CONTACTS 
0201 - Kaiser Permanente - Shadelands       925 906 2200
020101 - Walnut Creek, CA
020102 - Dr. Syed E. Naqvi, M.D.; Physician
020103 - Primary Care =925 206 2040
0202 - Kaiser Permanente - Shadelands       925 906 2200
020201 - Walnut Creek, CA
020202 - Ms. Jeanne Bradley; Coordinator =925 906 2200
020203 - Administration Department
0203 - Kaiser Permanente - Shadelands       925 906 2200
020301 - Walnut Creek
020302 - Ms. Nanette NLN; Nurse
020303 - Primary Care =925 206 2040

SUBJECTS
Annual Physical
Cholesterol
Physical Exam on 990628
Blood Tests

0606 -    ..
0607 - Summary/Objective
0608 -
060801 - Follow up ref SDS 15 0977.
060802 -
060803 - Got verbal report on test results from work on 990628.  Cholesterol
060804 - seems to be seriously high. ref SDS 0 7469  Kaiser is sending the
060805 - results and some comments on actions to improve the condition.  Need
060806 - to clarify results, then maybe do another test to verify.  Nanette was
060807 - very helpful confirming test results, and coordinating communication.
060808 - ref SDS 0 1734
060809 -
060810 - Sent ref DIT 1 to Syed linked to physical exam on 990628. ref SDS 15
060811 - 0977, and to this record confirming understandings, and requesting
060812 - follow up, including on the knee issue. ref SDS 0 7332
060813 -
060814 -    [On 990716 Nannette did not work that day, could not confirm if she
060815 -    was able to read the record. ref SDS 19 0001]
060816 -
060817 -    [On 990719 received report. ref SDS 21 5035]
060818 -
060819 -    [On 990719 received information on Synvisc knee therapy, which may
060820 -    relate to Kaiser's review. ref SDS 22 9894]
060821 -
060822 -    [On 990722 submitted follow up on knee issue. ref SDS 23 2646]
060823 -
060824 -
060825 -
0609 -
0610 -
0611 - Discussion
0612 -
061201 -  ..
061202 - Annual Physical Exam
061203 -
061204 - Follow up ref SDS 15 7855, ref SDS 14 4906.
061205 -
061206 - Tracy said he has the results of blood tests from work on 990628; she
061207 - asked if I have received them?
061208 -
061209 - I explained the results have not yet been received.
061210 -
061211 - Tracy advised that all of the results are good, except...
061212 -
061213 -     [On 990716 have not received tests. ref SDS 19 0001]
061214 -
061215 -     [On 990719 received report. ref SDS 21 5035]
061216 -
061217 -  ..
061218 - Cholesterol High - LDL 262
061219 -
061220 - Follow up ref SDS 15 3105, ref SDS 14 2061.
061221 -
061222 - Tracy advised that Kaiser's tests show...
061223 -
061224 -     Total cholesterol = 331
061225 -     HDL = 44
061226 -     LDL = 262
061227 -
061228 - Tracy advised HDL, which she explained is "good" cholesterol, is fine,
061229 -
061230 - For my age, LDL should be 160 - 190.
061231 -    ..
061232 -    Healthwise manual on page 261, says HDL removes excess
061233 -    cholesterol. ref OF 4 3760
061234 -
061235 -    Page 262 says...
061236 -
061237 -         Total cholesterol levels are categorrized as follows by the
061238 -         National Cholesterol Education Program:
061239 -
061240 -             •  Under 200 mg/dL: Desirable
061241 -
061242 -             •  200 - 239 mg/dL: Borderline high-
061243 -                risk
061244 -
061245 -             •  240 or higher: High-risk
061246 -
061247 -    ...as shown at ref OF 4 0608.
061248 -
061249 -    Healthwise does not seem to show different rates for HDL and LDL.
061250 -
061251 -    Generally, if Kaiser has found 331 level, this seems very serious
061252 -    relative to 240 being an indicator of high risk.
061253 -
061254 - We need to see the actual numbers, and get an opinion from Syed on
061255 - evaluating the results as called for in the Healthwise guidelines....
061256 - ref OF 3 1008 and ref OF 3 3465
061257 -
061258 -       [On 990719 received report. ref SDS 21 5035]
061259 -    ..
061260 -    On 940722 Dr. George Matula reported cholesterol a little
061261 -    high, that it could be a shor-term fluctuation, or a faulty test,
061262 -    and that it should be re-checked within 3 months. ref SDS 4 2409
061263 -
061264 -       [On 990719 sent letter asking about re-test. ref SDS 21 8585]
061265 -
061266 -       [On 990811 discussed retest with Syed. ref SDS 24 7933]
061267 - ..
061268 - Below, Nanette, a nurse or admin person in Syed's department,
061269 - confirmed the cholesterol test results. ref SDS 0 1734
061270 -
061271 -       She indicated that LDL levels can reach up to 800.
061272 -
061273 -       Nanette, further recalled seeing HDL levels in the 50s, but
061274 -       rarely in the 60s.  She said levels above 35, in my case 44, are
061275 -       good, and reduce the impact of high LDL, as set out in
061276 -       Healthwise, ref OF 4 3760
061277 - ..
061278 - Tracy advised today that Syed recommends working over the next 6
061279 - months toward reducing colesterol by increasing exercise, and changing
061280 - diet to eat less "fat."
061281 -
061282 - We reviewed Sylvia's research on fixing my knees, so exercise can be
061283 - increased, per meeting on 990625. ref SDS 14 4420
061284 -
061285 - Tracy said something about any particular food should not contain more
061286 - than about 33% of daily amount of total fat intake, and this can be
061287 - achieved by reading labels on food products.
061288 -
061289 - Tracy has a brochure Kaiser uses that shows guidelines on exercise and
061290 - diet, including fat intake levels.
061291 -
061292 - She wants to meet and review the guidelines, which she plans to
061293 - highlight showing applicable information.
061294 -
061295 -     This plan is cited in the letter to Syed. ref DIT 1 5456
061296 -
061297 -     [On 990719 Tracy submits diet guidance. ref SDS 21 9978]
061298 -
061299 - Tracy noted that...
061300 -
061301 -     •  hot dogs are a high fat food.
061302 -
061303 -     •  tuna packed in water is not high fat.
061304 -
061305 - Tracy advised that Syed has, or may, recommended medication to
061306 - supplement exercise and diet changes.
061307 -
061308 -    Healthwise on page 262 says diet lowers cholesterol for most
061309 -    people. ref OF 4 0260
061310 -
061311 -    Side effects of medication warrant caution using medication, e.g.,
061312 -    for people at the highest risk for heart disease. ref OF 4 1645
061313 -
061314 -     [On 990719 Tracy's letter offers medication. ref SDS 21 0988]
061315 - ..
061316 - Tracy will submit an email confirming our discussion this
061317 - morning, and will forward the brochure under separate cover, along
061318 - with the test results, discussed today.  This information will guide
061319 - our discussion for the meeting she wants.
061320 -
061321 -     Below, Nanette is coordinating with Tracy. ref SDS 0 7980
061322 -
061323 -     [On 990719 received report. ref SDS 21 5035]
061324 -
061325 - I asked if we can schedule the meeting at a convenient time for Tracy.
061326 -
061327 - Tracy wants to wait until after I review her letter.
061328 -
061329 -     [On 990716 have not received Tracy's letter. ref SDS 19 0001]
061330 -
061331 -
061332 -
0614 -

