Clozapine RX 4 Ecstasy: Double XX – Digital Appointment – Review of Lab Findings

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TTS_Digital_Appt_Tests_18083001_201808_Build

Feature Image

Keith Another Life - A Sliding Door

Blog – Clozapine RX 4 Ecstasy

Blogger Title

Double XX – Digital Appointment – Review of Lab Findings – By Keith Torkelson (2018)

Google Plus Information

Central City Community Health Center – Quest Diagnostics – EQR - MSG by AVEY (2018)

Charter Date – 20180831-F

Authorship – KE Torkelson

Editor – AVEY (MSG-2018)

Table - Related Blogs Associations – Physical Cluster

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Blog	Primary - Post	Secondary - Post
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Animalcules (Hub)	Homepage	HRE
BND	Portals
Clozapine RX	Lab Testing
HEALTHMAN	Celery	COPD
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Table - Related Blogs Associations – Physical Cluster – Last Reviewed: 20180831-F:

List – Tables – Figures – Matrices

Table - Related Blogs Associations

Figures – Partners

Figures - Chester Mojica Ordered Radiographs

Figure - Test Name CBC (INCLUDES DIFF/PLT)

Table - 20180821-TU: Homework Handout (Part A) – Offered by Team Martha

Feature - WBC Counts - Sample MyQuest Header Information

Figures – White Blood Cell Count – Immune Function (WBC) [DITTO]

Table - 20180821-TU: Homework Handout (Part B)

Figures – Carbohydrate Metabolism

Figures - Transparency – In Health & Human Services

Table - 20180821-TU: Homework Handout (Part C) - Phlebotomy Risks (2013-2018)

Figures – Partners

Abstract – Executive Summary

This report is one of our shortest this year. In addition, because if we so short it was more a pleasure to knock out. In short, this report addresses the lab work (testing) associated with our upcoming Physical Exam (September 27, 2018). If all goes well we will see our Primary Care Physician Doctor Chester D Mojica. For the physical some odd twenty (20) individual tests were run. The samples we provided are Blood and Urine. None of the results appear alarming. We discuss a couple labs more depth here in this report: Complete Blood Count (CBC) and Carbohydrate related tests. In addition, we offer a bit of insight into our first ever Chest X-ray (test) for which we were provided the results. We had two appointments in August (2018). At each appointment "Team Martha" sent us home with a homework assignment. We did not ask for the homework yet since we got some we took time to address the material. We hope at our scheduled, September 27, 2018 we get a written quiz to measure our learning:o) Our confidence level about both sets of knowledge is somewhere around 88%.

Lab Test - Feature - COPD - New & Improved

àMetadata > 11_OAI_Radiology_Portal_18042701_Account

This pertains to the chest x-ray that doctor Chester D Mojica ordered for us. We showed up early for our appointment on 20180425-W. The provider identified as West Coast Radiology (WCR). We filled out a couple of forms and they provided us material to read about their Patient Portal. While waiting about five (5) minutes we looked over the Patient Portal Information (PPI). We were called in for two radiographs (x-rays). For certain we know one view was a lateral. Yet we are uncertain if the second was a posteroanterior or an anteroposterior. After the tech/techs determined they captured good shots they let us return back up front. We said we read the PPI material and we determined you need provided some sort of access code. They gave us the necessary access code. The two pictures included here come directly off WCRs Patient Portal.

West Coast Radiology Patient Portal’s - Alert

“These radiologic images have been provided, as reference only. Qualified clinicians should only do interpretation of radiologic images. You should review these images only in consultation with your provider. If appropriate, please schedule a follow-up appointment with your provider.” We are hoping that Chester D Mojica will interpret our chest radiographs at our upcoming (September) Physical Exam. While in Vet School we did not perform very well in our two Radiology courses. Yet throwing caution to the wind. We find both x-rays unremarkable. These two samples will be discussed more in our paper on COPD.

