EFTA01108062.pdf

WOODSON C. MERRELL, M.D. 44 EAST 67th STREET NEW YORK, NEW YORK 10065 Telephone: (212) 535-1012 rim Fax: (212) 535-1172 Date: July 27, 2011 Patient: Jeffrey Epstein (Email: jeevacation@gmail.com) • Call me Monday afternoon, or sometime early next week to review today's lab results • Supplements to begin for now: o Niacin 500mg twice a day (taking with food may reduce flushing); if flushing is too much, call me or Rony for a prescription for a sustained release form o One Enteric-coated baby aspirin every 1 to 2 days o Because of partial folic acid enzyme converting deficiency (MTHFR), take FolaPro form of folic acid by Metagenics; 1 twice a week o Nordic Naturals Omega 3 Fatty Acid Fish Oil; 1 capsule twice a day or 2 capsules once a day (approx 800 mg OPA/DHA) o Magnesium Citrate (Solgar is a good brand); 200mg once a day (taken at bedtime may act as a mild muscle relaxant) o Sublingual (under the tongue) B12 (Solgar is a good brand); 1,000mcg daily o Culturelle is an excellent brand of probiotic (acidophilus) to help digestion and intestinal immunity; one capsule/day • Give a trial of a very low dose of Crestor. Start with /2 of a 5mg tablet twice a week. If no side effects occur (usually musculoskeletal or cognitive) after 2 weeks, increase to every other day. After 3-4 weeks on this dosage regimen recheck cholesterol blood test. Stop at any time if side effects occur • Follow up with Dr. Rony Shimony 110 East 59th Street 8th Floor NY NY 10021 - - 212- 752-2700 for cardiovascular cholesterol consultation after above blood test: I will send him a note with a copy of today's • Schedule a one hour visit for an annual check up in the fall • We discussed that the triglycerides are still high; cut back not only on starches, but also oils (this will help with weight loss as well) • Due to a tendency for slightly high blood sugar (elevated glycohemoglobin), eliminate all refined carbohydrates (sugar, white flour, white rice, rolls, potatoes, etc.). Use small amounts of complex carbohydrates (whole grains); use lots of vegetables and a couple fruits as your main source of starch • Eliminate all saturated fats from your diet. This is obviously important for your cardiovascular and cholesterol issues, but saturated fat also promotes inflammation (inflammatory prostaglandins, cytokines, etc) in the body in general • Begin a regular aerobic exercise program • Try to do a daily breath-based session/meditation (at least 2 minutes, preferably 15) with frequent breath breaks throughout the day. This will not only reduce stress in general and on your cardiovascular system, but reduce cortisol levels as well • If your PTH has gone up significantly from previous, you should see your Yale parathyroid specialist (depending on today's lab results) • Try as much as possible to go on a plant-based diet. Consider reading Arthur Agatston's "The South Beach Diet" and Dean Omish's "Reversing Heart Disease" EFTA01108062 09/23/2011 11:59 2123695048 ADV CARDIOVASC IMAG PAGE 01 Cd13011 imaging A550. W/44/ZUAL `$:15:4U AM SAUL 1/0V1 r LATver Advannufainikwasathirlwaghtg 62 East 88th St New York, NY 10128 Phone (212) 3894200 FAX (212)3894048 Steven D. Wolff, M.D., Phi) Director Rony Simony