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Suggest Treatment For Breathlessness And Muscle Pain
Question: I was just in hospital for sob and muscle aches.
Hg is 6.8, lymphocytes is 23.4, ck was 247, ck-my was 7.62, mpv was 12.8, d-dimmer was .45. Protein in urine
Ct scan and stress test was negative
Still having sob for over one week.
Stated they ruled out heart attack, blood clots and lungs are clear.
Was on short term Prednisone for 10 days at decreasing amounts starting at 60 mg for a bad cold/ cough that was not stopping.
60 and female
Hg is 6.8, lymphocytes is 23.4, ck was 247, ck-my was 7.62, mpv was 12.8, d-dimmer was .45. Protein in urine
Ct scan and stress test was negative
Still having sob for over one week.
Stated they ruled out heart attack, blood clots and lungs are clear.
Was on short term Prednisone for 10 days at decreasing amounts starting at 60 mg for a bad cold/ cough that was not stopping.
60 and female
Brief Answer:
Need some more investigations
Detailed Answer:
Dear XXXX!
I welcome you here at my Virtual Clinic and I have thoroughly gone through your case and understand your health concerns.
I recommend you to discontinue Lipitor, as it also causes muscle aches and dyspnea (difficulty breathing).
It seems you have Some kind of myopathy (muscular system problem). your CK levels are high and its usually due to neuromuscular diseases and acute myocardial infarction. Neuromuscular disorders include myopathies, muscular dystrophy, rhabdomyolysis, drug-induced myopathies. But CK can also be elevated in the absence of neuromuscular diseases or cardiac injury ( as you said they ruled out heart attack, so its less likely) such as after:
*strenuous exercise
*intramuscular injection
*and with renal disease.
I need you to go for some blood work to help me better assist you:
*Thyroid Profile
*Liver function tests
*Renal function tests
*Ultrasound abdomen with spleen,Kidney,ureter, bladder,liver status
*Blood Iron studies
*last but not least XRay chest PA view (very important).
I also need answers of these questions regarding your case history:-
*Are you taking some other medications?
*History of recent weight loss?
*any change in stools color(bleeding haemorrhoids, or gastrointestinal bleed)?
*any history of bleeding wound?
*Urinary tract bleed, on urination?
Your Hb level is significantly down. I have to start you on multivitamin and Iron supplements (Over The Counter available) and diet modifications. Take multivitamin daily and 1 Iron pill with fresh orange juice. Salt restricted diet is prefered for you. use green leafy vegetables like spinach. Use plenty of fluids and fruits and high fiber diet.
I will wiat for response. Please feel free for any doubts/queries. I will be more than happy to ssist you anytime. You may "ask me a direct question" from my profile too.
Regards!
Your Physician
Dr. Hanif XXXXXXX PA, USA
Need some more investigations
Detailed Answer:
Dear XXXX!
I welcome you here at my Virtual Clinic and I have thoroughly gone through your case and understand your health concerns.
I recommend you to discontinue Lipitor, as it also causes muscle aches and dyspnea (difficulty breathing).
It seems you have Some kind of myopathy (muscular system problem). your CK levels are high and its usually due to neuromuscular diseases and acute myocardial infarction. Neuromuscular disorders include myopathies, muscular dystrophy, rhabdomyolysis, drug-induced myopathies. But CK can also be elevated in the absence of neuromuscular diseases or cardiac injury ( as you said they ruled out heart attack, so its less likely) such as after:
*strenuous exercise
*intramuscular injection
*and with renal disease.
I need you to go for some blood work to help me better assist you:
*Thyroid Profile
*Liver function tests
*Renal function tests
*Ultrasound abdomen with spleen,Kidney,ureter, bladder,liver status
*Blood Iron studies
*last but not least XRay chest PA view (very important).
I also need answers of these questions regarding your case history:-
*Are you taking some other medications?
*History of recent weight loss?
*any change in stools color(bleeding haemorrhoids, or gastrointestinal bleed)?
*any history of bleeding wound?
*Urinary tract bleed, on urination?
Your Hb level is significantly down. I have to start you on multivitamin and Iron supplements (Over The Counter available) and diet modifications. Take multivitamin daily and 1 Iron pill with fresh orange juice. Salt restricted diet is prefered for you. use green leafy vegetables like spinach. Use plenty of fluids and fruits and high fiber diet.
I will wiat for response. Please feel free for any doubts/queries. I will be more than happy to ssist you anytime. You may "ask me a direct question" from my profile too.
Regards!
Your Physician
Dr. Hanif XXXXXXX PA, USA
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
I did have a normal chest X-ray.
https://www.YYYY.org/YYYY/inside.0000
https://www.YYYY.org/YYYY/inside.0000
Brief Answer:
Start the treatment right away.
Detailed Answer:
Hi dear XXXX!
Welcome back and thanks for consulting me. I appreciate your cooperation. Being your physician, I assure you not to worry as I will take care of your health issues.
Its anemia, which is causing Shortness of breath and muscle weakness. Your heart and lungs are normal. 96% Oxygen saturation at pulse oximeter (doctor attached to your finger) shows good quality red cells and hemoglobin.
Your d-dimer value is a good news for you as it rules out deep venous thrombosis and thrombus (clots) formation in other sites of the body.
In this situation, I usually prescribe Fer-In-Sole (OTC ferrous sulfate) per oral 300mg 3 times a day. Take tablets of vitamin C along with ferrous sulfate. It enhances absorption. Taking Ferrous Sulfate on an empty stomach increases its absorption and efficacy of treatment. Better to take with a cup of orange juice. Take avocado, green leafy vegetables (spinach) and salads. Take plenty of fluids. You don't need any kind of physical activity restrictions.
Take Over The Counter Vitamin B-12 2000mcg, and take 1 tablet per oral daily.
Keep a look at your stool color to rule out any gastrointestinal bleeding that may be causing low hemoglobin levels.
After 2 weeks, please go for a Complete Blood Count and you may consult me again directly from my profile, to keep track of the progress, as hemoglobin should increase by 2mg/dl in 2weeks with aforementioned treatment. Direct questions reach directly to me in no time and I handle the case promptly.
May you get very well soon and have a wonderful time ahead. Please don't forget to give your valuable feedback and five star rating, so that I may be in a better position to help you in future too. Go to my profile to write a Review regarding your experience with me here at my virtual clinic.
Regards!
Your Physician
DR. HANIF
PHILADELPHIA-PA, USA
Start the treatment right away.
Detailed Answer:
Hi dear XXXX!
Welcome back and thanks for consulting me. I appreciate your cooperation. Being your physician, I assure you not to worry as I will take care of your health issues.
Its anemia, which is causing Shortness of breath and muscle weakness. Your heart and lungs are normal. 96% Oxygen saturation at pulse oximeter (doctor attached to your finger) shows good quality red cells and hemoglobin.
Your d-dimer value is a good news for you as it rules out deep venous thrombosis and thrombus (clots) formation in other sites of the body.
In this situation, I usually prescribe Fer-In-Sole (OTC ferrous sulfate) per oral 300mg 3 times a day. Take tablets of vitamin C along with ferrous sulfate. It enhances absorption. Taking Ferrous Sulfate on an empty stomach increases its absorption and efficacy of treatment. Better to take with a cup of orange juice. Take avocado, green leafy vegetables (spinach) and salads. Take plenty of fluids. You don't need any kind of physical activity restrictions.
