to close LESV. Food then backed
041065 - up above LESV.
041067 - ..
041068 - Naproxen pills got hung up also, which were taken to relieve
041069 - metatarsalgia pain during hiking to raise HDL and EPCs required
041070 - to regress atherosclerosis.
041072 - ..
041073 - This was effective shown by HDL 72 on 170216, however, Naproxen
041074 - severely ulcerated LESV. So, increased PPI to lower reflux for
041075 - recovery from ulcerated LESV.
041077 - ..
041078 - Increased PPI caused increased blood pressure.
041080 - ..
041081 - After recovery from ulceration on LESV, PPI was reduced to
041082 - minimal amounts, and so blood pressure has recovered back to
041083 - normal, more so since hiking increased.
041085 - ..
041086 - Mylanta and Calcium Carbonate (Tumms) also raise blood pressue,
041087 - so have reduced these.
041089 - ..
041090 - EGD dilation now performed on 4 week schedule, hoping for
041091 - incease to 6 weeks.
041093 - ..
041094 - Next EGD dilation on 180109 0800.
041095 -
041097 - ..
041098 - 6. Hiking
041099 -
041100 - Inability to hike most of last year due to feet and knee
041101 - injuries caused lipid lab on 171011 report of lower HDL 55,
041102 - i.e., below 60. ref SDS 16 5C7M
041104 - ..
041105 - On 170726, had PRP injection treatments in feet and left knee.
041106 - This was immediately effective for the knee, but took several
041107 - months to take effect for the feet, so could not hike to train
041108 - for Half Dome scheduled on 170913.
041110 - ..
041111 - Per above, Lauren is familiar with PRP - she has patients who got the
041112 - treatment after returning from duty in the Middle East. ref SDS 0 W982
041113 - She said it works for 50% of patients and not for others.
041115 - ..
041116 - On 171011, Doctor Simpson ordered another lab at patient's
041117 - discretion, nominally scheduled for 180108.
041119 - ..
041120 - Lauren said this lab order is good until I get the blood draw.
041121 -
041122 - When HDL reaches 60+ Doctor Simpson will order another CCTA to
041123 - evaluate for progression/regression of atherosclerosis, since
041124 - prior test nearing 3 years ago on 151019.
041126 - ..
041127 - Lauren was familiar with Doctor Simpson's plan reported in Progress
041128 - Notes for meeting on 171011.
041130 - ..
041131 - HDL 60+ depends on hiking.
041133 - ..
041134 - On 170929, purchased shoes from On-the-Run that provided
041135 - cushioning that enabled hiking.
041137 - ..
041138 - During October and November hiked 660 miles.
041140 - ..
041141 - On 171124 did outside lab reported HDL 61. ref SDS 18 1O6N
041142 - Want another month of hiking to increase HDL toward 70.
041144 - ..
041145 - Lauren will order lab to include electrolytes and HGBA1c. Can get
041146 - it with lipid panel ordered by Doctor Simpson.
041147 -
041148 - Ordered another 6 pair of shoes on 171110. When received they
041149 - were defective, not having cushioning needed for hiking 11 - 15
041150 - miles per day. Hoka replaced the shoes, but they were also
041151 - defective. Hoka replaced them, but they were wrong width
041152 - specification. Hoka replaced them again, and they were
041153 - received today. May be okay.
041155 - ..
041156 - If shoes are adequate, can then hike everyday for a month.
041157 - Will then do blood draw, and expect HDL 70 +/-.
041158 -
041160 - ..
041161 - 7. Medication
041162 -
041163 - Need liquid naproxen so it will not hang up and ulcerate LESV.
041164 - Cannot use acetaminophen and ibuprofen because they lower HDL.
041166 - ..
041167 - Lauren said liquid naproxen is available but only for inpatients.
041169 - ..
041170 - We reviewed special circumstances that justify prescription in this
041171 - case where patient needs naproxen because it is benign - does not
041172 - lower nor raise HDL. Since other common pain medications lower HDL,
041173 - and since the patient is working hard to raise HDL, and since naproxen
041174 - pills have caused severe ulceration of LESV, then liquid naproxen is a
041175 - good solution for managing severe pain that occurs with hiking.