e 110 59 St Ste 8A New York. NY 10022 Patient Name: EPSTEIN, JEFFREY ACC. 727659 DOB: 01/20/1953 MRN: 0406090 Exam Completed: 00/22/2011 5:55PM Examination LUMBAR SPINE MRI Comparison None available Clinical Weary Pain in back and legs Technique Sagittal FSE, Axial FSE. SagIttal FLAIR Tt. Sagittal IR Findings There is minimal degeneratiw grade 1 anterollsthesis 011.4 on L5. Conus ends normally at the loww, T12 lava' and appears intrinsically normal. There Is no acute fracture 711412-L2-L3 them Is no focal disc herniation or stenos's. 134.4. there is disc bulge end facet arthrosis. 144.5. Mere it anterolisthesis, there is broad disc bulge with facet arthrosis ant ligernenturn eawm hypertrophy. There is severe central canal. substitute, arid moderate to marked trammel stenceil. Then• It Impingement of the L5 and encroachment on the exiting L4 nerves. 1541 there is diet: bulge asymmetrIC to the tight yen right greeter than in t= it arises*. There is mild to moderate right suberticvlar stenos is with encroachment on the right S1 nano. Impression Stare 144.5 and to a lesser depose rIgMe Med 15,51 stenos's. Thank you for the courtesy of this retinal. Dictated by: Jaws, Mohammad MD Electronically Signed By: Awl. Mohammad, MD 09/23/2011 914 AM Transcribed by: Mars. Mohammad, MD on September 23, 2011 9:14 AM EFTA01108063  Sent 10/02/2009 09:24:15. Page - 2 !R!callLTHD;SLPP66;SLPI6.31IPPI10;EXIT; FINAL REPORT EPSTEIN,JEFFREY F#: 8000434390 DOB:01/20/53 56Y Sex: M ADM: MOSKOWITZ,BRUCE W ACCT #: 060006996 ORD: MOSKOWITZ,BRUCE W TRANS: AMBULATORY OCC OCC Exam Date: 10/02/09 0829 Exam: 7508 MR MRI LUMBAR SPINE W/O CNTRST CI#: 3308778 Ord Diag.: 724.4-LUMBOSACRAL NEURITIS NO ORD#: 0003 SEDATION : NO-SEDATION ADMINISTERED CONTRAST USED: *NONE* MRI of the lumbar spine without contrast: Sagittal Ti, T2 and STIR images demonstrate normal bone marrow signal. There is diminished signal within the L1 to and L4-L5 intervertebral discs. These findings are consistent with dehydration. There is a disc bulge which is diffuse at the L4-L5 level with protrusion centrally associated with moderate degenerative changes of the apophyseal joints bilaterally the combination causing a moderate central stenosis. There is also mild encroachment on the left lateral recess. There is a disc bulge at L5-S1 but no significant central or lateral re ss tehgais. IMPRESSION: , - There is a d ffuse disc bulge at 1 associated with central prof ' AUSihd m ate .tenosis as well as left lateral recess stenosis. Transcriptionist- HOWARD 0 BUTLER, M.D. Reading Radiologist- HOWARD 0 BUTLER, M.D. Released Date Time- 10/02/09 0923 MOSKOWITZ,BRUCE W 1411 N Flagler Dr, #9300 W Palm Beach, FL 33401 EFTA01108064  Quest O Diagnostics QUEST DIAGNOSTICS INCORPORATED CLIENT SERVICE 800.631.1390 PATIENT INFORMATION EPSTEIN,JEFFREY DOB: 01/20/1953 AGE: 58 SEFCRT STATUS ORDERING PHYSICIAN FINAL GENDER: M FASTING: N SPECIMEN INFORMATION CLIENT INFORMATION SPECIMEN: K2534668 T11886 10013575 REQUISITION: MANUAL327631 PHONE: 212.750.9895 WOODSON MERRELL, M.D. 44 E 67TH STREET NEW YORK, NY 10065 COLLECTED: 07/27/2011 13:05 RECEIVED: 07/27/2011 20:43 REPORTED: 08/04/2011 08:15 Teat Name In Range Out of Range Reference Range Lab COMP METAB PANEL TBR