Take Over The Counter Vitamin B-12 2000mcg, and take 1 tablet per oral daily.
Keep a look at your stool color to rule out any gastrointestinal bleeding that may be causing low hemoglobin levels.
After 2 weeks, please go for a Complete Blood Count and you may consult me again directly from my profile, to keep track of the progress, as hemoglobin should increase by 2mg/dl in 2weeks with aforementioned treatment. Direct questions reach directly to me in no time and I handle the case promptly.
May you get very well soon and have a wonderful time ahead. Please don't forget to give your valuable feedback and five star rating, so that I may be in a better position to help you in future too. Go to my profile to write a Review regarding your experience with me here at my virtual clinic.
Regards!
Your Physician
DR. HANIF
PHILADELPHIA-PA, USA
Above answer was peer-reviewed by :
Dr. Raju A.T
My hg is normal. The hg that was 6.8 was the hg for glucose which is also normal.
I am still short of breath and when I stand for about an hour or more, I get muscle back pain too. Moderate to severe.
The only abnormal finding is my ak level is elevated and my stomach is distended which is uncomfortable and maybe is from the Prednisone I was on. That is when it became distended and still is. And, of course, still sob.
I have no bleeding that I notice and no weight loss at all. Some weight gain after being on Prednisone a month ago.
I sent my records. Did you receive them? Were you able to open the link? I can copy and paste if you can't open link. The link was in the previous message.
I am still short of breath and when I stand for about an hour or more, I get muscle back pain too. Moderate to severe.
The only abnormal finding is my ak level is elevated and my stomach is distended which is uncomfortable and maybe is from the Prednisone I was on. That is when it became distended and still is. And, of course, still sob.
I have no bleeding that I notice and no weight loss at all. Some weight gain after being on Prednisone a month ago.
I sent my records. Did you receive them? Were you able to open the link? I can copy and paste if you can't open link. The link was in the previous message.
Brief Answer:
I am here to help you with all issues
Detailed Answer:
Welcome back dear XXXX!
I appreciate your cooperation for the best of your health.
Test value 6.8 you wrote as Hg. That was a misnomer. But no issues. It happens on Virtual Clinics sometimes. It was Glycated Haemoglobin (HbA1C) and I am happy for you on having normal blood sugar control over the past 4months.
Your CK 247 is high. Normal levels fall in 60-174 IU/L. Your High levels clearly indicate damage to CK rich tissues in body. Heart and brain is excluded by your doctor (as you explained in your main question). Now left is your skeletal muscles (we now need to rule out muscle damage that is going on in your body). You need to go for serial periodic CK Labs. If it decreases it means muscle damage is decreasing.
In my expert opinion, Proteins in urine might be due to the same reason i.e. skeletal muscle proteins damage, leads to those proteins in urine(myoglobinuria).
After standing for a while your muscle weakness is a clear indication of a disease of skeletal muscle damage.
Yes steroid use causes mild gastric discomfort.
Use of medications e.g statins, some endocrine disease e.g hypothyroidism also leads to high CK levels.
You need some labs to confirm:
Liver functuon tests
Complete blood count (CBC), including hemoglobin, hematocrit, and platelets
Serum chemistries, including blood urea nitrogen (BUN), creatinine, glucose, calcium, potassium, phosphate, uric acid, and liver function tests (LFTs)
Prothrombin time (PT)
Activated partial thromboplastin time (aPTT)
Take 1multivitamin daily especially rich in vit. E and C. Take low fat, high carbohydrate, high fiber and frequent meals. When backache, take hydrating glucose rich drink. Avoid strenuous exercise. Frequent rest is best for you. Avoid hot humid environment. Alcohol, and stimulants e.g Amphetamines are poisons for you.
Dear XXXXXXX No, I am unable to open the link because its your personal patient portal account that asks me login details. You may download and atrach the files directly.
If you need any future help, feel free to ask me a direct question from my profile.
Regards!
I am here to help you with all issues
Detailed Answer:
Welcome back dear XXXX!
I appreciate your cooperation for the best of your health.
Test value 6.8 you wrote as Hg. That was a misnomer. But no issues. It happens on Virtual Clinics sometimes. It was Glycated Haemoglobin (HbA1C) and I am happy for you on having normal blood sugar control over the past 4months.
Your CK 247 is high. Normal levels fall in 60-174 IU/L. Your High levels clearly indicate damage to CK rich tissues in body. Heart and brain is excluded by your doctor (as you explained in your main question). Now left is your skeletal muscles (we now need to rule out muscle damage that is going on in your body). You need to go for serial periodic CK Labs. If it decreases it means muscle damage is decreasing.
In my expert opinion, Proteins in urine might be due to the same reason i.e. skeletal muscle proteins damage, leads to those proteins in urine(myoglobinuria).
After standing for a while your muscle weakness is a clear indication of a disease of skeletal muscle damage.
Yes steroid use causes mild gastric discomfort.
Use of medications e.g statins, some endocrine disease e.g hypothyroidism also leads to high CK levels.
You need some labs to confirm:
Liver functuon tests
Complete blood count (CBC), including hemoglobin, hematocrit, and platelets
Serum chemistries, including blood urea nitrogen (BUN), creatinine, glucose, calcium, potassium, phosphate, uric acid, and liver function tests (LFTs)
Prothrombin time (PT)
Activated partial thromboplastin time (aPTT)
Take 1multivitamin daily especially rich in vit. E and C. Take low fat, high carbohydrate, high fiber and frequent meals. When backache, take hydrating glucose rich drink. Avoid strenuous exercise. Frequent rest is best for you. Avoid hot humid environment. Alcohol, and stimulants e.g Amphetamines are poisons for you.
Dear XXXXXXX No, I am unable to open the link because its your personal patient portal account that asks me login details. You may download and atrach the files directly.
If you need any future help, feel free to ask me a direct question from my profile.
Regards!
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
This is my history and summary. I have had another blood panel with some results back and I will send those too.
Wanted to let you know that I have been on Synthroid for years due to a benign small lump on Thyroid. Not Goiter. So, they want my levels to be low normal.
I also have slight asthma and that is why I am on Singular. This is not Asthma and I have never been wheezing.
With Menopause, I encountered some irregular heart beats and they put me on a beta blocker and it helped a lot.
The second blood panel came back normal so far but CK is still elevated.
About your hospitalization
You were admitted on:May 21, 2015 You last received care in the:NHMMC Medical Unit
You were discharged on:May 22, 2015 Unit phone number:704-384-6715
Why you were hospitalized
Chest pain, unspecified chest pain type
Problem List
Problem Entered Chronic
Migraine NOS/not Intrcbl 6/4/2009
More... Overview
Headache 6/4/2009
More... Overview
Asthma
Hypertension
Migraine
Depression
Hypothyroidism
More... Overview
PVC's (premature ventricular contractions) 2/5/2014
Abnormal glucose 12/3/2014
Shortness of breath 5/21/2015
Chest discomfort 5/21/2015
Elevated CK-MB level 5/21/2015
Hyperglycemia 5/21/2015
Muscle ache 5/22/2015
Treatment Team
Provider Service Role Primary office phone
Attending Provider
XXXXXXX F Locascio, MD Emergency Medicine Attending Provider 704-384-6550
XXXXXXX M Ghuneim, MD Emergency Medicine Attending Provider 704-377-2424
Asaad Elsayed XXXXXXX MD Internal Medicine Attending Provider 704-384-9740
Others who treated you
XXXXXXX XXXXXXX Velasco-Trujillo, MD Internal Medicine Consulting Physician 704-384-9740
XXXXXXX R XXXXXXX NP -- Nurse Practitioner 704-384-9740
Dixon R Dehority, MD Internal Medicine Consulting Physician 704-384-9740
Patient PCP Information
Provider PCP Type
XXXXXXX T Crawford, MD General
You are allergic to the following
Allergen Reactions
Augmentin Nausea And Vomiting
Hctz (Hydrochlorothiazide) Other
Leg cramps
Norvasc (Amlodipine) Swelling
Other
Leg pain
Immunizations Administered for This Admission
No immunizations on file.
