Labs
Two sets: the 2025 Function Health pre-crisis baseline (the right reference for current monitoring on olanzapine + duloxetine + statin), and the June 2026 GeneSight panel showing how he metabolizes his psych meds.
🧬 GeneSight pharmacogenomics (June 2026)
How Dad's genes affect his psychiatric meds. Ordered to weigh a duloxetine dose change — it also answered an open clopidogrel question and flagged a benzo-safety gene. Full GeneSight interpretation →
Duloxetine: runs high, not low
CYP2D6 intermediate metabolizer → duloxetine levels run relatively high for the dose. The genetics argue against escalating it: lower the dose, or switch (Pristiq bypasses his slow pathway). This was the reason for the test.
Clopidogrel should work ✓
CYP2C19 ultrarapid metabolizer → he activates clopidogrel (Plavix) fully. Not the non-responder we'd flagged as an open question — reassuring for his post-Watchman + post-stroke antiplatelet coverage.
Some benzos accumulate
UGT2B15 poor metabolizer → Ativan (lorazepam) and oxazepam clear slowly and build up (sedation + fall risk). Xanax + Klonopin are gene-clean — the safer choices if a benzo is ever needed.
No blockers elsewhere
Olanzapine is genetically fine ("use as directed"). MTHFR normal (no methylfolate needed). SJS-risk genes (HLA-A*3101, HLA-B*1502) negative — carbamazepine / lamotrigine are lower-risk if an anticonvulsant is added for kindling.
2025 Function Health baseline
Severe baseline insulin resistance
Fasting insulin 57, glucose 105, A1c 5.8%. Olanzapine worsens exactly these markers — drug-duration choice matters.
Atherogenic dyslipidemia
Small dense LDL pattern B with LDL particle number 1789. Low HDL, high triglycerides. CAD history (quad bypass 2023) compounds the risk profile.
Reassuring at baseline
Liver (AST/ALT/Alk Phos/GGT), kidney (Cr 1.10), electrolytes (K 4.0), magnesium RBC 6.1, and thyroid all normal pre-crisis. Good news for olanzapine metabolism + QT risk and for duloxetine hepatic monitoring — worth a recheck on-drug.
Omega-3 status
EPA+DPA+DHA at 3.0% by wt — high relative risk of sudden cardiac death per Cleveland HeartLab cutoff. Omega-6:Omega-3 ratio 12.5:1. Vascepa is the modern Rx intervention.
Other historical context
ANA ≥1:1280 sustained across two draws, all specific autoantibodies negative, ESR + complement normal. GRAIL Galleri (June 2025): no cancer signal detected. DHEA-S low, testosterone low-normal.
Source PDFs
Source of truth. Hand these to the care team, not the summary. 2025 Function Health ordered by Lauren Jefferis MD (Quest + Cleveland HeartLab + GRAIL); 2026 GeneSight ordered by Ninoska Gaminara NP-C (Myriad / Assurex).
- GeneSight Psychotropic + MTHFR — pharmacogenomic panel (CYP2D6 / CYP2C19 / UGT2B15 + more)
- Hormones · autoimmune · omega-3 · heavy metals · B12 metabolites
- CMP · CBC · lipids (LDL-P / NMR) · A1c · insulin · vit D · thyroid · UA
- Autoimmune follow-up (specific antibodies after positive ANA)
- GRAIL Galleri multi-cancer early detection
Important framing
This summary is Paul's lay reading for the family record. Not clinical advice, not a diagnosis. It exists to make sure nothing in the baseline gets overlooked by the team managing the current crisis.