GLUCOSE 102 65-139 mg/dL The glucose reference range is based on a non-fasting state. SODIUM 142 135-146 mmol/L POTASSIUM 4.1 3.5-5.3 mmol/L CHLORIDE 107 98-110 mmol/L CARBON DIOXIDE 21 21-33 MMO1/L UREA NITROGEN 24 7-25 mg/dL CREATININE 0.94 0.76-1.46 mg/dL BUN/CREATININE RATIO NOTE 6-22 Bun/Creatinine ratio is not reported when the Bun and Creatinine values are within normal limits. CALCIUM 9.5 8.6-10.2 mg/dL PROTEIN,TOTAL 6.9 6.2-8.3 g/dL ALBUMIN 4.4 3.6-5.1 g/dL GLOBULIN, CALCULATED 2.5 2.1-3.7 g/dL A/G RATIO 1.8 1.0-2.1 BILIRUBIN,TOTAL 0.5 0.2-1.2 mg/dL ALKALINE PHOSPHATASE 57 40-115 U/L AST 19 10-35 U/L ALT 16 9-60 U/L EGFR NON AFR AMERICAN 89 >=60 mL/min/1.73m2 EGFR AFRICAN AMERICAN 103 >=60 mL/min/1.73m2 URIC ACID 7.7 4.0-8.0 mg/dL TBR GGT 14 3-85 U/L TBR TSH,3RD GENERATION 1.67 0.40-4.50 mIU/L TBR FERRITIN 88 20-380 ng/mL TBR VITAMIN B12 + FOLATE TBR VITAMIN 812,SERUM 316 200-1100 pg/mL Please note: although the reference range for Vitamin B12 is 200-1100 pg/mL, it has been reported that between 5 and 10% of patients with values between 200 and 400 pg/mL may experience neuropsychiatric and hematologic abnormalities EPSTEIN,JEFFREY - K2534668 Page 1 - Continued on Page 2 Ian nwi ars.. Ike atrceliid kip Mae Ansiiiilfidaintlemeled4.nstka.sr* its esnr\.N Ned Deponiv. 0.4010Woadi MVMMM Y imphionew.1 % !XX 111,10 EFTA01108065  Quest O 4 Diagnostics GUEST DIAGNOSTICS INCORPORATED PATIENT INFORMATION EPSTEIN,JEFFREY DOB: 01/20/1953 AGE: 58 T STATUS ORDERING PHYSICIAN FINAL GENDER: M FASTING: N SPECIMEN INFORMATION CLIENT INFORMATION SPECIMEN: X2534668 T11886 10013575 COLLECTED: 07/27/2011 13:05 REPORTED: 08/04/2011 08:15 Test Name In Range Out of Range Reference Range Lab due to occult 812 deficiency; less than 1% of patients with values above 400 pg/mt will have symptoms. FOLATE.SERUM 5.1 > 5.4 ng/mL Normal: >5.4 Borderline: 3.4-5.4 Low: <3.4 CORTISOL,E.N. TER CORTISOL (PM) 10.6 3.0-17.0 mcg/dL DHEA SULFATE 219 25-240 mcg/dL TBR CARDIO CRP (R) 0.8 mg/L TBR Lower relative cardiovascular risk according to AHA/CDC guidelines. For ages >17 Years: cCRP mg/L Risk according to AHA/CDC guidelines <1.0 Lower relative cardiovascular risk. 1.0-3.0 Average relative cardiovascular risk. 3.1-10.0 Higher relative cardiovascular risk. Consider retesting in 1 to 2 weeks to exclude a benign transient elevation in the baseline CRP value secondary to infection or inflammation. >10.0 Persistent elevation, upon retesting, may be associated with infection and inflammation. PSA,TOTAL 0.5 <=4.0 ng/mL TBR See footnote 1 IDTKOOLOBINA1C Percent TBR Reference Range: < 5.7E Decreased risk of diabetes 5.7-6.0% Increased risk of diabetes 6.1-6.4% Higher risk of diabetes > OR = 6.5E Consistent with diabetes EPSTEIN,JEFFREY - K2534668 Page 2 - Continued on Page 3 Owo Opea0oplesIL. t..statillcd lye amoomeaOseilliouvoc..heibit•Orielrwhaultsci Ong ly• 4`0141i0•81PCSITICII moor:we Alcor{ 411•, 14 C1101.101. Rt. KC 10110. I ,S570 EFTA01108066  a% Quest fi Diagnostics e QUEST DIAGNOSTICS INCORPORATED PATIENT I NPORMAT ION EPSTEIN,JEFFREY REPORT STATUS ORDERING PHYSICIAN FINAL DOB: 01/20/1953 AGE: 58 GENDER: M FASTING: N SPECIMEN INFORMATION CLIENT INFORMATION SPECIMEN: X2534668 T11886 10013575 COLLECTED: 07/27/2011 13:05 REPORTED: 08/04/2011 08:15 Test Name In Range Out of Range Reference Range Lab HOMOCYSTEINE,CARDIO TBR HOMOCYSTICINS 16.1 H. 411.4:MICROM01/L VITAMIN D,25-OH,LC/MS/MS TBR VITAMIN D, 25-OH, TOTAL 30 30-100 ng/mL VITAMIN D, 25-OH, D3 30 ng/mL VITAMIN D, 25-0H, D2 <4 ng/mL 25-OHD3 indicates both endogenous production and supplementation. 