Vital Signs
Blood Pressure Pulse Temperature Respirations Height Weight
153/82 86 97.9 °F (36.6 °C) (Oral) 18 5' 9" (1.753 m) 199 lb 12.8 oz (90.629 kg)
Body Mass Index Oxygen Saturation Smoking Status
29.49 kg/m2 94% Former Smoker
Procedures/Surgeries
Active Care Plan Problems
None
Medications
Based on the information you provided to us as well as any changes during this visit, the following is your updated medication list. Compare this with your prescription bottles at home. If you have any questions or concerns, contact your primary care physician's office.
Current Medications
As of 5/22/2015 3:23 PM
atenolol 25 mg tablet
Commonly known as:TENORMIN
take 1 tablet by mouth once daily
ibuprofen 800 mg tablet
Commonly known as:ADVIL,MOTRIN
Take 1 tablet (800 mg total) by mouth 2 (two) times a day as needed for Pain.
levothyroxine 112 mcg tablet
Commonly known as:SYNTHROID, LEVOTHROID
take 1 tablet by mouth once daily
lisinopril 20 mg tablet
Commonly known as:PRINIVIL,ZESTRIL
take 1 tablet by mouth once daily
montelukast 10 MG tablet
Commonly known as:SINGULAIR
take 1 tablet by mouth once daily
omeprazole 20 mg capsule
Commonly known as:PRILOSEC
Take 1 capsule (20 mg total) by mouth daily.
PROAIR HFA 108 (90 BASE) MCG/ACT inhaler
Generic drug:albuterol sulfate HFA
inhale 2 puffs by mouth every 4 hours if needed
ranitidine 300 MG tablet
Commonly known as:ZANTAC
Take 1 tablet (300 mg total) by mouth at bedtime.
SUMAtriptan 50 MG tablet
Commonly known as:IMITREX
TAKE 1 TABLET BY MOUTH AT ONSET OF MIGRAINE; MAY REPEAT ONCE IN 2 HOURS AS NEEDED
triamterene-hydrochlorothiazide 37.5-25 mg per tablet
Commonly known as:MAXZIDE-25
Take 1 tablet by mouth 3 (three) times a week. Tuesday/Thursday/Sunday
Instructions for after Discharge
Other Instructions
Discharge instructions
Follow-up with primary care physician
Continue holding Lipitor
Appointments which have been scheduled for you
Jun 29, 2015 10:45 AM
Consultation with XXXXXXX Mark Hendler, MD
Novant Health Pulmonary and Critical Care (Matthews) (--)
1450 Matthews Township Pky Ste 380
Matthews NC 28105-2389
704-384-9200
Please bring all current insurance documents. Bring list of current medications.
Tobacco Cessation
Quitting smoking reduces the chances of future health problems and reduces chances of life shortening illnesses. All tobacco products and second hand smoke should be avoided. Call 1-800-LUNG-USA for information on classes and materials available to help you quit smoking.
Acknowledgement of AVS Instructions
Discharge instructions have been reviewed with the patient/support person. The patient/support person has been provided a copy of the discharge instructions.
Instructions on MyChart Enrollment
MyChart Activation Letter:
Thank you for enrolling in MyChart. Please follow the instructions below to securely access your online medical record. MyChart allows you to send messages to your doctor, view your test results, renew your prescriptions, schedule appointments and more.
How Do I Sign Up?
1.In your Internet browser, go to http://www.mynovant.org.
2.Click on the “I have an activation code” link.
3.Enter your MyChart access code exactly as it appears below. You will not need to use this code after you have completed the sign-up process. If you do not sign up before the expiration date, you must request a new code.
MyChart access code: Not generated
Current MyChart Status: Active
4.Enter the last four digits of your Social Security number (xxxx) and date of birth (mm/dd/yyyy) as indicated, and click Next. You will be taken to the next sign-up page.
5.Create a MyChart ID. This will be your MyChart login ID and cannot be changed, so think of one that is secure and easy to remember.
6.Create a MyChart password. You can change your password at any time.
7.Enter your password reset question and answer, and click Next. This can be used at a later time if you forget your password.
8.Select your communication preference, and if you select email, enter your email address. You will receive an email notification when new information is available in MyChart.
9.Click Sign In. You are now able to view your medical record online. You may also download our MyChart XXXXXXX app by searching for “MyChart” in your app store to take advantage of these MyChart features -- all from the convenience of your phone!
Additional Information
If you have questions, please call 855-803-3742 to talk to our MyChart staff. Remember, MyChart is NOT to be used for urgent needs. For medical emergencies, dial 911.
Entry Date
5/21/2015
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
Sodium 141 136 - 146 mmol/L Final
Potassium 4.1 3.7 - 5.4 mmol/L Final
Chloride 106 97 - 108 mmol/L Final
Carbon Dioxide (CO2) 23 20 - 32 mmol/L Final
Anion Gap 12 7 - 16 mmol/L Final
Glucose 170 (H) 65 - 99 mg/dL Final
BUN 17 8 - 27 mg/dL Final
Creatinine 0.70 0.57 - 1.00 mg/dL Final
Calcium 9.3 8.6 - 10.2 mg/dL Final
Alkaline Phosphatase 122 25 - 165 IU/L Final
Total Bilirubin 0.26 0.00 - 1.20 mg/dL Final
Total Protein 7.2 6.0 - 8.5 gm/dL Final
Albumin, Serum 4.2 3.6 - 4.8 gm/dL Final
Globulin 3.0 1.5 - 4.5 gm/dL Final
Albumin/Globulin Ratio 1.4 1.1 - 2.5 Final
BUN/Creatinine Ratio 24.3 11.0 - 26.0 Final
ALT (SGPT) 23 0 - 40 IU/L Final
AST 22 0 - 40 IU/L Final
GFR-African XXXXXXX >60 mL/min/1.73m2 Final
Comment:
African-American:
Normal GFR (glomerular filtration rate) > 60 mL/min/1.73 meters squared.
< 60 may include impaired kidney function based on creatinine, age, gender,
and race normalized to accepted average body surface area
GFR Non-African XXXXXXX >60 mL/min/1.73m2 Final
Comment:
Non XXXXXXX American:
Normal GFR (glomerular filtration rate) > 60 mL/min/1.73 meters squared.
< 60 may include impaired kidney function based on creatinine, age, gender,
and race normalized to accepted average body surface area.
Entry Date
5/22/2015
Result Narrative
Ventricular Rate 73
Atrial Rate 73
P-R Interval 150
QRS Duration 92
Q-T Interval 412
QTC Calculation(Bezet) 453
Calculated P Axis 42
Calculated R Axis 34
Calculated T Axis 44
Diagnosis Normal sinus rhythm
Possible Lateral infarct , age undetermined
Abnormal ECG
No previous ECGs available
LOCASCIO, XXXXXXX (1378) on 5/21/2015 3:53:50 PM certifies that he/she has
reviewed the ECG tracing and confirms the independent interpretation is
correct.
