Heavy regimen locked in.
Tics are Dad's biggest current complaint. Pushing for Phase 2 transition + neurologist access.
This week
Concrete actions for Paul, Angela, and Joe.
- Request scans from Good Samaritan Hospital. Dad's direct ask on the 5/27 call — he wants Paul to review the EKG, MRI, and CT from his April admission to adjust care. Two paths: ask Good Sam directly (long shot — privacy walls), and ask Lynn (much more likely; she probably already has them in his Haven file).
- Push for Phase 2 transition + neurologist consult. Dad is eager to move to The Recovery Team — phone access, pool, and (per his ask) a neurologist for the Tourette's. He reports Dr. Ignatov has done what he can on the tic side. Stephanie (counselor) was on the call and aware. Ask Lynn about Phase 2 bed-hold timing + whether The Recovery Team has neurology access.
- Standing asks for Lynn / Dr. Ignatov. Confirm EKG on file from April ER, get Watchman implant date, push the gabapentin / kindling-prophylaxis question. Bundle into the same call as the scans + Phase 2 ask.
- Update Dad's chart re: allergies. Aspirin = historical childhood, currently tolerated post-CABG (Nov 2023). Epinephrine = not a real allergy; childhood reaction was Kounis-syndrome anaphylaxis. Shellfish = anaphylactic with cardiac arrest history.
- Phase 3 prep — start identifying Apollo Beach providers. Insurance verification has the longest lead time. Full prep doc →
Watching for
Soft alerts on the medical side. Not crises — just stuff to keep eyes on.
SI monitoring — duloxetine window
Through 2026-06-05
Black-box warning is most active in first 14 days of SNRI treatment. Duloxetine started 5/22 → window closes 6/5. Confirm daily SI check-ins with his counselor through that date.
DAPT step-down planning
Gated on Watchman implant date
Aspirin + clopidogrel is a time-limited post-Watchman protocol (45 days–6 months typical). Need the implant date to know when it steps down to aspirin alone.
Olanzapine metabolic effects
Insulin 57, A1c 5.8 at baseline
Olanzapine is the worst atypical for insulin resistance. Continuous glucose monitor (Dexcom Stelo / Libre Lingo, OTC) would catch excursions early. Worth applying.
Sleep stack — Phase 2 consolidation
6 agents currently
Melatonin + olanzapine + trazodone + Vistaril + valerian + passion flower. Heavier than needed long-term. Plan to taper as PAWS subsides at The Recovery Team.
Tics — limited current relief
Per Dad, 5/27 call
NAC 300mg/day + clonidine PRN aren't fully covering it. Dad reports this is his biggest current complaint and a key reason he wants Phase 2 — neurologist access. NAC dose escalation + neurology consult both on the ask list.
Recent updates
- Call with Dad — eager for Phase 2, tics biggest complaint, requesting Good Sam scans (notes)
- Full doctor's orders received + dashboard refactored
- Cardiovascular block locked in (atorvastatin + metoprolol + clonidine taper)
- Clopidogrel added — post-Watchman DAPT
- NAC started for tics
- Duloxetine started — SI window opens
By section
Quick view of what's behind each area.
🗺️ Care plan
Phase 1 / 2 / 3 + what we're pushing
Phase 1 (Haven, current) → Phase 2 (The Recovery Team PHP) → Phase 3 (IOP at home in Apollo Beach). Includes the kindling explainer + modern lenses.
💊 Medications
12 scheduled · ~25 PRN
Five cardiovascular meds (post-Watchman DAPT + AFib + HTN). Three psych scheduled. Six-agent sleep stack. Per-drug concerns + monitoring asks.
👥 Care team
Haven now · Apollo Beach next
Lynn (DON, primary liaison), Dr. Ignatov (medical director, ABPM dual-board), Erin Sharp (PMHNP), Corrin (EMDR), counselor, deputy, peer.
🧪 Labs
2025 Function Health baseline
Severe baseline insulin resistance + atherogenic dyslipidemia + sustained high-titer ANA. Reassuring liver/kidney/thyroid. Reference point for current monitoring.
📅 Timeline
CABG 2023 → today
Chronological log of medical events + recovery milestones + medication starts.
🧬 About Dad
Foundational medical history
Tourette's since adolescence. AFib + Watchman. CAD + quadruple bypass (Nov 2023). Mini-stroke (2025). Chronic back pain. Allergies clarified.