041176 -
041177 - [On 180201 1842 received letter from Lauren explaining
041178 - sources report that taking acetaminophen causes blood tests
041179 - to falsley show HDL is lowered, but that it is actually
041180 - lowered. ref SDS 25 KO5H
041182 - ..
041183 - Lauren will negotiate with the Pharmacy about ordering it in this
041184 - case.
041186 - ..
041187 - Need another prescription for hydrocodone to recover severe
041188 - body pain after hikes.
041190 - ..
041191 - Lauren will order another prescription for Hydrocodone. If more will
041192 - be needed, then will have to fill out a form to comply with opiod
041193 - management requirements.
041195 - ..
041196 - We reviewed the record using hydrocodone sparingly, only when
041197 - absolutely necessary before long hikes, and at most 1 pill every 2 or
041198 - 3 weeks.
041199 -
041200 - [On 180110 1331 at 1700 received medication from UPS
041201 - delivery. ref SDS 23 D29O
041202 -
041203 -
041205 - ..
041206 - Follow Up Meetings
041207 -
041208 - She will schedule another telephone meeting for 2 months.
041210 - ..
041211 - She wants to meet at the hospital, and so will ask the scheduling
041212 - folks to set a meeting at the hospital in June.
041213 -
041214 - [On 180126 0948 Manita called and scheduled telephone call
041215 - with Lauren on 180411 1700, and set meeting with Lauren at
041216 - the hospital on 180605 0900. ref SDS 24 KO5H
041218 - ..
041219 - [On 180710 1621 called VA Medical Center in San Francisco
041220 - and talked to Fina again in Medical Practice, asking Lauren
041221 - to call cellphone tomorrow instead of landline on file with
041222 - the VA. Fina said the call tomorrow on 180711 1645 has
041223 - been cancelled. There is no explanation; however, Fina
041224 - said Lauren's schedule now shows she is out of the office
041225 - attending a professional conference. ref SDS 28 QR4G
041227 - ..
041228 - Thanked Lauren for good care.
041230 - ..
041231 - Lauren said this is the most complicated case she has ever had, but
041232 - she is glad the patient is doing well, and all the issues seem under
041233 - control.
041234 -
041235 -
041236 -
041238 - ..
0413 -
0414 -
0415 - 1732
0416 -
041601 - Lauren called back. She said the pharmacist requested source for
041602 - research on acetaminaphen causing lower HDL.
041603 -
041604 - lauren.rettberg@va.gov
041606 - ..
041607 - Lauren will submit sources to both the Pharmacy and Doctor Simpson in
041608 - Cardiology.
041609 -
041610 -
041611 - [On 180108 1944 Lauren has not ordered liquid naproxen;
041612 - sent letter asking about progress placing the order with VA
041613 - Pharmacy. ref SDS 22 KO5H
041615 - ..
041616 - [On 180126 0948 Manita called today; she will submit letter
041617 - to remind Lauren about ordering liquid naproxen.
041618 - ref SDS 24 YU9J
041620 - ..
041621 - [On 180201 1842 received letter from Lauren explaining
041622 - sources report that taking acetaminophen causes blood tests
041623 - to falsley show HDL is lowered, but that it is actually
041624 - lowered. ref SDS 25 KO5H
041625 -
041626 -
041627 -
041628 -
041630 - ..
0417 -
0418 -
0419 - 1734
0420 -
042001 - Searching for....
042002 -
042003 - acetaminophen hdl
042005 - ..
042006 - Found...
042007 -
042008 - 1. Mayo Clinic
042009 - Mayo Medical Laboratories
042011 - ..
042012 - Test ID: HDCH
042013 -
042014 - Cholesterol, High-Density Lipoprotein (HDL), Serum
042015 -
042016 - https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8429
042017 -
042018 - No date listed.
042020 - ..
042021 - Cautions
042023 - ..
042024 - Result can be falsely decreased in patients with elevated
042025 - levels of N-acetyl-p-benzoquinone imine (NAPQI, a metabolite
042026 - of acetaminophen), N-acetylcysteine (NAC), and Metamizole.
