Metric	Start (mid-Jul)	Now		Source
Blood Pressure	129/86	117/77	▾ better	cuff — most reliable
Nocturnal Dip	6.2%	6.3%	▾ better	ring estimate
Arterial Stiffness (PWV)	7.97	7.67	▾ better	ring estimate — trend only
Vascular Age	52	48	▾ better	ring estimate
Weight	185 lb	168.4 lb	▾ better	since April peak
Resting HR	55	59	▾ better	athletic both

Show all 30 readings

When	Reading	Pulse
08-20 11:14	128/85	56	PM
08-12 07:41	120/82	63	AM
08-03 16:37	118/67	73	PM
07-30 15:21	123/81	58	PM
07-29 21:40	120/80	59	EVE
07-29 18:05	123/83	59	EVE
07-29 11:39	117/79	58	PM
07-29 07:52	109/70	85	AM
07-27 23:46	118/77	80	NIGHT
07-27 14:15	118/71	68	PM
07-27 07:28	111/67	78	AM
07-27 06:55	114/76	64	AM
07-26 20:44	118/79	88	EVE
07-26 09:50	121/84	64	AM
07-25 15:37	108/73	76	PM
07-25 14:00	112/75	81	PM
07-25 13:07	109/77	80	PM
07-23 19:48	126/84	79	EVE
07-23 17:29	124/84	72	EVE
07-23 07:34	103/66	79	AM
07-22 22:56	124/84	67	NIGHT
07-22 19:45	129/83	82	EVE
07-21 23:21	115/77	68	NIGHT
07-20 10:03	133/86	73	AM
07-16 16:23	132/87	87	PM
07-16 14:08	134/92	74	PM
07-15 23:46	113/72	64	NIGHT
07-15 14:37	124/84	73	PM
07-15 12:14	135/90	71	PM
07-15 10:22	135/90	72	AM

Show all 39 nights

Night	Dip %
2026-08-20	6.3%
2026-08-19	5.8%
2026-08-13	4.2%
2026-08-11	8.3%
2026-08-10	5.8%
2026-08-04	15.4%
2026-08-01	6.1%
2026-07-31	8.0%
2026-07-30	3.4%
2026-07-29	12.6%
2026-07-28	9.0%
2026-07-27	12.5%
2026-07-26	9.7%
2026-07-25	6.2%
2026-07-24	3.0%
2026-07-23	8.4%
2026-07-22	4.9%
2026-07-19	2.5%
2026-07-18	4.3%
2026-07-17	3.8%
2026-07-16	7.6%
2026-07-14	7.3%
2026-07-13	5.8%
2026-07-12	7.5%
2026-07-11	5.4%
2026-07-07	8.0%
2026-07-06	4.1%
2026-07-01	4.5%
2026-06-27	9.9%
2026-06-20	5.6%
2026-06-19	4.5%
2026-06-18	9.5%
2026-06-17	7.7%
2026-06-15	3.4%
2026-06-14	8.8%
2026-06-12	4.3%
2026-06-11	5.7%
2026-06-10	12.1%
2026-06-09	5.5%

Show all weight readings

Date	Weight (lb)
2026-08-26	168.4
2026-08-20	170.6
2026-08-12	173.0
2026-07-25	176.0
2026-07-23	180.0
2026-07-20	178.0
2026-07-16	181.6
2026-04-26	185.0
2025-08-15	181.0
2024-02-15	183.0
2024-01-15	182.0
2023-10-15	180.2
2023-03-15	179.0
2023-02-15	183.4
2023-01-15	181.2
2022-10-15	176.0
2022-06-15	172.0
2022-04-15	172.8
2022-01-15	168.0
2021-02-15	162.5
2019-08-15	170.0
2019-04-15	173.0
2018-07-15	168.0