Also confirmed by LOCASCIO, XXXXXXX (1378), editor NICKEL, XXXXXXX (11) on
5/22/2015 1:06:43 PM
Entry Date
5/21/2015
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
Troponin T <0.010 <=0.009 ng/mL Final
Comment:
A Cardiac Troponin T level of 0.010 ng/mL or greater
indicates myocardial damage. Elevated troponin may
also be due to pulmonary emboli, aortic dissection, heart
failure, renal failure, inflammation , trauma, toxins, etc.,
and ischemia in the setting of critical illness.
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
Magnesium 1.80 1.60 - 2.60 mg/dL Final
Entry Date
5/21/2015
Result Narrative
SINGLE CHEST RADIOGRAPH:
ADDITIONAL CLINICAL INFORMATION: Chest pain
COMPARISON: Prior study April 15, 2015.
FINDINGS:
The cardiac silhouette is unremarkable.
Pulmonary vasculature is normal.
There is no evidence of pneumothorax or pleural effusion.
The lungs are clear without evidence of focal consolidation.
The osseous structures are age-appropriate without acute abnormality.
Result Impression
IMPRESSION:
No evidence of active pulmonary disease.
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
CK 247 (H) 24 - 173 IU/L Final
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
CK-MB 7.62 (H) .00 - 5.34 ng/mL Final
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
WBC 6.7 3.7 - 11.0 thou/mcL Final
RBC 4.49 4.01 - 4.90 million/mcL Final
Hemoglobin 13.3 12.2 - 14.9 gm/dL Final
Hematocrit 39.2 35.8 - 47.9 % Final
MCV 87 82 - 98 fL Final
MCH 29.6 27.0 - 33.0 pg Final
MCHC 33.9 31.0 - 37.0 gm/dL Final
Platelet Count 197 150 - 400 thou/mcL Final
RDW Standard Deviation 41.3 38.1 - 49.1 fL Final
RDW Coefficient of Variation 13.4 11.8 - 14.9 % Final
MPV 12.8 (H) 8.9 - 11.2 fL Final
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
Neutrophils % 64.4 50.0 - 70.0 % Final
Lymphocytes, % 23.4 (L) 25.0 - 40.0 % Final
Monocytes % 7.0 4.0 - 12.0 % Final
Eosinophils % 4.5 1.0 - 6.0 % Final
Basophils % 0.7 0.0 - 2.0 % Final
Neutrophils Absolute 4.3 1.5 - 7.5 thou/mcL Final
Lymphocytes Absolute 1.6 1.0 - 4.5 thou/mcL Final
Monocytes Absolute 0.5 0.1 - 0.8 thou/mcL Final
Eos (Absolute Value) 0.3 0.0 - 0.5 thou/mcL Final
Basophils Absolute 0.0 0.0 - 0.2 thou/mcL Final
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
D-Dimer, Quant .45 (H) <=.42 ug/mL(FEU) Final
Comment:
Cutoff for Exclusion of DVT and PE <= 0.42 ug/ml (FEU)
Entry Date
5/21/2015
Result Narrative
PULMONARY CT ANGIOGRAM WITH INTRAVENOUS CONTRAST:
TECHNIQUE: Axially acquired CT images of the chest after injection of 75 mL of IOPAMIDOL 76 % IV SOLN contrast in the arterial phase. Oblique coronal maximum intensity projection (MIP) 3D images were obtained interpreted and archived.
ADDITIONAL CLINICAL INFORMATION: None available
COMPARISON: None available
INTERPRETATION:
CHEST:
There is no evidence of segmental or subsegmental pulmonary embolus. There is no evidence of dissection or aneurysm.
There is no evidence of mediastinal lymphadenopathy. The heart is within normal limits.
Lungs are well expanded without evidence of interstitial disease or consolidation. There is no evidence of pneumothorax or pleural effusion.
Bony thorax is age appropriate and soft tissues are unremarkable.
Result Impression
IMPRESSION:
Negative CT pulmonary angiogram
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
Hemoglobin A1C 6.8 (H) 4.8 - 5.6 % Final
Comment:
Reference Interval: 4.8 - 5.6%
Increased Risk for Diabetes: 5.7 - 6.4%
Diabetes: >=6.5%
Glycemic Control for Adults
with Diabetes: <7.0%
Entry Date
5/21/2015
Entry Date
5/22/2015
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
Troponin T <0.010 <=0.009 ng/mL Final
Comment:
A Cardiac Troponin T level of 0.010 ng/mL or greater
indicates myocardial damage. Elevated troponin may
also be due to pulmonary emboli, aortic dissection, heart
failure, renal failure, inflammation , trauma, toxins, etc.,
and ischemia in the setting of critical illness.
Entry Date
5/22/2015
Component Results
Component Value Flag Ref Range Units Status
Troponin T <0.010 <=0.009 ng/mL Final
Comment:
A Cardiac Troponin T level of 0.010 ng/mL or greater
indicates myocardial damage. Elevated troponin may
also be due to pulmonary emboli, aortic dissection, heart
failure, renal failure, inflammation , trauma, toxins, etc.,
and ischemia in the setting of critical illness.
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
TSH 0.23 (L) 0.45 - 4.50 mcIU/mL Final
Entry Date
5/22/2015
Component Results
Component Value Flag Ref Range Units Status
Cholesterol, Total 172 100 - 199 mg/dL Final
Triglycerides 444 (H) 0 - 149 mg/dL Final
HDL 30 (L) >=39 mg/dL Final
HDL AR >1.94 Final
LDL Cholesterol NA Final
Comment:
It is not recommended to calculate LDL Cholesterol
of samples with Triglyceride values exceeding
400 mg/dl.
Cholesterol/HDL Fasting 6 Final
Ratio Risk 2.0 Final
Entry Date
5/22/2015
Component Results
Component Value Flag Ref Range Units Status
Sodium 141 136 - 146 mmol/L Final
Potassium 3.7 3.7 - 5.4 mmol/L Final
Chloride 104 97 - 108 mmol/L Final
Carbon Dioxide (CO2) 23 20 - 32 mmol/L Final
Anion Gap 14 7 - 16 mmol/L Final
Glucose 136 (H) 65 - 99 mg/dL Final
BUN 17 8 - 27 mg/dL Final
Creatinine 0.81 0.57 - 1.00 mg/dL Final
Calcium 9.1 8.6 - 10.2 mg/dL Final
BUN/Creatinine Ratio 21.0 11.0 - 26.0 Final
GFR-African XXXXXXX >60 mL/min/1.73m2 Final
Comment:
African-American:
Normal GFR (glomerular filtration rate) > 60 mL/min/1.73 meters squared.
< 60 may include impaired kidney function based on creatinine, age, gender,
and race normalized to accepted average body surface area
GFR Non-African XXXXXXX >60 mL/min/1.73m2 Final
Comment:
Non XXXXXXX American:
Normal GFR (glomerular filtration rate) > 60 mL/min/1.73 meters squared.
< 60 may include impaired kidney function based on creatinine, age, gender,
and race normalized to accepted average body surface area.