042027 -
042028 - [On 180201 1842 received letter from Lauren explaining
042029 - sources report that taking acetaminophen causes blood tests
042030 - to falsley show HDL is lowered, but that it is actually
042031 - lowered. ref SDS 25 KO5H
042032 -
042034 - ..
042035 - 2. Cleveland HeartLab
042037 - ..
042038 - HDL Cholesterol, Direct
042039 -
042040 - FEBRUARY 11, 2013
042041 -
042042 - http://www.clevelandheartlab.com/tests/hdl-cholesterol-direct/
042043 -
042045 - ..
042046 - Limitations:
042048 - ..
042049 - Last sentence... "Acetaminophen use can falsely decrease test
042050 - results."
042051 -
042052 - [On 180201 1842 received letter from Lauren explaining
042053 - sources report that taking acetaminophen causes blood tests
042054 - to falsley show HDL is lowered, but that it is actually
042055 - lowered. ref SDS 25 KO5H
042056 -
042057 -
042059 - ..
0421 -
0422 -
0423 - 1751
0424 -
042401 - Sent letter to Lauren saying...
042402 -
042403 - 1. Subject: Acetaminophen Lowers HDL
042404 - Date: 2018-01-03 17:57
042408 - ..
042409 - 2. Lauren,
042411 - ..
042412 - 3. Per your request, please see sources on subject issue...
042413 -
042414 - 1. Mayo Clinic
042415 - Mayo Medical Laboratories
042417 - ..
042418 - Test ID: HDCH
042420 - ..
042421 - Cholesterol, High-Density Lipoprotein (HDL), Serum
042422 -
042423 - https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8429
042425 - ..
042426 - At the bottom of the page...
042428 - ..
042429 - Cautions
042431 - ..
042432 - Result can be falsely decreased in patients with elevated
042433 - levels of N-acetyl-p-benzoquinone imine (NAPQI, a metabolite
042434 - of acetaminophen), N-acetylcysteine (NAC), and Metamizole.
042435 -
042436 - [On 180201 1842 received letter from Lauren explaining
042437 - sources report that taking acetaminophen causes blood
042438 - tests to falsley show HDL is lowered, but that it is
042439 - actually lowered. ref SDS 25 KO5H
042441 - ..
042442 - [On 180202 1322 letter to Lauren concurs with her
042443 - analysis finding taking acetaminophen does not lower
042444 - HDLl, but does cause false lab reports on HDL, which can
042445 - be remedied by pausing acetaminophen a few days before a
042446 - lab. ref SDS 26 KO5H
042447 -
042449 - ..
042450 - 4. Another source...
042451 -
042452 - 2. Cleveland HeartLab
042454 - ..
042455 - HDL Cholesterol, Direct
042456 - FEBRUARY 11, 2013
042457 -
042458 - http://www.clevelandheartlab.com/tests/hdl-cholesterol-direct/
042460 - ..
042461 - At the bottom of the page...
042463 - ..
042464 - Limitations:
042466 - ..
042467 - Last sentence... "Acetaminophen use can falsely decrease test
042468 - results."
042470 - ..
042471 - 5. Thanks for assistance.
042472 -
042473 - [On 180108 1944 Lauren has not ordered liquid naproxen;
042474 - sent letter asking about progress placing the order with VA
042475 - Pharmacy. ref SDS 22 KO5H
042476 -
042477 - [On 180126 0948 Manita called today; she will submit letter
042478 - to remind Lauren about ordering liquid naproxen.
042479 - ref SDS 24 YU9J
042481 - ..
042482 - [On 180201 1842 received letter from Lauren explaining
042483 - sources report that taking acetaminophen causes blood tests
042484 - to falsley show HDL is lowered, but that it is actually
042485 - lowered. ref SDS 25 KO5H
042487 - ..
042488 - [On 180202 1322 letter to Lauren concurs with her analysis
042489 - finding taking acetaminophen does not lower HDLl, but does
042490 - cause false lab reports on HDL, which can be remedied by
042491 - pausing acetaminophen a few days before a lab. ref SDS 26
042492 - KO5H
042493 -
042494 -
042499 -
042500 -
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0426 -