Show HRV readings

Date	Avg HRV (ms)	Resting HR
2026-07-25	24.0	68.65
2026-07-24	31.0	66.52
2026-07-23	37.0	61.44
2026-07-22	28.0	65.61
2026-07-19	24.0	73.24
2026-07-18	26.0	70.18
2026-07-17	23.0	69.99
2026-07-16	26.0	66.64
2026-07-14	34.0	64.95
2026-07-13	28.0	69.82
2026-07-12	26.0	64.11
2026-07-11	47.0	62.94
2026-07-07	36.0	64.14
2026-07-06	37.0	63.66
2026-07-01	23.0	74.85
2026-06-27	22.0	71.86
2026-06-20	33.0	64.26
2026-06-19	35.0	65.51
2026-06-18	41.0	65.9
2026-06-17	45.0	65.68
2026-06-15	26.0	69.82
2026-06-14	35.0	66.0
2026-06-12	28.0	70.84
2026-06-11	27.0	69.91
2026-06-10	42.0	64.15
2026-06-09	39.0	66.15
2026-06-01	35.0	67.05
2026-05-31	20.0	79.07
2026-05-28	32.0	65.14
2026-05-27	35.0	63.77
2026-05-20	41.0	61.17
2026-05-19	39.0	64.11
2026-05-16	41.0	65.32
2026-05-15	28.0	68.77
2026-05-14	25.0	69.1
2026-05-11	27.0	68.34
2026-05-10	27.0	68.37
2026-05-09	41.0	65.88
2026-05-08	27.0	68.03
2026-05-05	38.0	66.31

Show daily food log

Date	kcal	Prot	Carb	Fat	Na
08-22	0	0g	0g	0g	0
08-13	1440	126g	24g	95g	1060
08-12	210	2g	18g	0g	0
08-10	405	25g	8g	30g	1000
08-09	1495	75g	95g	65g	2100
08-07	800	63g	14g	44g	1350
08-03	700	24g	60g	26g	1300
08-02	1080	100g	9g	57g	1100
08-01	750	30g	65g	28g	900
07-31	805	35g	71g	33g	1360
07-30	470	31g	24g	21g	960
07-29	840	64g	14g	49g	1300
07-28	700	55g	4g	50g	700
07-27	1215	64g	67g	49g	2250

Coronary Artery Calcium (CAC) score NORMAL 0 Agatston

ZERO

MINIMAL 1-99

MODERATE 100-299

SEVERE 300+

0400 Agatston

✓ ZERO ◄ lower is better

2026-08-26 · CT Coronary Artery Calcium Score, read by Matthew Kirby MD, signed 2026-08-26 13:31; ordered by Michael A Tolle MD

What this means long termThe strongest single piece of cardiac reassurance in this whole record. Zero means no detectable calcified plaque anywhere in the coronary arteries, and it is one of the most powerful DOWNWARD modifiers of predicted risk available. Two honest limits: it detects calcified plaque only, and it is not permanent. MESA data put the 'warranty period' of a zero score at roughly 3 to 7 years, which is the basis for the 5-to-7-year rescan advice. With Lp(a) at 140 there is a published argument for a shorter interval, since Lp(a) is linked to non-calcified plaque a calcium scan cannot see.

Total 0 Agatston. Per-vessel all zero: LMA 0, LAD 0, LCX 0, RCA 0, PDA 0. No identifiable plaque burden, low CAD risk. Radiologist repeat guidance: 5-7yr if low risk, 3-5yr if intermediate, 3yr if high risk or diabetic (NOTE: this differs from the 1-year relayed by phone 8/27). CAVEAT: CAC detects CALCIFIED plaque only.

CT: Pulmonary nodule INCIDENTAL 3 mm, left lower lobe mm

INCIDENTAL

▲ INCIDENTAL qualitative finding

2026-08-26 · CT Coronary Calcium, Kirby MD, signed 2026-08-26

What this means long termA 3 mm nodule is at the very bottom of the size scale, where estimated malignancy risk in a never-smoker is well under 1 percent. Per the radiologist, no follow-up is required in a low-risk patient, and never having smoked places you firmly in that column. The most likely origin is an old healed granuloma from a silent past infection, which is extremely common in this region. The one real limitation is that no prior imaging exists for comparison, so this scan becomes the baseline for any future one.

3 mm LLL nodule, image 24. Per radiologist: in a LOW-risk patient no further follow-up required; in a HIGH-risk patient follow-up imaging at 1 year. Never-smoker = low-risk column, so no follow-up indicated. Cardiologist described it verbally as "a small little nodule, not a big deal".

CT: Aortic valve calcification ABNORMAL Present

PRESENT

▲ PRESENT qualitative finding

2026-08-26 · CT Coronary Calcium, Kirby MD, signed 2026-08-26

What this means long termCalcium deposits on the aortic valve. Two reasons this deserves more attention than it received: elevated Lp(a) is specifically associated with aortic valve disease, and this sits alongside a family history of aortic dissection. Critically, a non-contrast calcium-score CT CANNOT assess stenosis, measure the aortic root, or determine whether the valve is bicuspid or tricuspid. Those questions need an echocardiogram, and they are currently unanswered. This is the strongest argument for requesting one.