Entry Date
5/22/2015
Component Results
Component Value Flag Ref Range Units Status
Magnesium 2.00 1.60 - 2.60 mg/dL Final
Entry Date
Entry Date
5/22/2015
Result Narrative
Pharmacological stress report:
CLINICAL HISTORY:
chest pain
RESULTS:
The patient was infused with Lexiscan using a standard pharmacologic protocol. With pharmacologic infusion heart rate and blood pressure were stable. Resting electrocardiogram showed normal. With pharmacologic infusion, .unchanged CONCLUSION:
1. Nondiagnostic ECG response to pharmacologic stress.
XXXXXXX Younce
Novant health Heart and Vascular Institute.
1401 Matthews Township Pkwy.
Suite 110
Matthews, NC 28105
Phone: 704 264 3500
Fax: 704 264 1395
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
Urine-color Yellow Yellow Final
Urine Appearance Clear Clear Final
Specific Gravity, Urine >1.050 (H) 1.001 - 1.035 Final
pH, Urine 5.5 5.0 - 9.0 Final
Protein, UA 10 (A) Negative mg/dL Final
UA Gluc Negative Negative mg/dL Final
Ketones, UA Negative Negative mg/dL Final
Bilirubin Urine Negative Negative mg/dL Final
Blood, UA Negative Negative mg/dL Final
Nitrite, Urine Negative Negative Final
WBC, UA 1 0 - 4 /HPF Final
Leukocytes, UA Large (A) Negative wbc Final
Urobilinogen, UA <2.0 <2.0 mg/dL Final
RBC, UA 2 (H) <=0 /HPF Final
Squam Epithel, UA 5 (H) 0 - 2 /HPF Final
Urine Mucous Few (A) None /HPF Final
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
CK 205 (H) 24 - 173 IU/L Final
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
CK-MB 6.58 (H) .00 - 5.34 ng/mL Final
Entry Date
Entry Date
5/23/2015
Component Results
Component
Final Report
50,000 cfu/ml Mixed gram positive flora
No susceptibility performed.
Culture Status (Abnormal)
POS
Entry Date
5/22/2015
Component Results
Component Value Flag Ref Range Units Status
CK 194 (H) 24 - 173 IU/L Final
Entry Date
5/22/2015
Component Results
Component Value Flag Ref Range Units Status
CK-MB 5.95 (H) .00 - 5.34 ng/mL Final
Entry Date
5/22/2015
Component Results
Component Value Flag Ref Range Units Status
Glucose, POC 129 (H) 70 - 99 mg/dL Final
Entry Date
5/22/2015
Result Narrative
INDICATIONS: Chest pain shortness of breath.
RADIOPHARMACEUTICAL: 6 mCi of Tc-99m Cardiolite at rest.
30 mCi of Tc-99m Cardiolite at peak stress.
Lexiscan 0.4 mg was administered intravenously over about 10 seconds, with Cardiolite injected 15 seconds later.
PERFUSION: There is normal distribution of activity throughout the left ventricular myocardium both at rest and following stress.
WALL MOTION AND THICKENING: Normal wall motion and thickening is seen throughout the left ventricular myocardium.
RESTING LEFT VENTRICULAR EJECTION FRACTION: Greater than 65%.
Result Impression
IMPRESSION:
1. NORMAL.
2. MPI RISK ASSESSMENT: LOW (JACC 2009;53(6):530-553)
here is one set of blood work I just had done.
The doctor has ordered a Pulmonary consult.
What do I still need to do? Has the liver blood work been done? Is that included in what I had done?
Thanks.
Component
Standard Range
Your Value
WBC 4.5 - 11.0 x 10^3/uL 6.1
Lymphocytes, % 25.0 - 40.0 % 24.5
% MONO 4.0 - 12.0 % 10.0
% GRAN 50.0 - 73.0 % 65.5
Lymphocytes Absolute 1.0 - 4.5 x 10^3/uL 1.5
Monocytes Absolute 0.1 - 1.0 x 10^3/uL 0.6
Grans Absolute 1.5 - 7.5 x 10^3/uL 4.0
RBC 4.00 - 5.20 x 10^3/uL 4.33
Hemoglobin 12.0 - 15.0 g/dL 12.7
Hematocrit 35.8 - 47.9 % 38.2
MCV 82.0 - 98.0 fL 88.2
MCH 26.0 - 34.0 pg 29.4
MCHC 31.0 - 37.0 g/dL 33.3
RDW 11.7 - 16.5 % 13.8
Platelet Count 150 - 400 x 10^3/uL 158
MPV 7.1 - 10.5 fL 9.8
General Information
Wanted to let you know that I have been on Synthroid for years due to a benign small lump on Thyroid. Not Goiter. So, they want my levels to be low normal.
I also have slight asthma and that is why I am on Singular. This is not Asthma and I have never been wheezing.
With Menopause, I encountered some irregular heart beats and they put me on a beta blocker and it helped a lot.
The second blood panel came back normal so far but CK is still elevated.
About your hospitalization
You were admitted on:May 21, 2015 You last received care in the:NHMMC Medical Unit
You were discharged on:May 22, 2015 Unit phone number:704-384-6715
Why you were hospitalized
Chest pain, unspecified chest pain type
Problem List
Problem Entered Chronic
Migraine NOS/not Intrcbl 6/4/2009
More... Overview
Headache 6/4/2009
More... Overview
Asthma
Hypertension
Migraine
Depression
Hypothyroidism
More... Overview
PVC's (premature ventricular contractions) 2/5/2014
Abnormal glucose 12/3/2014
Shortness of breath 5/21/2015
Chest discomfort 5/21/2015
Elevated CK-MB level 5/21/2015
Hyperglycemia 5/21/2015
Muscle ache 5/22/2015
Treatment Team
Provider Service Role Primary office phone
Attending Provider
XXXXXXX F Locascio, MD Emergency Medicine Attending Provider 704-384-6550
XXXXXXX M Ghuneim, MD Emergency Medicine Attending Provider 704-377-2424
Asaad Elsayed XXXXXXX MD Internal Medicine Attending Provider 704-384-9740
Others who treated you
XXXXXXX XXXXXXX Velasco-Trujillo, MD Internal Medicine Consulting Physician 704-384-9740
XXXXXXX R XXXXXXX NP -- Nurse Practitioner 704-384-9740
Dixon R Dehority, MD Internal Medicine Consulting Physician 704-384-9740
Patient PCP Information
Provider PCP Type
XXXXXXX T Crawford, MD General
You are allergic to the following
Allergen Reactions
Augmentin Nausea And Vomiting
Hctz (Hydrochlorothiazide) Other
Leg cramps
Norvasc (Amlodipine) Swelling
Other
Leg pain
Immunizations Administered for This Admission
No immunizations on file.
Vital Signs
Blood Pressure Pulse Temperature Respirations Height Weight
153/82 86 97.9 °F (36.6 °C) (Oral) 18 5' 9" (1.753 m) 199 lb 12.8 oz (90.629 kg)
Body Mass Index Oxygen Saturation Smoking Status
29.49 kg/m2 94% Former Smoker
Procedures/Surgeries
Active Care Plan Problems
None
Medications
Based on the information you provided to us as well as any changes during this visit, the following is your updated medication list. Compare this with your prescription bottles at home. If you have any questions or concerns, contact your primary care physician's office.
