About Dad
Foundational medical history — the pre-existing conditions that reframe how to read the current regimen. Not new diagnoses. Long-standing context the care team is managing around.
Vitals
- Name: Paul Mederos Sr.
- DOB: 2/14/1963 · 63 years old
- Pronouns: he/him
- Lives: Apollo Beach, FL · with Angela (spouse)
- Children: Paul (son) · Joe (son)
- Insurance: CareFirst BlueChoice (Open Access PPO) · Insurance & coverage →
Major conditions
Tourette's syndrome
~50 years · since adolescence · biggest current complaint (5/27)
The original reason benzodiazepines entered Dad's life decades ago — alprazolam (Xanax) for tic and anxiety control. Tics are not a new symptom; they're a lifelong feature.
Current regimen targets the tics with NAC 300 mg + clonidine PRN, but Dad reports (5/27 call) the tics are his worst-felt symptom right now and a key motivator for moving to Phase 2. He's asked for a neurologist consult — Dr. Ignatov reportedly has done what he can.
Irregular heartbeat (AFib) + Watchman device
Watchman placed ~2025 (date TBC)
Atrial fibrillation triggered the mini-stroke (likely ischemic, AFib-related). Watchman (left atrial appendage closure device) was implanted to prevent further stroke without chronic anticoagulation. This is the reason for the current aspirin + clopidogrel DAPT — standard post-Watchman 45-day–6-month protocol, then step-down to aspirin alone.
Ventricular arrhythmia (history)
Amiodarone prescribed — per Oct 2025 list, since stopped
The Oct 2025 baseline shows amiodarone (a serious antiarrhythmic) prescribed for ventricular arrhythmias — deeper than the AFib alone — apparently stopped over "vision problems" (a classic amiodarone ocular side effect). Active vs. resolved needs cardiology to confirm, but it raises the stakes on every QT-prolonging med (olanzapine, duloxetine, any tic antipsychotic). Flag for the cardiology handoff.
ADHD + migraine
Both treated in Oct 2025 · meds since dropped
The Oct 2025 list shows Quelbree (viloxazine) for ADHD and Nurtec (rimegepant) for migraine — both active then, both gone from the current regimen. The non-stimulant ADHD choice was tic-smart. If headaches or attention issues resurface, these are known, effective tools that fell off the list.
Coronary heart disease + quad bypass
Quadruple bypass · November 2023
Established coronary artery disease + quadruple bypass in Nov 2023 (~2.5 years ago). Drives the high-intensity statin (atorvastatin 40 mg), the beta-blocker (metoprolol), and aggressive lipid management. Origin point for daily aspirin tolerance — taken without issue from this event onward.
Mini-stroke
TIA / small infarct · 2025
Discovered weeks after the event via subtle memory issues + slurred speech, triggered scans. Likely AFib-related embolic. Led to Watchman implant. Type TBC — needs cardio records.
Pre-diabetes signals + risky cholesterol pattern
2025 Function Health baseline
Fasting insulin 57, A1c 5.8%, LDL-P 1789, small dense pattern B, HDL 26, TG 237. Already on the edge. Olanzapine 10 mg HS is the main pharma vector for worsening this. Full labs →
Chronic back pain
Original opioid indication
The ~6-month opioid stretch was for back pain — hydrocodone-acetaminophen (4–5/day) + morphine, per the Oct 2025 list. Current non-opioid management: lidocaine patch nightly + acetaminophen PRN. Ibuprofen on PRN list but bleed risk on DAPT — should be flagged.
Elevated autoimmune marker (ANA)
2025 baseline · ≥1:1280
Two draws positive at top of ladder, all specific autoantibodies negative, ESR + complement normal. Could be drug-induced (long benzo history). Not actionable on its own — historical context if any autoimmune-looking signs appear.
Allergies
Shellfish / seafood — highest-stakes
Severe childhood anaphylaxis that triggered cardiac arrest (likely Kounis syndrome — allergic coronary vasospasm from massive histamine release in cardiac tissue). Phase 3 care team must know.
Aspirin
Historical childhood allergy of unclear origin. Has been on daily low-dose aspirin since the Nov 2023 CABG with no problems. Currently tolerating. Chart should reflect "historical allergy, currently tolerated."
Epinephrine — reported but not actual
As a child, he had an anaphylactic reaction to shellfish, was given an EpiPen, then went into cardiac arrest. Most likely cause: the anaphylaxis itself triggered Kounis syndrome — the EpiPen catecholamine surge added cardiac strain on top of an already-stressed system. The anaphylaxis caused the arrest, not an epi reaction. In a future anaphylaxis emergency, epi is still indicated — administer in an ER with cardiac monitoring given his post-MI / AFib / Watchman status. Preference to avoid epi in non-emergency contexts is honored.
The recovery arc — what brought us here
How to read his benzodiazepine use — accounts differ (unresolved)
Updated 2026-06-16. This was briefly framed as a clean "dependence, not addiction" — too tidy. The accounts conflict and it's not yet resolved, so the record shouldn't assert either extreme:
- Angela's account: he was taking it off-label — more than needed at a time.
- Dad's account: he took it as prescribed, and was usually prescribed more than he took, leaving headroom to "bump up" when he chose.
These overlap more than they first appear: both describe self-directed upward dosing — the gap is mostly valence (misuse vs. "using my headroom"). Genuinely unresolved: whether he ever went beyond the total prescribed (the "where did extras come from / why weren't early refills flagged?" loose end), and how much Angela's read is colored by the separation vs. ground truth she has.
What doesn't change: the kindling + physical-withdrawal danger are real regardless of motivation — the medical plan is unchanged. How to resolve it: with data, not accounts — pull the real prescribing record (doses, quantities, refill cadence) from Tiffany Joseph / CVS. The takeaway for the next prescriber is the same either way: he self-titrated a benzodiazepine, so future controlled meds need tight dispensing and no large PRN cushion.
- ~30 years of daily Xanax (alprazolam) — originally prescribed for Tourette's tic and anxiety control as a teen, continued indefinitely.
- ~6 months of opioids (hydrocodone + morphine) — per the Oct 2025 list — for chronic back pain.
- April 9, 2026 — cold-turkey stop of both. This is the kindling event. CNS is now sensitized; any future abrupt withdrawal carries escalating seizure / death risk.
- April 25, 2026 — ER admission · April 28 — discharged to Haven Detox.
- Late April / early May — Baker Act, hold at NeuroBehavioral Hospital after reported SI.
- May 13, 2026 — voluntary re-entry to Haven Detox.
- Full timeline →