SUBJECTS
Prostrate Cancer Testing

0704 -
070401 -  ..
070402 - Prostate Examination
070403 -
070404 - Follow up ref SDS 15 1584, ref SDS 14 7885.
070405 -
070406 - Tracy said the results of the PSA test for prostate cancer show there
070407 - is no indication of cancer at this time, consistent with the
070408 - examination on 990628. ref SDS 15 1584
070409 -
070410 -
070411 -
0705 -

SUBJECTS
Knee Treatments

0804 -
080401 -  ..
080402 - Knee Treatment Review
080403 -
080404 - Follow up ref SDS 17 0001, ref SDS 16 9662.
080405 -
080406 - Tracy says above that Syed is recommending exercise. ref SDS 0 5074
080407 -
080408 - This increases the need to make progress on the knee problem.
080409 -
080410 - On 990708, Sylvia is waiting to complete research pending receipt of
080411 - medical history on this subject. ref SDS 18 6699  The history is set
080412 - out in the record on 990625, when Sylvia examined my knees. ref SDS 14
080413 - 5152
080414 -
080415 - The letter today, ref DIT 1, asks Syed to assist Sylvia in providing
080416 - the medical history to the orthopedist. ref DIT 1 7290
080417 -
080418 - It is understood that this initiative has a low liklihood of success
080419 - based on Sylvia's intial research, reported on 990701. ref SDS 16 9662
080420 -
080421 - We want to ensure conclusions are based on the complete record.
080422 -
080423 -    [On 990722 submitted follow up on knee issue. ref SDS 23 2646]
080424 -
080425 -    [On 990719 Synvisc knee treatment needs review. ref SDS 22 9894]
080426 -
080427 -
080428 -
080429 -
0805 -

SUBJECTS
Primary Care Physician
Questions, Suggestions

1005 - 1308
1006 -
100601 -  ..
100602 - Primary Care Physician, Communication
100603 -
100604 - Need email address for Syed.
100605 -
100606 - Called Jeanne.
100607 -
100608 - She did not answer. Another person asked me to call...
100609 -
100610 -                          925 906 2040
100611 -
100612 - ...this number was for making appointments, which is not the current
100613 - task.  We need an email address.
100614 -
100615 - Called back and got same woman.  She transferred me to Nanette.
100616 - ..
100617 - Nanette was very helpful.
100618 -
100619 - I explained background:  Syed became Primary Care Physician, and
100620 - performed an exam on 990628, which Tracy called about this morning,
100621 - per above. ref SDS 0 6392
100622 -
100623 - Nanette feels Syed might be able to coordinate the knee issue, per
100624 - above, ref SDS 0 7332, as suggested in my letter. ref DIT 1 7290
100625 -
100626 - She said Syed is out of the office until next Monday, 990719.
100627 -
100628 - She pulled my medical record and confirmed cholesterol readings,
100629 - entered above, ref SDS 0 7469, and offered some explanation that
100630 - aligns with the Healthwise Handbook. ref SDS 0 6440
100631 - ..
100632 - Nanette will coordinate with Tracy on issuing her letter.....
100633 - ref SDS 0 2240
100634 -
100635 - I will forward the letter for Syed to Jeanne for submission to Syed
100636 - when he returns on Monday.
100637 -
100638 - Nanette will notify Syed on Monday that I have submitted a letter for
100639 - him to Jeanne.
100640 -
100641 -    [On 990716 Nannette did not work that day, could not confirm if she
100642 -    was able to read the record. ref SDS 19 0001]
100643 -
100644 -
100645 -
1007 -