25-0HD2 is an indicator of exogenous sources such as diet or supplementation. Therapy is based on measurement of Total 25-0HD, with levels <20 ng/mL indicative of Vitamin D deficiency, while levels between 20 ng/mL and 30 ng/mL suggest insufficiency. Optimal levels are or = 30 ng/mL. TESTOSTERONE,FREE,BIO/TOT AMD TESTOSTBRONE,TOTAL,LCMSM$ 152 : 250-1100 ng/dt TESTOSTERONE FREE 38.0' L 46,C-224.0 pg/mL TESTOSTERONE BIOAVAILABLE 78.1 . L 110.0-575.0 ng/dL SEEM 11 : 22-77 nmol/L ALBUMIN, SERUM 4.5 3.6-5.1 g/dL EPSTEIN,JEFFREY - K2534668 Page 3 - Continued on Page 4 •)/n/ Ilan/ Dar -v<. ibeast//41/0/taanlentin/olea 0av Dornie.t molt me *a ,..k...., I orimlllaVaat. / 0/./1O/Dirsilics INC•paridoel •I *els telWyee COMISIM.116•4•0 SM Sal 'inn EFTA01108067  a% Quest e r4 Diagnostics QUEST DIAGNOSTICS INCORPORATED PATIENT INFORMATION EPSTEIN,JEFFREY REPORT STATUS ORDERING PHYSICIAN FINAL DOB: 01/20/1953 AGE: 58 GENDER: M FASTING: N SPECIMEN INFORMATION CL I ENT INFORMATION SPECIMEN: K2534668 T11886 10013575 COLLECTED: 07/27/2011 13:05 REPORTED: 08/04/2011 08:15 Test Name In Range Out of Range Reference Range Lab VAP (TM) CHOLESTEROL TEST DIRECTLY MEASURED LIPID ATT TOTAL LDL-C DIRECT 99 <130 mg/dL (Desirable range <100 mg/dL for CHD, Diabetes, or its equivalent) TOTAL HDL-C DIRECT 26 L >40 mg/dL TOTAL VLDL-C DIRECT 62 H <30 mg/dL SUM TOTAL CHOLESTEROL 187 <200 mg/d1. TRIGLICERIDES-DIRECT 71 H <150 mg/dL Note: Triglycerides may be elevated if p Tent has not fasted. TOTAL NON-1410L-C(LDL+VLDL) 161 H <160 mg/dL FOR SETTING LDL-C GOAL ATT LP(a) CHOLESTEROL 8.0 <10 mg/dL IDL-C 25 H <20 mg/dL REAL-LDL-C 67 <100 mg/dL SUM TOTAL LDL-C 99 <130 mg/dL REAL-LDL SIZE PATTERN A A ( 1I 1 I Pattern B Pattern Pattern A Small, Dense LDL A/B e Buoyant LDL REMNANT LIPO (IDL+VLDL3) 52 H <30 ms/dL Presence of additional risk factors, consider lowering LDL-C goal. CONSIDER INSULIN RESIST/ ATT METABOLIC SYNDROME NO SUB-CLASS INFORMATION ATT HDL-2(LARGE,BUOYANT) 8 L >10 mg/dL HDL-3(SMALL,DENSE) 18 L >30 mg/dL VLDL-3(REMNANT LIPO) 27 H `10 mg/dL. EPSTEIN,JEFFREY - K2534668 Page 4 - Continued on Page 5 liverI Ow anwritituovaW rd• *sear.OSIAIN D tiresICS Mai OW IISIM011t elanDUWW. roe l DYISIKSIM1110•0011• Weft •tielted ODIECONTL RenteMs) Y.TI IISS70 EFTA01108068  alk Quest d Diagnostics a QUEST DIAGNOSTICS INCORPORATED PATIENT INFORMATION EPSTEIN, JEFFREY REPCRT STATUS ORDERING PHYSICIAN FINAL DOB: 01/20/1953 AGE: 58 GENDER: M FASTING: N SPECIMEN INFORMATION CLIENT INFORMATION SPECIMEN: K2534668 T11886 10013575 COLLECTED: 07/27/2011 13:05 REPORTED: 08/04/2011 08:15 FOOTNOTE(S): 1 This test was performed using the Siemens (Bayer) chemiluminescent method. Values obtained from different assay methods cannot be used interchangeably. PSA levels, regardless of value, should not be interpreted as absolute evidence of the presence or absence of disease. PERFORMING LABORATORY