Aortic valvular calcifications on the extracoronary structures read. No stenosis assessment on a non-contrast calcium-score CT. RELEVANT to the standing family history of aortic issues (grandfather, 2nd degree) and to the baseline aortic-root echo request already on the 2026-08-20 ask list - this strengthens that ask.

CT: Hepatic steatosis ABNORMAL Present

PRESENT

▲ PRESENT qualitative finding

2026-08-26 · CT Coronary Calcium, Kirby MD, signed 2026-08-26

What this means long termFat in the liver. The supporting labs say it is mild and metabolic rather than alcohol related: an AST/ALT ratio of 0.49 is the classic non-alcoholic pattern, and normal platelets, albumin and bilirubin all argue against scarring or impaired function. This is the finding most responsive to what you are already doing, since exercise reduces liver fat even without weight loss, and 7 to 10 percent weight loss improves it substantially.

Fatty liver on CT. Cardiologist: "not good but not bad", watch it, nothing to do for now, go easy on alcohol. Corroborating labs: ALT 65 (upper-normal), triglycerides 157, HDL 36, normal platelets 299 (argues against advanced fibrosis). AST/ALT ratio 0.49 = NAFLD pattern, not alcohol pattern.

CT: Other extracoronary NORMAL No effusions

NORMAL

✓ NORMAL qualitative finding

2026-08-26 · CT Coronary Calcium, Kirby MD, signed 2026-08-26

What this means long termNo pericardial or pleural effusions, no lung consolidation, only age-appropriate spinal changes. Nothing incidental beyond the findings listed separately.

No pericardial or pleural effusions. Visualized lung fields without focal consolidation. Age-related degenerative changes of the spine.

ECG, 12-lead NORMAL Sinus rhythm, within normal limits

NORMAL

✓ NORMAL qualitative finding

2026-08-26 · MyChart, ECG-ROUTINE 12 LEAD W/INTRPT & RPT

What this means long termNormal sinus rhythm within normal limits: rate, rhythm and conduction all unremarkable, with no evidence of prior silent heart attack, no chamber enlargement, no arrhythmia. Together with a zero calcium score this is a clean baseline cardiac assessment.

Normal. NOTE: portal shows "Not yet reviewed by care team", though the cardiologist reviewed it verbally at the 2026-09-01 visit ("Your EKG is normal").

Lipoprotein(a) / Lp(a) HIGH 140 nmol/L

OPTIMAL

MODERATE

HIGH

0250 nmol/L

▲ HIGH ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termGenetic and lifelong: diet, exercise and weight loss do not move it, and statins do not meaningfully lower it either. Roughly 1 in 5 people carry an elevated level. It raises lifetime risk of coronary disease and of aortic valve stenosis over decades. Because the number itself is fixed, the entire long-term strategy is to push the risks that CAN move (LDL, ApoB, blood pressure) further down than standard targets to compensate. This single value is why a statin was started despite a zero calcium score.

RESOLVED from pending placeholder. Ref <75. Risk cut points (Tsimikas JACC 2017;69:692-711): optimal <75, moderate 75-125, HIGH >125. At 140 = high category, ~1.9x optimal ceiling. Genetically determined, not modifiable by diet/exercise/weight loss. Basis for cardiologist starting rosuvastatin 2026-09-01 and for "getting off it is possible but not probable".

ApoB HIGH 101 mg/dL

OPTIMAL

MODERATE

HIGH

40160 mg/dL

▲ MODERATE ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termCounts atherogenic particles directly, so it predicts cardiovascular risk better than LDL cholesterol does. One particle carries one ApoB, meaning two people with identical LDL can carry very different particle counts. On lipid-lowering therapy with elevated Lp(a), a desirable long-term target is under 80. This is the number to watch at the December recheck.

Ref <90. Optimal <90, moderate 90-129, high >=130. Currently MODERATE. Desirable target <80 for lipid-lowering therapy / elevated-risk patients. Best single measure of atherogenic particle count; more informative than LDL-C. Statin target.

LDL Cholesterol (calc) HIGH 116 mg/dL

OPTIMAL

BORDERLINE

HIGH

VERY HIGH

40200 mg/dL

▲ BORDERLINE ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe primary modifiable driver of plaque formation, and the direct target of rosuvastatin. Cumulative lifetime LDL exposure, not any single reading, is what builds arterial plaque, so years spent lower compound in your favour. The cardiologist asked for 'very low' without naming a figure; with Lp(a) at 140 the usual intent is well under 70. Worth getting that target stated explicitly.

Lab ref 0-99. NCEP: optimal <100, low-risk 100-129. Cardiologist wants this "very low" given Lp(a) 140. Primary target of rosuvastatin 5mg started 2026-09-01.