Current Medications
As of 5/22/2015 3:23 PM
atenolol 25 mg tablet
Commonly known as:TENORMIN
take 1 tablet by mouth once daily
ibuprofen 800 mg tablet
Commonly known as:ADVIL,MOTRIN
Take 1 tablet (800 mg total) by mouth 2 (two) times a day as needed for Pain.
levothyroxine 112 mcg tablet
Commonly known as:SYNTHROID, LEVOTHROID
take 1 tablet by mouth once daily
lisinopril 20 mg tablet
Commonly known as:PRINIVIL,ZESTRIL
take 1 tablet by mouth once daily
montelukast 10 MG tablet
Commonly known as:SINGULAIR
take 1 tablet by mouth once daily
omeprazole 20 mg capsule
Commonly known as:PRILOSEC
Take 1 capsule (20 mg total) by mouth daily.
PROAIR HFA 108 (90 BASE) MCG/ACT inhaler
Generic drug:albuterol sulfate HFA
inhale 2 puffs by mouth every 4 hours if needed
ranitidine 300 MG tablet
Commonly known as:ZANTAC
Take 1 tablet (300 mg total) by mouth at bedtime.
SUMAtriptan 50 MG tablet
Commonly known as:IMITREX
TAKE 1 TABLET BY MOUTH AT ONSET OF MIGRAINE; MAY REPEAT ONCE IN 2 HOURS AS NEEDED
triamterene-hydrochlorothiazide 37.5-25 mg per tablet
Commonly known as:MAXZIDE-25
Take 1 tablet by mouth 3 (three) times a week. Tuesday/Thursday/Sunday
Instructions for after Discharge
Other Instructions
Discharge instructions
Follow-up with primary care physician
Continue holding Lipitor
Appointments which have been scheduled for you
Jun 29, 2015 10:45 AM
Consultation with XXXXXXX Mark Hendler, MD
Novant Health Pulmonary and Critical Care (Matthews) (--)
1450 Matthews Township Pky Ste 380
Matthews NC 28105-2389
704-384-9200
Please bring all current insurance documents. Bring list of current medications.
Tobacco Cessation
Quitting smoking reduces the chances of future health problems and reduces chances of life shortening illnesses. All tobacco products and second hand smoke should be avoided. Call 1-800-LUNG-USA for information on classes and materials available to help you quit smoking.
Acknowledgement of AVS Instructions
Discharge instructions have been reviewed with the patient/support person. The patient/support person has been provided a copy of the discharge instructions.
Instructions on MyChart Enrollment
MyChart Activation Letter:
Thank you for enrolling in MyChart. Please follow the instructions below to securely access your online medical record. MyChart allows you to send messages to your doctor, view your test results, renew your prescriptions, schedule appointments and more.
How Do I Sign Up?
1.In your Internet browser, go to http://www.mynovant.org.
2.Click on the “I have an activation code” link.
3.Enter your MyChart access code exactly as it appears below. You will not need to use this code after you have completed the sign-up process. If you do not sign up before the expiration date, you must request a new code.
MyChart access code: Not generated
Current MyChart Status: Active
4.Enter the last four digits of your Social Security number (xxxx) and date of birth (mm/dd/yyyy) as indicated, and click Next. You will be taken to the next sign-up page.
5.Create a MyChart ID. This will be your MyChart login ID and cannot be changed, so think of one that is secure and easy to remember.
6.Create a MyChart password. You can change your password at any time.
7.Enter your password reset question and answer, and click Next. This can be used at a later time if you forget your password.
8.Select your communication preference, and if you select email, enter your email address. You will receive an email notification when new information is available in MyChart.
9.Click Sign In. You are now able to view your medical record online. You may also download our MyChart XXXXXXX app by searching for “MyChart” in your app store to take advantage of these MyChart features -- all from the convenience of your phone!
Additional Information
If you have questions, please call 855-803-3742 to talk to our MyChart staff. Remember, MyChart is NOT to be used for urgent needs. For medical emergencies, dial 911.
Entry Date
5/21/2015
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
Sodium 141 136 - 146 mmol/L Final
Potassium 4.1 3.7 - 5.4 mmol/L Final
Chloride 106 97 - 108 mmol/L Final
Carbon Dioxide (CO2) 23 20 - 32 mmol/L Final
Anion Gap 12 7 - 16 mmol/L Final
Glucose 170 (H) 65 - 99 mg/dL Final
BUN 17 8 - 27 mg/dL Final
Creatinine 0.70 0.57 - 1.00 mg/dL Final
Calcium 9.3 8.6 - 10.2 mg/dL Final
Alkaline Phosphatase 122 25 - 165 IU/L Final
Total Bilirubin 0.26 0.00 - 1.20 mg/dL Final
Total Protein 7.2 6.0 - 8.5 gm/dL Final
Albumin, Serum 4.2 3.6 - 4.8 gm/dL Final
Globulin 3.0 1.5 - 4.5 gm/dL Final
Albumin/Globulin Ratio 1.4 1.1 - 2.5 Final
BUN/Creatinine Ratio 24.3 11.0 - 26.0 Final
ALT (SGPT) 23 0 - 40 IU/L Final
AST 22 0 - 40 IU/L Final
GFR-African XXXXXXX >60 mL/min/1.73m2 Final
Comment:
African-American:
Normal GFR (glomerular filtration rate) > 60 mL/min/1.73 meters squared.
< 60 may include impaired kidney function based on creatinine, age, gender,
and race normalized to accepted average body surface area
GFR Non-African XXXXXXX >60 mL/min/1.73m2 Final
Comment:
Non XXXXXXX American:
Normal GFR (glomerular filtration rate) > 60 mL/min/1.73 meters squared.
< 60 may include impaired kidney function based on creatinine, age, gender,
and race normalized to accepted average body surface area.
Entry Date
5/22/2015
Result Narrative
Ventricular Rate 73
Atrial Rate 73
P-R Interval 150
QRS Duration 92
Q-T Interval 412
QTC Calculation(Bezet) 453
Calculated P Axis 42
Calculated R Axis 34
Calculated T Axis 44
Diagnosis Normal sinus rhythm
Possible Lateral infarct , age undetermined
Abnormal ECG
No previous ECGs available
LOCASCIO, XXXXXXX (1378) on 5/21/2015 3:53:50 PM certifies that he/she has
reviewed the ECG tracing and confirms the independent interpretation is
correct.
Also confirmed by LOCASCIO, XXXXXXX (1378), editor NICKEL, XXXXXXX (11) on
5/22/2015 1:06:43 PM
Entry Date
5/21/2015
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
Troponin T <0.010 <=0.009 ng/mL Final
Comment:
A Cardiac Troponin T level of 0.010 ng/mL or greater
indicates myocardial damage. Elevated troponin may
also be due to pulmonary emboli, aortic dissection, heart
failure, renal failure, inflammation , trauma, toxins, etc.,
and ischemia in the setting of critical illness.
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
Magnesium 1.80 1.60 - 2.60 mg/dL Final
Entry Date
5/21/2015
Result Narrative
SINGLE CHEST RADIOGRAPH:
ADDITIONAL CLINICAL INFORMATION: Chest pain
COMPARISON: Prior study April 15, 2015.
FINDINGS:
The cardiac silhouette is unremarkable.
Pulmonary vasculature is normal.
There is no evidence of pneumothorax or pleural effusion.
The lungs are clear without evidence of focal consolidation.
The osseous structures are age-appropriate without acute abnormality.
Result Impression
IMPRESSION:
No evidence of active pulmonary disease.