INFORMATION: AMD Quest Diagnostics Nichols Chantilly 14225 Newbrook Drive Chantilly VA 20151 Laboratory Director: Kenneth Sisco, MD,PhD CLIA No: 49D0221801 ATT Atherotech Inc. 201 London Parkway Birmingham AL 35211 CLIA No: 01D0641541 TBR Quest Diagnostics One Malcolm Avenue Teterboro NJ 07608 Laboratory Director: William E. Tarr, M.D. CLIA No: 3100696246 EPSTEIN,JEFFREY - K2534668 Page 5 - End of Report na , lettl:0•••••5441..7* auxiprei lup se Won 14•41C.KppioNlisav ,•• neimathn , ta.".1%• Cat ,Corp..0 anent AN 'tea ...tom. ODYAM MTh kW., SDI SC* 11H/0 EFTA01108069  418k (21JICSI A ‘ -41 Nagnostics PATIENT INFORMATION Rl PQRT STA:US FINAL lailer EPSTEIN,JEFFREY QUEST DIAGNOSTICS INCORPORATED ORDERING PHYSICIAN CLIENT SERVICE 800.631.1390 DOB: 01/20/1953 AGE: 58 GENDER: M FASTING: N SPECIMEN INFORMATION CLIENT INFORMATION SPECIMEN: K2534657 T11886 10013575 REQUISITION: PHONE: 212.750.9895 WOODSON MERRELL, M.D. 44 E 67TH STREET NEW YORK, NY 10065 COLLECTED: 07/27/2011 13:05 RECEIVED: 07/27/2011 20:42 REPORTED: 08/01/2011 08:15 Teat Name In Range Out of Range Reference Rang. Lab MERCURY,BLOOD 5 <=10 mcg/L AND ARSENIC,BLOOD <3 <23 mcg/L AND Urine is usually the best specimen for the analysis of Arsenic in body fluids. Blood levels tend to be low even when urine concentrations are high. PERFORMING LABORATORY INFORMATION: AND Quest Diagnostics Nichols Chantilly 14225 NembrOOk Drive Chantilly VA 20151 Laboratory Director: XenneLh SISCO, MD. PhD CLIA NO: 49D0221801 EPSTEIN,JEFFREY - K2534657 Page 1 - End of Report 11.y..a •,•••,./...i.baMil. ••,....0). as 4.• naol)I......11.“111. lk • • CLI, M4iPain•INg•••••...4 ia.• •••#n4106t4 02111•1111. &WASNI 50 .111611 EFTA01108070  lrift (.211(!st imi lAagnostics liar • GUEST DIAGNOSTICS INCORPORATED PATIENT INPORMATION EPSTEIN,JEFFREY REPORT STATUS FINAL ORDERING PHYSICIAN CLIENT SERVICE 800.631.1790 DOB: 01/20/1953 AGE: 58 GENDER: M FASTING: N SPECIMEN INFORMATION CLIENT INFORMATION SPECIMEN: F0887635 T11886 10013575 REQUISITION: PHONE: 212.750.9895 WOODSON MERRELL, M.D. 44 E 67TH STREET NEW YORK, NY 10065 COLLECTED: 07/27/2011 13:05 RECEIVED: 07/27/2011 23:26 REPORTED: 07/29/2011 08:15 Test Name In Range Out of Range Reference Range Lab CALCIUM 9.6 8.6-10.2 mg/dL TBR PTH,INTACT 10-65 pg/mL TBR Interpretive Guide Intact Calcium Normal Parathyroid Function Normal Normal Hypoparathyroidism Low or Low Normal Low Primary Hyperparathyroidism Normal or High High Secondary Hyperparathyroidism High Normal or Low Tertiary Hyperparathyroidism High High Non-Parathyroid Hypercalcemia Low or Low Normal High PERFORMING LABORATORY INFORMATION: TBR Guest Diagnostics One Malco:r Avenue Teterboro NJ 07608 Laboratory Director: William E. Tarr. M.D. CLIA NO: 31D069&246 EPSTEIN,JEFFREY - F0887635 Page 1 - End of Report EFTA01108071  Quest Diagnostics Quest Diagnostic! One Malcolm Avenue Teterboro. New Jersey 07608-1070 Quest Trail, 800.63 I . I 390 Date of Report: 07/29/2011 Patient Name: 111886 10013575 Ordering Physician: EPSTEIN. JEFFREY WOODSON MERRELL, M.D. Route: 10013575 Specimen: F0887635 44 E 67TH STREET Account Number: Patient ID: (80443348 NEW YORK, NY 10065 TI l886 Age: 58 Sex: M Intact Parathyroid Hormone and Total Calcium Patient Results - Intact