Figures - Chester Mojica Ordered Radiographs

[INSERT X-RAYS Baselines for Efforts]

Keith Torkelson - Chest X-ray Side View

Keith Torkelson - Chest X-ray - Alternate View

Getting On To Lab (Blood & Urine) Work

Figures – White Blood Cell Count – Immune Function (WBC) [DITTO]

Figures – White Blood Cell Count – Reference Range

[INSERT LEUKOMOID INTERPRETATION]

Table - 20180821-TU: Homework Handout (Part A) – Offered by Team Martha

“This SmartCare article is prepared for:”

CBC Blood Test Education

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##	Element	Status (X=FE)	K&U Grade	QUANT
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1	RBC Count	X	A	1.0
2	WBC Count	X	A	1.0
3	Total Hbg	X	B	0.8
4	Hematocrit	X	B	0.8
5	MCV	X	B	0.8
6	MCH	X	B	0.8
7	Hbg Concentration	X	B	0.8
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	CALC (SUM/Items) =			6/7 = 85.7
	Pre-Exam Knowledge Confidence Score (PEKCS) =			3.4 “B”
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Table - 20180821-TU: Homework Handout (Part A) – Offered by Team Martha – Homework Confidence – Last Reviewed: 20180831-F:

Lithium Vignette (AVEY) - CBCs

This is a good time to throw in a Vignette. Let’s call it: The Lithium Tremor Stigma Story. The year was sometime around 1992. Buster (AKA Keith) is in his second year of Veterinary School. He had agreed (consented) for a second experimental trial using Lithium. Lithium has a side effect: “May elicit tremors”. Buster’s hardest class that quarter was the 6.0 or so unit Hematology. It was CBC lab day. One of the first tasks was to create an acceptable whole blood smear. His lab partners were: Anh, Terri, and Mindy. They all had it together. By observing their product Buster knew something was amiss with his. When the Teacher Assistant on his rounds reached our table Buster states: Hey what’s up. The TA looked at about three (3) of Buster’s slides (smears) and exclaimed: How did your do that: Man? Buster relies: What is wrong? He said none of your slides pass. Let me watch you do a couple. So Buster all Stigmatized follows the TA’s cue. The TA says you have smeared some odd 20 mini ridges of blood across the whole slide. The peaks or saw-tooth structures were too thick thus unreadable. The TA said I never saw anything like it - use one of your partners’ satisfactory slides for the rest of the lab. Now if Buster was all into disclosure he would have said to the TA and his three (3) lab partners: I think my fine motor problems are due to the Lithium a medication my doctors are experimenting about with me. The down side of lithium is supposed to be insignificant in the face of proven benefits. But you know how Stigma is???

Feature - WBC Counts - Sample MyQuest Header Information

Delivery Method SmartPhone or PC

Figures – White Blood Cell Count – Immune Function (WBC) [DITTO]

WBC Homework

CBC’s are indicated when you are receiving medications that may alter your CBC values. For us the issue to look for is called Leukopenia. Leukopenia is dangerously low White Cell (WBC). It looks like from that graph that low begins between 6.0 and 4.0 units. The Red dots indicate elevated White Blood Cells (WBCs). This state is called Leukocystosis or elevated WBCs. For us it is protective to have elevated WBC’s. The last ten (10) or so data points reflect our conscious efforts to get our WBC levels down. If we succeed for the remainder of 2018 we are looking for a linear series of Green Dots (Data Points)

Table - 20180821-TU: Homework Handout (Part B)

Table - Leukocytosis Cause Elimination List

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Item	Contributor	Impact 2018	Note
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1	Certain medicines such as corticosteroids	Unlikely
2	Infections	Possible
3	Disease such as lupus, rheumatoid arthritis, or allergy	Unlikely
4	Leukemia	Ruled Out
5	Severe emotional (Sleep Helps)	Likely
6	Severe physical stress	Likely
7	Tissue damage such as from burns or a heart attack	Possible
	-
8	Dental Infections	Possible