HDL Cholesterol LOW 36 mg/dL

LOW

ACCEPTABLE

PROTECTIVE

2090 mg/dL

▲ LOW higher is better ►

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termLow HDL travels with high triglycerides and fatty liver as part of one metabolic pattern rather than three separate problems. Raising it with drugs has repeatedly failed to improve outcomes, so it is best read as a marker of that underlying pattern. The levers that do move it are the ones already in motion: sustained aerobic exercise and continued fat loss.

Ref >=40. Low. Not directly drug-targeted; exercise and weight loss are the levers already in motion.

Triglycerides HIGH 157 mg/dL

NORMAL

BORDERLINE

HIGH

50500 mg/dL

▲ BORDERLINE ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termHighly responsive to carbohydrate intake, alcohol and body fat, so this is among the most movable numbers here. Mildly elevated alongside HDL 36 and hepatic steatosis, it points at insulin resistance even though A1c is normal. Sustained low-carbohydrate eating typically improves this one first, often well before the other lipids shift.

Ref 0-150. Mildly high. Pairs with HDL 36 and hepatic steatosis: metabolic/insulin-resistance pattern despite normal A1c.

Total Cholesterol NORMAL 183 mg/dL

DESIRABLE

BORDERLINE

HIGH

100300 mg/dL

✓ DESIRABLE ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termIn range, and the least useful number in this panel. Total cholesterol lumps together the atherogenic particles and the protective HDL, so a 'normal' total can hide a bad split. Yours does exactly that: 183 looks fine while ApoB, LDL and non-HDL are all above target and HDL is low. Judge the components, not this.

Ref 7-200. In range, and the least useful number in the panel given high ApoB/LDL and low HDL.

Total Chol / HDL Ratio HIGH 5.1 ratio

OPTIMAL

ACCEPTABLE

ELEVATED

HIGH

29 ratio

▲ ELEVATED ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termA composite risk index rather than a thing to treat. Currently driven almost entirely by the low HDL of 36 rather than by an alarming total cholesterol. It will improve as either HDL rises or LDL falls, so expect the statin to move it without HDL changing at all.

Ref <5.0. Driven by the low HDL of 36.

Non-HDL Cholesterol HIGH 147 mg/dL

OPTIMAL

ABOVE GOAL

HIGH

60220 mg/dL

▲ ABOVE GOAL ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termCaptures every atherogenic particle in one number, which makes it more reliable than LDL when triglycerides are elevated. Recommended goal is 30 above the LDL goal. Tracks closely with ApoB, so if the two ever disagree markedly, ApoB is the one to trust.

Ref <130. Recommended goal <130, i.e. 30 above the LDL goal.

Hemoglobin A1c NORMAL 5.4 %

NORMAL

PRE-DIABETES

DIABETES

4.08.0 %

✓ NORMAL ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termReflects average blood sugar over roughly three months, so it is immune to the day-to-day noise that makes a single glucose reading unreliable. At 5.4 this is solidly normal and is the reason the isolated fasting glucose of 103 should be read as a blip rather than as early prediabetes. The most reassuring metabolic number in the panel.

Ref 4.0-5.6. Normal. 5.7-6.4 = increased diabetes risk. IMPORTANT: this normal A1c contextualizes the single fasting glucose of 103 as a one-morning blip, NOT prediabetes.

Glucose (fasting) HIGH 103 mg/dL

NORMAL

IMPAIRED

DIABETIC

60140 mg/dL

▲ IMPAIRED ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termA single morning snapshot, easily pushed up by stress, poor sleep, or the dawn cortisol rise, and notably unreliable on a low-carbohydrate diet where physiological insulin resistance is expected. Read it against the A1c of 5.4, which says three months of average glucose were normal. Worth rechecking in December rather than acting on now.

Ref 70-99. Marginally high on a single fasting draw. Interpret against A1c 5.4 (normal) - not prediabetic. Worth retesting with the 3-month Quest panel.

Creatinine NORMAL 1.2 mg/dL

LOW

NORMAL

ELEVATED

0.42.0 mg/dL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termA muscle-breakdown product the kidneys clear, so it stands in for kidney function. Upper-normal here, and worth reading alongside eGFR 74. Muscle mass and a meat-heavy diet both push it up independently of kidney health, so in a lean, active, low-carb eater an upper-normal value is less alarming than the same number in a sedentary person. Trend it rather than react to it.

