Now · Notes & comms · Alyssa med update

NP Alyssa (TRT) — med + care update — 2026-06-08

Alyssa, the NP responsible for Dad's medications at The Recovery Team, called Paul with a full update on meds, symptoms, and the care plan. She wants to share with Angela + Joe too, but hadn't reached them yet.

Headline

  • Medically, Dad is in a good spot. What could be removed has been removed; what remains carries real heart + brain trade-offs.
  • Benzo taper is complete and was successful — finished at Haven before the move to TRT. We're now managing PAWS (post-acute withdrawal) + symptoms, not detoxing. (Ties to the "is he healed?" note on the meds page.)
  • One med added (losartan, for BP), two off the board (Vistaril, trazodone), GeneSight drawn today.

Medication changes

  • ➕ Losartan 25 mg added — BP has been high (160+ systolic). Low-dose ARB trial on top of amlodipine + metoprolol to see if it stabilizes. Reassess once readings settle.
  • ➖ Vistaril discontinued — "no more" per Alyssa.
  • ➖ Trazodone effectively stopped — Dad hasn't taken it in over a week.
  • Indications clarified (prior Haven framing kept on the meds page for the trail): olanzapine → Tourette's (a longstanding tic med he came in with), duloxetine → nerve pain + mood (an SNRI — not a tic drug), NAC → inflammation.
  • Unchanged: aspirin, clopidogrel, atorvastatin, metoprolol, amlodipine, pantoprazole (GI — no change, no issues).

Symptoms + care plan

  • 🫀 Heart meds are normal given his history. The cardiac block (metoprolol, atorvastatin, etc.) makes sense post quad-bypass + lung clots + stroke risk. A cardiologist can re-assess as an outpatient.
  • 🧠 Psych meds are normal for his Tourette's. None are new. There's likely better, more modern treatment available — which is why he needs a neurologist who specializes in Tourette's + motor conditions.
  • 🧠 Neurologist referral is an outside job. TRT doesn't have in-house neurology. The practical constraint Alyssa flagged: find a specialist who accepts his insurance.
  • 🧬 GeneSight drawn today — a genetic test for how psych meds (especially duloxetine) will work for him, and what alternatives might fit. Results pending (~1–2 weeks).

Logistics — sending Dad things

Confirmed the address where we can mail Dad items:

  • 3945 W Atlantic Ave, Delray Beach, FL 33444
  • Give Albin (his therapist) a heads-up first. Albin retrieves packages and opens them with Dad together — so let him know ahead of time rather than sending cold.

What it means

The reassuring read: the medication picture is coherent and trending lighter, not heavier. The benzo taper — the highest-risk piece — is done and went well. What remains is there for real reasons (heart and brain), and the things that could safely come off (Vistaril, trazodone) have. The next moves are outpatient-shaped: a cardiologist to re-assess the heart meds, and a neurologist who takes his insurance to modernize the Tourette's care. BP at 160+ is the one active watch item — losartan is the first lever, and the duloxetine's BP effect is worth keeping in the frame.

Family advocate's running record. Not medical advice.