Table - 20180821-TU: Homework Handout (Part B) – Last Reviewed: 20180831-F:

Incidence of Arestin

By chance this year we had enough money to pay the exorbitant co-pays for Dental care. We agreed to a very expensive treatment. The medication is new and improved and therefore there is no generic available. The medicine, a topical antibiotic, is called Arestin. Initially, our dentist took a complete set of measurements about the roots of our teeth. We had deep pits. He felt these pits indicated treatment with Arestin. In other words our gums were inflamed if not infected. As an indicator that the Arestin treatments have worked our oral infection level should resolve. There is not way to link for sure our last CBC (Green) value directly with our proximate Arestin Treatment. A direct measure for the Arestin efficacy is re-measuring the pits. We hope our root pits go away forever.

Item 5 - Improved Sleep - Stress – WBCs – Rated “M”

Good and regular sleep has a profound effect on our mood as well as stamina. Our most significant other ever (MSOE) of twenty years: Says: "The sex is been better when you get good sleep”. “We do more and different things!” (JNZ 1998-2018)

Figures – Carbohydrate Metabolism

20180921 - TORKELSON, KEITH E - GLUCOSE

Collection Date: 08/09/2018 (Reported 08/10/2018)

Figure – Carbohydrate Metabolism – Glucose (BGL)

20180921 - TORKELSON, KEITH E - HEMOGLOBIN A1c

Figure – Carbohydrate Metabolism – Hemoglobin A1c (A1C)

Link to Celery Diet

What can we say! That Red Data Point (RDP) back near July 2017 alarmed us. We know at least a dozen people that have Diabetes. Diabetic complications killed a friend of ours Raul Romero when he was only about thirty-five (35) years old. In response to our RDP (BGL) we started formally drafting our Celery Diet Protocol (CDP-Beta). We would like migrating our number down into the middle range (81 mg/dL BGL) and level out there. Our A1c is close to where our target is. We will put Carbohydrate Metabolism on hold until next years or an interim BGL result stimulates refreshed vigilance. If we piqued your interest we are writing a paper about our Celery Diet.

Figures - Transparency – In Health & Human Services

[INSERT ROH & BROOKHUST MCFADDEN DENTAL]

Keith's Retina Surgeon - Typing in Good News

Photo by Keith Torkelson

Keith's New & Improved Dental Team

A Model for Transparency - Photo by Keith Torkelson

Discussion – Photo Journalism Welcome - HELD OVER

Table - 20180821-TU: Homework Handout (Part C) - Phlebotomy Risks (2013-2018)

Note: “There is very little risk involved with having your blood taken. Veins and arteries vary in size from one person to another, and from one side of the body to the other. Taking blood from some people may be more difficult than from others.”

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Risk	Conversion	Impact if any…
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Excessive Bleeding	Low incidence
Fainting	No
Light headed	No
Hematoma	Low incidence
Infection	Very Low Incidence
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Miss so bad need new site	Very Low Incidence
Mislabeled or Unlabeled Tube (S)	Average 1 per year	With CBC promotes Anxiety

Table - 20180821-TU: Homework Handout (Part C) – Phlebotomy Risks

Brief History - Phlebotomy

We probably would not have addressed phlebotomy in this paper without prompting. As we mentioned earlier on 20180821-TU Team Martha sent us home with homework. Part of our assignment addressed Phlebotomy risks. Phlebotomy error management is a huge topic for us here at MSG. Keith (Buster) is a frequent flyer when it comes to blood draws. As a minimum he gets 1 tube drawn per month. Whenever the phlebotomist “main-gels” the preferred draw site (left arm) and seeks another draw point Buster considers it a failure. Large and long-lived hematoma production is another warning sign. Earlier in this report we address Team Martha. Martha Gil (MA) spearheads Team Martha. When Martha pulls the blood out of us herself the chances for a favorable outcome are high. When trainees get involved Buster gives consent yet if they miss and suggest another location we request Martha.

[INSERT SCAN OF HOMEWORK]