Ref 0.6-1.3. Upper-normal.

eGFR NORMAL 74 mL/min/1.73m2

KIDNEY DISEASE

MILDLY REDUCED

NORMAL

20120 mL/min/1.73m²

✓ MILDLY REDUCED higher is better ►

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termEstimates kidney filtration. Relevant here specifically because lisinopril acts on the kidney and dehydration transiently lowers filtration, which is exactly the combination flagged for remote travel. Adequate now, and the number to trend rather than react to. A single value is far less informative than its direction over years.

Ref >60. Adequate. Relevant to lisinopril (ACE inhibitor) - worth trending, especially with dehydration risk on the Tonga trip.

BUN NORMAL 22 mg/dL

LOW

NORMAL

ELEVATED

440 mg/dL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termUrea nitrogen rises with dehydration and with high protein intake, and falls with liver disease. Upper-normal here and consistent with the concentrated urine on the same draw, so read it as a hydration signal rather than a kidney problem, particularly given the ACE inhibitor and the hot-climate travel ahead.

Ref 7-25. Upper-normal. Consistent with the concentrated urine (SG 1.031) on the same draw = mild dehydration at collection.

BUN/Creatinine Ratio NORMAL 18.33 ratio

LOW

NORMAL

ELEVATED

435 ratio

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe ratio separates dehydration from intrinsic kidney disease: dehydration raises BUN faster than creatinine and pushes this ratio up. At 18.3 it sits in the upper half of normal, which fits mild dehydration at the draw and matches the specific gravity of 1.031.

Ref 6-25.

Sodium NORMAL 141 mmol/L

LOW

NORMAL

HIGH

125155 mmol/L

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termTightly regulated, so it moves very little even when intake swings. Normal here. Relevant to watch on a diuretic or with heavy sweating plus large volumes of plain water, which is the scenario worth respecting on a remote trip.

Ref 135-146.

Potassium NORMAL 4.6 mmol/L

LOW

NORMAL

HIGH

3.06.0 mmol/L

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe specific safety check for being on an ACE inhibitor, which raises potassium. Normal here, which closes that open question. The standing caution is unchanged: avoid potassium supplements and salt substitutes, and be careful with concentrated electrolyte packets on the trip, since those are the realistic route to a dangerous level.

Ref 3.5-5.3. ANSWERS THE OPEN LISINOPRIL QUESTION from the 2026-08-20 ask list: serum K+ is normal on the ACE inhibitor. Concentrated-K+ electrolyte packets remain the thing to flag, but no current hyperkalemia.

Chloride NORMAL 109 mmol/L

LOW

NORMAL

HIGH

90120 mmol/L

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termTracks sodium and acid-base balance. Upper-normal and unremarkable on its own; it is interpreted with CO2 and the anion gap rather than alone.

Ref 98-110. Upper-normal.

CO2 (bicarbonate) NORMAL 25 mmol/L

LOW

NORMAL

HIGH

1538 mmol/L

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe blood's buffering reserve. Normal, which argues against any meaningful acid-base disturbance. Worth a glance on a sustained ketogenic diet, since deep ketosis can nudge it down; yours is mid-range, so nothing to note.

Ref 21-31.

Anion Gap NORMAL 7 mmol/L

LOW

NORMAL

ELEVATED

224 mmol/L

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termA calculated check for unmeasured acids in the blood. Normal at 7, which rules out the acid buildup that would matter on a ketogenic diet. Nutritional ketosis does not produce a dangerous gap; this confirms that in your case.

Ref 5-16.

Calcium NORMAL 9.4 mg/dL

LOW

NORMAL

HIGH

7.511.5 mg/dL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termNormal, and here is the important subtlety: a normal blood calcium does NOT rule out the vitamin D deficiency doing harm. The body defends blood calcium first, pulling it from bone if absorption drops. So this number staying normal while vitamin D sits at 14 is expected, and it is not evidence that the deficiency is harmless.

Ref 8.6-10.4. Normal despite vitamin D deficiency of 14.

ALT (SGPT) NORMAL 65 U/L

NORMAL

ELEVATED

10120 U/L

✓ NORMAL ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe liver enzyme most specific to liver cells. In range but near the ceiling, which matters because CT already showed hepatic steatosis, and because statins warrant baseline liver enzymes. Fatty liver is often reversible with continued fat loss and low alcohol, so the long-term question is simply whether this drifts up or settles down at the recheck.

Ref 21-72. In range but near the ceiling. Notable because CT showed hepatic steatosis - this is the enzyme to watch, and rosuvastatin makes baseline liver enzymes worth trending.