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
CK 247 (H) 24 - 173 IU/L Final
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
CK-MB 7.62 (H) .00 - 5.34 ng/mL Final
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
WBC 6.7 3.7 - 11.0 thou/mcL Final
RBC 4.49 4.01 - 4.90 million/mcL Final
Hemoglobin 13.3 12.2 - 14.9 gm/dL Final
Hematocrit 39.2 35.8 - 47.9 % Final
MCV 87 82 - 98 fL Final
MCH 29.6 27.0 - 33.0 pg Final
MCHC 33.9 31.0 - 37.0 gm/dL Final
Platelet Count 197 150 - 400 thou/mcL Final
RDW Standard Deviation 41.3 38.1 - 49.1 fL Final
RDW Coefficient of Variation 13.4 11.8 - 14.9 % Final
MPV 12.8 (H) 8.9 - 11.2 fL Final
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
Neutrophils % 64.4 50.0 - 70.0 % Final
Lymphocytes, % 23.4 (L) 25.0 - 40.0 % Final
Monocytes % 7.0 4.0 - 12.0 % Final
Eosinophils % 4.5 1.0 - 6.0 % Final
Basophils % 0.7 0.0 - 2.0 % Final
Neutrophils Absolute 4.3 1.5 - 7.5 thou/mcL Final
Lymphocytes Absolute 1.6 1.0 - 4.5 thou/mcL Final
Monocytes Absolute 0.5 0.1 - 0.8 thou/mcL Final
Eos (Absolute Value) 0.3 0.0 - 0.5 thou/mcL Final
Basophils Absolute 0.0 0.0 - 0.2 thou/mcL Final
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
D-Dimer, Quant .45 (H) <=.42 ug/mL(FEU) Final
Comment:
Cutoff for Exclusion of DVT and PE <= 0.42 ug/ml (FEU)
Entry Date
5/21/2015
Result Narrative
PULMONARY CT ANGIOGRAM WITH INTRAVENOUS CONTRAST:
TECHNIQUE: Axially acquired CT images of the chest after injection of 75 mL of IOPAMIDOL 76 % IV SOLN contrast in the arterial phase. Oblique coronal maximum intensity projection (MIP) 3D images were obtained interpreted and archived.
ADDITIONAL CLINICAL INFORMATION: None available
COMPARISON: None available
INTERPRETATION:
CHEST:
There is no evidence of segmental or subsegmental pulmonary embolus. There is no evidence of dissection or aneurysm.
There is no evidence of mediastinal lymphadenopathy. The heart is within normal limits.
Lungs are well expanded without evidence of interstitial disease or consolidation. There is no evidence of pneumothorax or pleural effusion.
Bony thorax is age appropriate and soft tissues are unremarkable.
Result Impression
IMPRESSION:
Negative CT pulmonary angiogram
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
Hemoglobin A1C 6.8 (H) 4.8 - 5.6 % Final
Comment:
Reference Interval: 4.8 - 5.6%
Increased Risk for Diabetes: 5.7 - 6.4%
Diabetes: >=6.5%
Glycemic Control for Adults
with Diabetes: <7.0%
Entry Date
5/21/2015
Entry Date
5/22/2015
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
Troponin T <0.010 <=0.009 ng/mL Final
Comment:
A Cardiac Troponin T level of 0.010 ng/mL or greater
indicates myocardial damage. Elevated troponin may
also be due to pulmonary emboli, aortic dissection, heart
failure, renal failure, inflammation , trauma, toxins, etc.,
and ischemia in the setting of critical illness.
Entry Date
5/22/2015
Component Results
Component Value Flag Ref Range Units Status
Troponin T <0.010 <=0.009 ng/mL Final
Comment:
A Cardiac Troponin T level of 0.010 ng/mL or greater
indicates myocardial damage. Elevated troponin may
also be due to pulmonary emboli, aortic dissection, heart
failure, renal failure, inflammation , trauma, toxins, etc.,
and ischemia in the setting of critical illness.
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
TSH 0.23 (L) 0.45 - 4.50 mcIU/mL Final
Entry Date
5/22/2015
Component Results
Component Value Flag Ref Range Units Status
Cholesterol, Total 172 100 - 199 mg/dL Final
Triglycerides 444 (H) 0 - 149 mg/dL Final
HDL 30 (L) >=39 mg/dL Final
HDL AR >1.94 Final
LDL Cholesterol NA Final
Comment:
It is not recommended to calculate LDL Cholesterol
of samples with Triglyceride values exceeding
400 mg/dl.
Cholesterol/HDL Fasting 6 Final
Ratio Risk 2.0 Final
Entry Date
5/22/2015
Component Results
Component Value Flag Ref Range Units Status
Sodium 141 136 - 146 mmol/L Final
Potassium 3.7 3.7 - 5.4 mmol/L Final
Chloride 104 97 - 108 mmol/L Final
Carbon Dioxide (CO2) 23 20 - 32 mmol/L Final
Anion Gap 14 7 - 16 mmol/L Final
Glucose 136 (H) 65 - 99 mg/dL Final
BUN 17 8 - 27 mg/dL Final
Creatinine 0.81 0.57 - 1.00 mg/dL Final
Calcium 9.1 8.6 - 10.2 mg/dL Final
BUN/Creatinine Ratio 21.0 11.0 - 26.0 Final
GFR-African XXXXXXX >60 mL/min/1.73m2 Final
Comment:
African-American:
Normal GFR (glomerular filtration rate) > 60 mL/min/1.73 meters squared.
< 60 may include impaired kidney function based on creatinine, age, gender,
and race normalized to accepted average body surface area
GFR Non-African XXXXXXX >60 mL/min/1.73m2 Final
Comment:
Non XXXXXXX American:
Normal GFR (glomerular filtration rate) > 60 mL/min/1.73 meters squared.
< 60 may include impaired kidney function based on creatinine, age, gender,
and race normalized to accepted average body surface area.
Entry Date
5/22/2015
Component Results
Component Value Flag Ref Range Units Status
Magnesium 2.00 1.60 - 2.60 mg/dL Final
Entry Date
Entry Date
5/22/2015
Result Narrative
Pharmacological stress report:
CLINICAL HISTORY:
chest pain
RESULTS:
The patient was infused with Lexiscan using a standard pharmacologic protocol. With pharmacologic infusion heart rate and blood pressure were stable. Resting electrocardiogram showed normal. With pharmacologic infusion, .unchanged CONCLUSION:
1. Nondiagnostic ECG response to pharmacologic stress.
XXXXXXX Younce
Novant health Heart and Vascular Institute.
1401 Matthews Township Pkwy.
Suite 110
Matthews, NC 28105
Phone: 704 264 3500
Fax: 704 264 1395
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
Urine-color Yellow Yellow Final
Urine Appearance Clear Clear Final
Specific Gravity, Urine >1.050 (H) 1.001 - 1.035 Final
pH, Urine 5.5 5.0 - 9.0 Final
Protein, UA 10 (A) Negative mg/dL Final
UA Gluc Negative Negative mg/dL Final
Ketones, UA Negative Negative mg/dL Final
Bilirubin Urine Negative Negative mg/dL Final
Blood, UA Negative Negative mg/dL Final
Nitrite, Urine Negative Negative Final
WBC, UA 1 0 - 4 /HPF Final
Leukocytes, UA Large (A) Negative wbc Final
Urobilinogen, UA <2.0 <2.0 mg/dL Final
RBC, UA 2 (H) <=0 /HPF Final
Squam Epithel, UA 5 (H) 0 - 2 /HPF Final
Urine Mucous Few (A) None /HPF Final
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
CK 205 (H) 24 - 173 IU/L Final
Entry Date
5/21/2015
Component Results
Component Value Flag Ref Range Units Status
CK-MB 6.58 (H) .00 - 5.34 ng/mL Final
Entry Date
Entry Date
5/23/2015
Component Results
Component
Final Report
50,000 cfu/ml Mixed gram positive flora
No susceptibility performed.