Mil 104.00 Inhnl I Calcium 9.60 2.0 4.0 6.0 8.0 10.0 12.0 14.0 61 Total Calcium (mg/dL) Legend A Primary or Tertiary Hyperparathyroidism a Secondary Hyperparathyroidism O Hypercalcemia of Malignancy 0 Hypoparathyroidism 0 Patient Result 'This paphwal represeniation in not intended to nulnaiime fur the Clinical laboratory Report afiirh may contain more complete information. Refererne value. on the graph shove are horn a Nuptial:my data net from Quem Diagnostics Nichol% Manure. Intact PTH valuta phoned on thin graph were unelyaerl ttning an 'mat PTH IRMA rasa) 'chow perfamance chafer tetr, tict ae very 'imam to the DPC method currently colored at Quern DicIgnO•Ik's. Qucg.ljucsi Ihistivnth.h. llc u.sorisied Ingo out *It whociattd ljunt thurnomics saris .rc the fel:bitted tbdemurk%•f (Ith•I Disietunliv• IncorpoiScd. C Ifil I Quca hiagyhhtic. laccrphruhcil. All herd% rt.hr. yd. EFTA01108072  FROM TO 012125351172 01/10/2011 15 38 41 #4236 P 001/002 TO: ATTENTION: RYS/F 1 8 212-434.6971 free: S L fleas - Digiliedlx F9 2, 3 11/18/11 1.38 pe DEPARTMENT of trinitvEK110NAI. CARDIAC a VASCPLAR SEM1CZ Rony Y. Shimony, M.D., F.A.CC. Derider, neerfir Candiskuntir Duran Lemur Hill Lemon Hai1-14upkil Han sell Vega, butisor N 19th Sinn Heart sod Vascular Institute of New York PROGRESS NOTES PATIENT: Epstein, Jeffrey DATE: December 2, 2010 AGE: 57 SEX: M SALIENT ISSUES • Blood tests done with Dr. Woodson Merrell on 11/18/2010 revealed a total cholesterol of 199 end HDL of 26. LDL could not be calculated secondary to trig)ycerides of 679. The cholesterol to HDL ratio was 7.7. CRP was 0.9. Hemoglobin Mc was 5.8. REVIEW OF SYSTEMS • Review of systems in detail is otherwise negative. PHYSICAL EXAMINATION • GENERAL' On physical examination, he is in no distress. • VITAL SIGNS BP 120/70 mmHg. • THORAXANDLuta:is Chest is clear. • CARDIOVASCULAR. There is no S3 gallop. • ABDOMEN. Abdomen is soft. • EXTREMITIES. Extremities are benign. DIAGNOSTIC STUDIES • A CTA of the coronary arteries done today revealed a total coronary calcium score of 53 (0 in the left main artery and 53 in the left anterior descending artery). This represented a 13% increase from 2008. There was a zero calcium score seen in the circumflex artery and the right coronary artery. The resultant was less than 50% calcified plaque in the proximal to mid left anterior descending artery. There was 25% to 50% stenosis in the ostial part of first diagonal artery. The right coronary artery and the circumflex artery as well as the left main artery were normal. • An echocardiogram done today revealed normal left ventricular size and systolic function. The valvular structures were normal There was trivial mitral regurgitation secondary to valve leaflet closure. • On exercise treadmill test today. he exercised to 20.4 METs with a peak heart rate of 148 beats per minute, representing 90% of predicted maximum heart rate. The peak blood pressure was 145/70 inning. There was no chest pain, no ST segment depressions to suggest ischemia, and no arrhythmias. An echocardiogram done immediately post peak exercise demonstrated normal left ventricular size, systolic function, and augmentation, with no regional wall motion abnormality. IMPRESSION • Mr. Epstein