AST (SGOT) NORMAL 32 U/L

NORMAL

ELEVATED

10120 U/L

✓ NORMAL ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termNormal. Read together with ALT it is the more useful signal: the AST/ALT ratio here is 0.49, well under 1, which is the pattern typical of non-alcoholic fatty liver rather than alcohol-related damage. That is consistent with the near-zero reported alcohol intake and argues the steatosis is metabolic in origin.

Ref 10-62. Normal. AST/ALT ratio 0.49 (<1) is the typical NAFLD pattern rather than alcohol-related, consistent with reported near-zero alcohol intake.

Alkaline Phosphatase NORMAL 72 U/L

LOW

NORMAL

ELEVATED

20250 U/L

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termComes from liver bile ducts and from bone. Normal here, which helps separate the fatty liver (a liver-cell problem, reflected in ALT) from a bile-duct problem, and offers some reassurance on the bone side despite the low vitamin D.

Ref 40-150.

Bilirubin, Total NORMAL 0.4 mg/dL

NORMAL

ELEVATED

02.5 mg/dL

✓ NORMAL ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termA breakdown product the liver clears. Normal, which indicates the liver's processing function is intact. Together with normal albumin and normal platelets, it says the fatty liver has not impaired how the organ actually works.

Ref 0.2-1.2.

Albumin NORMAL 4.6 g/dL

LOW

NORMAL

HIGH

2.56.0 g/dL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe main protein the liver manufactures, and one of the best single indicators that the liver is doing its synthetic job. Solidly normal at 4.6. This is meaningful reassurance about the hepatic steatosis: fat is present, but function is preserved.

Ref 3.6-5.1.

Total Protein NORMAL 6.5 g/dL

LOW

NORMAL

HIGH

5.09.5 g/dL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termAlbumin plus globulins. Normal, in the lower half of range, which is unremarkable and consistent with the normal albumin.

Ref 6.0-8.3.

Globulins NORMAL 1.9 g/dL

LOW

NORMAL

HIGH

1.05.5 g/dL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe antibody and transport-protein fraction. At the low end of normal, which is not a problem and argues against chronic inflammatory or immune activation, a mildly useful counterpoint to the slightly raised eosinophils.

Ref 1.8-4.2.

A/G Ratio NORMAL 2.4 ratio

LOW

NORMAL

HIGH

0.53.5 ratio

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termAlbumin divided by globulins. At the top of normal because globulins are low rather than because anything is wrong. A LOW ratio is the one that prompts investigation; yours is the opposite.

Ref 1.0-2.5.

TSH NORMAL 0.976 mIU/L

SUPPRESSED

NORMAL

ELEVATED

0.16.0 mIU/L

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe pituitary's instruction to the thyroid, and the single best measure of whether levothyroxine dosing is right. Sitting comfortably mid-range on 0.125 mg means the Hashimoto's is well controlled: not under-replaced (which would push TSH up) and not over-replaced (which would suppress it, a real concern long term for bone density and atrial fibrillation).

Ref 0.460-4.460. Mid-range. ANSWERS the TSH/free-T4 recheck request from the 2026-08-20 ask list: levothyroxine 0.125mg dosing is well titrated for the Hashimotos.

Free T4 (Thyroxine) NORMAL 1.44 ng/dL

LOW

NORMAL

HIGH

0.42.0 ng/dL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe circulating hormone your levothyroxine directly supplies. Sits high in the normal range, which is typical and expected on replacement therapy because you are taking T4 directly rather than making it in a steady trickle. With a mid-range TSH this is not over-replacement.

Ref 0.70-1.48. High-normal, which is typical and expected on levothyroxine replacement. Not a problem with TSH 0.976.

Free T3 (Triiodothyronine) NORMAL 2.43 pg/mL

LOW

NORMAL

HIGH

1.04.5 pg/mL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe active hormone your body converts from T4. Mid-range, which shows conversion is working normally, the thing people on levothyroxine sometimes worry about. Nothing here supports adding T3 therapy.

Ref 1.58-3.91. Mid-range.

Vitamin D, 25-OH Total LOW 14 ng/mL

DEFICIENT

INSUFFICIENT

OPTIMAL

HIGH

080 ng/mL

▲ DEFICIENT higher is better ►

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe most out-of-range actionable value in this panel, and it was never raised at the cardiology visit. Long-term deficiency affects bone density, immune function and muscle strength, and is independently associated with both fatty liver and higher blood pressure, which are the two other findings here. Unlike Lp(a) this is fully correctable with supplementation. Not a false low: the assay only under-reads above triglycerides 500.