Culture Status (Abnormal)
POS
Entry Date
5/22/2015
Component Results
Component Value Flag Ref Range Units Status
CK 194 (H) 24 - 173 IU/L Final
Entry Date
5/22/2015
Component Results
Component Value Flag Ref Range Units Status
CK-MB 5.95 (H) .00 - 5.34 ng/mL Final
Entry Date
5/22/2015
Component Results
Component Value Flag Ref Range Units Status
Glucose, POC 129 (H) 70 - 99 mg/dL Final
Entry Date
5/22/2015
Result Narrative
INDICATIONS: Chest pain shortness of breath.
RADIOPHARMACEUTICAL: 6 mCi of Tc-99m Cardiolite at rest.
30 mCi of Tc-99m Cardiolite at peak stress.
Lexiscan 0.4 mg was administered intravenously over about 10 seconds, with Cardiolite injected 15 seconds later.
PERFUSION: There is normal distribution of activity throughout the left ventricular myocardium both at rest and following stress.
WALL MOTION AND THICKENING: Normal wall motion and thickening is seen throughout the left ventricular myocardium.
RESTING LEFT VENTRICULAR EJECTION FRACTION: Greater than 65%.
Result Impression
IMPRESSION:
1. NORMAL.
2. MPI RISK ASSESSMENT: LOW (JACC 2009;53(6):530-553)
here is one set of blood work I just had done.
The doctor has ordered a Pulmonary consult.
What do I still need to do? Has the liver blood work been done? Is that included in what I had done?
Thanks.
Component
Standard Range
Your Value
WBC 4.5 - 11.0 x 10^3/uL 6.1
Lymphocytes, % 25.0 - 40.0 % 24.5
% MONO 4.0 - 12.0 % 10.0
% GRAN 50.0 - 73.0 % 65.5
Lymphocytes Absolute 1.0 - 4.5 x 10^3/uL 1.5
Monocytes Absolute 0.1 - 1.0 x 10^3/uL 0.6
Grans Absolute 1.5 - 7.5 x 10^3/uL 4.0
RBC 4.00 - 5.20 x 10^3/uL 4.33
Hemoglobin 12.0 - 15.0 g/dL 12.7
Hematocrit 35.8 - 47.9 % 38.2
MCV 82.0 - 98.0 fL 88.2
MCH 26.0 - 34.0 pg 29.4
MCHC 31.0 - 37.0 g/dL 33.3
RDW 11.7 - 16.5 % 13.8
Platelet Count 150 - 400 x 10^3/uL 158
MPV 7.1 - 10.5 fL 9.8
General Information
Brief Answer:
You are doing good. Please follow my recommendations.
Detailed Answer:
WelCOME AGAIN MISS XXXX!
I want to relax you with the worries you have about your health. Look at your CK and CK-MB Component results below. Gradually decreasing. So you should be happy for that. Its not that alarming in the background of all the workup you have been gone through and I have carefully reviewed those detailed Labs and results of procedures.
1. CK-MB 7.62 (H) .00 - 5.34 ng/mL
CK 247 (H) 24 - 173 IU/L
2. CK 205 (H) 24 - 173 IU/L
CK-MB 6.58 (H) .00 - 5.34 ng/mL
3. CK 194 (H) 24 - 173 IU/L
CK-MB 5.95 (H) .00 - 5.34 ng/mL
You have totally normal heart, working very well.
Your liver function test is included in that, and yes thats normal.
Your lungs are also doing good. I have found No evidence of active pulmonary disease. I comment on your CT pulmonary angiogram as Negative. You are a former Smoker, for that Tobacco Cessation is the best thing you can do and leave smokers' company too to avoid passive smoking.
Your TSH is a bit low, and in my expert opinion, thyroxine dose may be needed adjustment to keep TSH in limits. You may consult your prescribing physician although its not a point to worry much.
Make a control of your blood sugar level too, although your HbA1C level wasn't so high, it still poses a risk of Diabetes. You can periodically check your blood glucose levels by yourself.
They said to consult a pulmonologist to access the status of medicines you are taking. Sometimes without wheezing sounds you have narrowed airways and that causes shortness of breath. I recommend you to consult once your pulmonologist. Also avoid any kind of allergens like, outside pollens (grass, trees, flowers), animal dander, carpet dust, smoke etc.
Keep taking Atenolol, it will stop premature ventricular contractions and palpitations. Otherwise your EKG is normal, I have seen that.
All of your kidney function tests are within limits.
CONCLUSION:
* Please Consult a pulmonologist, in person at the clinic.
*Please Follow my treatment suggestions I gave you in my 2nd answer.
Hope I satisfactorily covered all aspects and helped you today. Have a nice time and get very well soon.
If ever you need any future consultations, you may go directly to my profile and click "ask me a question" orange button. I will always be there for you.
Regards!
Dr. Hanif XXXXXXX USA
You are doing good. Please follow my recommendations.
Detailed Answer:
WelCOME AGAIN MISS XXXX!
I want to relax you with the worries you have about your health. Look at your CK and CK-MB Component results below. Gradually decreasing. So you should be happy for that. Its not that alarming in the background of all the workup you have been gone through and I have carefully reviewed those detailed Labs and results of procedures.
1. CK-MB 7.62 (H) .00 - 5.34 ng/mL
CK 247 (H) 24 - 173 IU/L
2. CK 205 (H) 24 - 173 IU/L
CK-MB 6.58 (H) .00 - 5.34 ng/mL
3. CK 194 (H) 24 - 173 IU/L
CK-MB 5.95 (H) .00 - 5.34 ng/mL
You have totally normal heart, working very well.
Your liver function test is included in that, and yes thats normal.
Your lungs are also doing good. I have found No evidence of active pulmonary disease. I comment on your CT pulmonary angiogram as Negative. You are a former Smoker, for that Tobacco Cessation is the best thing you can do and leave smokers' company too to avoid passive smoking.
Your TSH is a bit low, and in my expert opinion, thyroxine dose may be needed adjustment to keep TSH in limits. You may consult your prescribing physician although its not a point to worry much.
Make a control of your blood sugar level too, although your HbA1C level wasn't so high, it still poses a risk of Diabetes. You can periodically check your blood glucose levels by yourself.
They said to consult a pulmonologist to access the status of medicines you are taking. Sometimes without wheezing sounds you have narrowed airways and that causes shortness of breath. I recommend you to consult once your pulmonologist. Also avoid any kind of allergens like, outside pollens (grass, trees, flowers), animal dander, carpet dust, smoke etc.
Keep taking Atenolol, it will stop premature ventricular contractions and palpitations. Otherwise your EKG is normal, I have seen that.
All of your kidney function tests are within limits.
CONCLUSION:
* Please Consult a pulmonologist, in person at the clinic.
*Please Follow my treatment suggestions I gave you in my 2nd answer.
Hope I satisfactorily covered all aspects and helped you today. Have a nice time and get very well soon.
If ever you need any future consultations, you may go directly to my profile and click "ask me a question" orange button. I will always be there for you.
Regards!
Dr. Hanif XXXXXXX USA
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
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Dr. Vaishalee Punj
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