had muscular reaction with cramps to Lipitor as well as Crestor. His blood tests reflect lack of exercise for 6 months as well as no medications. We will start him on Livalo (piUtvastatin) at 2 mg p.o. daily ae well es Niaspan 500 mg p.o. daily, to be titrated to 1000 mg. He tolerated Niaspan in the past well. He will also be placed on a baby aspirin 81 mg p.o. daily. He is to have blood tests done in 6 weeks. The patient has been (continued) Lenox Hill buenintional Cardiac end Vascular Sancta PC • 110 Brat 59th Street, Sth Floor, Nen York, NY 100224304 Tell 212 752 2700 • Am: 212 7522949 EFTA01108073  FROM TO 012125351172 01/10/2011 15 38 52 #4236 P 002/002 To: ATIENT101: RYS/F i 1 0 212.431.6971 Froa: S 1. Ream - DigItiedix F9 3/ 3 81/111/11 pa DEPARTMENT t1F INTEIMiNT1ONAL CARDIAC & VA44:111All silanas RoityY. Shimony, M.D., F.A.C.C. Demur, C haft fe Cartsnavbr DIMON Lenox Hill LIM% Hill Her en! Vanier hinds ar 5.Pth Srrnt Heart and Vascular Institute of New York PROGRESS NOTES Epstein, Jeffrey Page 2 of 2 December 2, 2010 complaining of some leg cramps with exercise. We will proceed with peripheral vascular evaluation of his carotid arteries, abdominal aorta, and lower extremities with ABI/PVR and Doppler studies. PLAN • Start l.ivalo (pitavastatin) 2 mg p.o. daily and Niaspan 500 mg p.o. daily, titrating to 1000 mg. Baby aspirin 81 mg p.o. • Blood tate in 6 weeks. • Peripheral vascular evaluation of carotids, abdominal aorta, and lower extremities with ABI/PVR and Doppler studies. • Medications and plan reviewed with patient in detail. 0:12/2/201012.NET (002) /RYS T: 12/ 4/7010 10:2$ ET/ tan /air cci Dr. Woodson Merrell RONY Y. SHIMONY, MD, FACC (Phone 212-535-1012, Fax: 212.535.1172) Dr. Eva Anderson-Dubin 1040 Sth Ave Fl 15 New York NY 10028 ADDENDUM DIAGNOSTIC STUDIES • Carotid Dopplers done today were normal. A lower extremity vasculature study was entirely normal and triphasic. The study was done due to his complaint of claudication. • A BI/P VR of the lower extremities revealed a brachial-ankle index of 1.1 on the right and 1.13 on the left both are normal. The aorta below the renal arteries and above the iliac arteries was normal in size, measuring 2.0 x 1.9 cm in maximum diameter in the mid section. IMPRESSION • Mr. Epstein's leg symptoms may be coming from spinal issues. He will follow up with Dr. Woodson Merrell. PLAN • Followup with Dr. Woodson Merrell. D:12/2/701013:22 ET (005) IRIS T 12/0/2010 10:18 ET/um/sk 11-4S4t . /.. • s .....1. cc: Dr. Woodson Merrell RONY Y. SHIMONY, MD, FACC (Phone: 212-535-1012, Fax: 212.535.1172) Dr. Eva Andersson-Dubin 1040 5th Ave Fl 15 New York NY 10028 Era ILE Intenenlionel Canfisc and Vaaculas Services, PC • 110 East 59th Street, alb Flow, New York, NY 100M-1504 Telt 212 7522700 • Nun 212 752 2949 EFTA01108074 FROM T0012126351172 01/10/2011 156427 #4238 P 002/003 Sent 12/02/2010 14 14 56. Page - 2 LENOX RILL HOSPITAL TRENT OF RADIOLOGY Fi .1/Addendum PATIENT: EPSTEIN,JEFFREY PT TYPE: OP MR NO: 1530026 ACCT 101888945 DOH: 01/20/1953 HOS? SVC: PCV CLI: PCV ATTENDING PRY ICILH: RONY . SHIMONY, MD ORDERING PHYSIC/AN: BONY Y. SHIMONY, MD EXAM: 12/02/2010 1000 CT ANGIO CORONARY ARTERIES CPT:75574 ADMIT DIAGNOSIS: REASON: SCREENING