Ref >29. DEFICIENT per Endocrine Society (deficiency <=20, insufficiency 21-29, optimal >=30). At 14 this is the single most out-of-range actionable value in the entire panel and was NOT raised at the 2026-09-01 cardiology visit. Assay: CMIA, Abbott Alinity. NOT falsely low - triglycerides 157 are well under the >500 interference threshold. ACTION: raise with Dr Tolle for a repletion protocol.

WBC NORMAL 5.6 10*3/uL

LOW

NORMAL

ELEVATED

2.015.0 10³/µL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termTotal immune cell count. Normal, and this is the context that makes the mildly raised eosinophils reassuring rather than concerning: the overall count is unremarkable, so nothing suggests a systemic process. An isolated small rise in one subtype against a normal total is a far more benign picture.

Ref 4.0-9.6.

RBC NORMAL 5.23 10*6/uL

LOW

NORMAL

HIGH

3.56.5 10⁶/µL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termRed cell count. Normal, in the upper half, consistent with the mild dehydration at the draw concentrating the blood slightly.

Ref 4.20-5.60.

Hemoglobin NORMAL 15.9 g/dL

LOW

NORMAL

HIGH

1020 g/dL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe oxygen-carrying protein. Normal, which rules out anemia. Relevant to endurance training and to altitude or exertion tolerance, and reassuring before a physically demanding trip.

Ref 13.0-17.0.

Hematocrit NORMAL 49 %

LOW

NORMAL

HIGH

3060 %

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe proportion of blood volume made of red cells. Upper-normal, which is the third independent signal (with BUN and urine specific gravity) that you were mildly dehydrated at this draw. Dehydration concentrates blood and pushes this up without any change in actual red cell mass.

Ref 39-51. Upper-normal, consistent with the mild dehydration at draw.

Platelet Count NORMAL 299 10*3/uL

LOW

NORMAL

HIGH

80500 10³/µL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termIncluded here because falling platelets are one of the earliest quiet signals of advanced liver fibrosis. At 299 this is solidly normal, which is meaningful reassurance that the fatty liver seen on CT is mild rather than scarred. A useful number to keep watching alongside ALT over the coming years.

Ref 130-400. Normal platelets argue against advanced liver fibrosis from the steatosis.

MCV NORMAL 94 fL

LOW

NORMAL

HIGH

70110 fL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termAverage red cell size, the first clue to the cause of any anemia. Normal here. A high MCV can hint at B12 or folate deficiency or at alcohol use, so a mid-range value is a quiet point against both.

Ref 79-100.

MCH NORMAL 30 pg

LOW

NORMAL

HIGH

2238 pg

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termAverage hemoglobin per red cell. Normal, and consistent with the normal MCV. Nothing to act on.

Ref 27-34.

MCHC NORMAL 32 g/dL

LOW

NORMAL

HIGH

2840 g/dL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termHemoglobin concentration within red cells. At the lower boundary of normal, which on its own means little when MCV, MCH and hemoglobin are all normal.

Ref 32-36.

RDW-SD NORMAL 13 %

NORMAL

ELEVATED

1020 %

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termHow much red cell sizes vary. Normal, which argues against an early or evolving deficiency state, since mixed cell populations widen this before the average size ever shifts.

Ref 11.50-15.00.

Eosinophils, absolute HIGH 0.6 10*3/uL

NORMAL

MILD

MODERATE

02.0 10³/µL

▲ MILD ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termA white cell that rises with allergy and with parasitic infection. Only mildly elevated, and allergy or atopy is by far the likeliest explanation. Its real long-term value is as a documented pre-travel baseline: if this is rechecked after remote travel and has climbed, that becomes an interpretable signal instead of an ambiguous one. Note the draw predates the statin, so the new medication cannot explain it.

Ref 0.0-0.5. Mild eosinophilia; 11.3% of differential (typical upper normal ~5%). Common benign causes: allergy/atopy, asthma. Also worth considering given international travel history: parasitic infection, and drug reaction. NOT raised at the 2026-09-01 cardiology visit. ACTION: mention to Dr Tolle, especially pre/post remote travel.

Neutrophils, absolute NORMAL 3.0 10*3/uL

LOW

NORMAL

ELEVATED

0.510 10³/µL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe main bacterial-infection responder. Normal, no sign of acute infection or of significant systemic inflammation.

Ref 1.5-7.0. 53.2%.

Lymphocytes, absolute NORMAL 1.6 10*3/uL

LOW

NORMAL

ELEVATED

0.35.0 10³/µL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termViral-response and long-term immune memory cells. Normal, indicating intact baseline immune capacity.

