To: Dr. Maxa and team

Re: Bloodwork - Follow Up testing - Harold Michael Smith, Jr. - 1/10/1969

I wanted to provide a little more lifestyle data, as well as the results of other testing that I have undergone in advance of my next appointment (which is currently scheduled for 2/17/2023). Along with this, I would like to request that Dr Maxa consider ordering some additional testing. Because there are a few topics at hand, I will number them in a list for clarity.

  1. Lipid Panel - Considering that I have varied my macro-nutrient profile significantly over the past year and my body composition has changed fairly dramatically, many metabolic indicators may be abnormal. Before applying a cholesterol-lowering medication immediately, I would like to apply recommended nutritional and exercise-based measures for a period of time and then repeat these tests. Recognizing that my triglyceride and HDL absolute values and ratio are good, the high LDL number is less indicative of an increased risk of the formation of arterial plaque.
  1. Suggestion:
  1. Patient apply lifestyle interventions (nutrition and exercise)
  2. Order Coronary Calcium Scan
  3. Repeat Lipid Panel 2/17, including particle size detail
  4. Repeat (full) Lipid Panel after 4+ months of lifestyle interventions
  1. Potassium - Above reference range per CMP 1/19/2023.
  1. When we repeat the CMP and Lipid panel, I would like to also perform the tests listed below.

Hemoglobin A1c

C-Peptide

Vitamin D – 25

DHEA-S

ESR

Iron

Ferritin

Fasting Insulin

GGT

Homocysteine

hsCRP

Magnesium (Mg)

Phosphorous (P)

TSH

Testosterone                

Sex Hormone Binding Globulin

  1. BMC/BMD - Based on (2) DXA scans, my Bone Mineral Content and Bone Mineral Density may be below ideal ranges.
  1. T-Score: -0.50

  1. Would Dr Maxa recommend a Bone Density Screening?
  1. Additional metabolic data for my record (as measured 8/16/2022)
  1. RER:  0.74
  2. RMR: 1515 kcals
  3. VO2 Max: 38 ml/min/kg

Additional details of my physiological journey can be found at the links below. These are my personal, publicly-available webpages:

Hacking Ultra: A Systems Approach to the Ultramarathon

https://www.youtube.com/@hackingultra

Blood Markers

http://blog.hackingultra.com/hacking-ultra/blood-markers/

Body Composition and Fitness

http://blog.hackingultra.com/hacking-ultra/fitness-measurement/

Metabolic Adaptation – Protein-based Gluconeogenesis for Glycogen and Blood Glucose (Brain) Requirements

http://blog.hackingultra.com/hacking-ultra/metabolic-adaptation-the-protein-as-fuel-question/