Ref 0.8-3.2. 29.0%.

Monocytes, absolute NORMAL 0.3 10*3/uL

NORMAL

ELEVATED

01.5 10³/µL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termCleanup and chronic-inflammation cells. Normal. A persistently raised monocyte count can accompany chronic inflammatory states, so a normal value here is a mild point against any ongoing smouldering process.

Ref 0.2-0.8. 5.4%.

Basophils, absolute NORMAL 0.0 10*3/uL

NORMAL

ELEVATED

00.3 10³/µL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe rarest white cell, involved in allergic responses. Normal. Notable in your case because basophils often rise alongside eosinophils in allergic conditions, and yours did not, which slightly weakens a purely allergic explanation for the eosinophils and is worth mentioning.

Ref 0.0-0.1. 0.9%.

Immature Granulocytes, absolute NORMAL 0.0 10*3/uL

NORMAL

ELEVATED

00.3 10³/µL

✓ NORMAL mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termImmature white cells released early when the marrow is under pressure, typically in serious infection. Zero, as expected in a well person.

Ref 0.0-0.1. 0.2%.

NRBC NORMAL 0 /100 WBC

NORMAL

PRESENT

02 /100 WBC

✓ NORMAL ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termNucleated red cells should not circulate in adults. Zero, as expected. Their presence would signal marrow stress or a serious systemic illness, so this is a quiet all-clear.

Zero.

Urine Specific Gravity HIGH 1.031 SG

DILUTE

NORMAL

CONCENTRATED

1.01.04 SG

▲ CONCENTRATED mid-range is best

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termA direct read on hydration at the moment of collection, and it says mildly dehydrated at an 8:48am fasting draw in an air-conditioned building. That is the exact failure mode the cardiologist warned about for the trip: on an ACE inhibitor, sweating in heat without drinking risks a drop in blood pressure and fainting. Treat it as a baseline habit signal.

Ref 1.005-1.030. Concentrated = mildly dehydrated at the 08:48 fasting draw. Directly relevant to the cardiologist hydration warning on lisinopril.

Urine Culture NORMAL No Growth

NEGATIVE

✓ NEGATIVE qualitative finding

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termA final culture with no bacterial growth. This definitively clears the 'abnormal' tag on the urinalysis reflex and the 'few bacteria' seen on microscopy, which were almost certainly skin contamination during collection. No infection, no antibiotic, no action.

STATUS FINAL, RESULT: No Growth. CLEARS the "abnormal" flag on the urinalysis reflex and the FEW bacteria finding - no infection. No action needed.

Urinalysis (dipstick + micro) NORMAL Unremarkable

UNREMARKABLE

✓ UNREMARKABLE qualitative finding

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termNo protein, no blood, no glucose, no leukocyte esterase, no nitrites. The protein result matters most long term: on an ACE inhibitor with a family history of vascular disease, protein in the urine would be the earliest sign of kidney strain, and there is none.

pH 5, protein NEG, glucose normal, ketones NEG, blood NEG, leukocyte esterase NEG, nitrite NEG, bilirubin NEG, urobilinogen normal. WBC 1, RBC 1 (both ref 0-6). Squamous epithelial OCC, calcium oxalate crystals RARE, bacteria FEW. Only true out-of-range item is specific gravity 1.031.

PSA, Total NORMAL 0.6 ng/mL

NORMAL

ELEVATED

010 ng/mL

✓ NORMAL ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termWell below the referral threshold. The long-term value of this number is its trajectory: a rising trend over years is far more informative than any single reading, so having 0.6 on record at 49 is a useful anchor for every future test.

Ref 0.00-4.00. Well below cutoff. Abbott Alinity CMIA.

PSA, Free NORMAL 0.34 ng/mL

NORMAL

ELEVATED

02.0 ng/mL

✓ NORMAL ◄ lower is better

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termThe unbound fraction of PSA. Interpreted as a percentage of total rather than alone: yours is 57 percent, which is firmly reassuring. Reported here for completeness.

Abbott Alinity CMIA.

PSA, % Free NORMAL 57 %

SUSPICIOUS

REASSURING

0100 %

✓ REASSURING higher is better ►

2026-08-24 · Quest via MyChart, fasting draw 2026-08-24 08:48

What this means long termA higher percentage of free PSA points away from cancer. At 57 this is firmly in the reassuring range and, combined with a total PSA of 0.6, makes prostate cancer very unlikely at this time.

Ref >26%. Reassuring; higher % free = lower cancer probability.