Phase 1 · Day 14 of ~30

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. Listed in current priority order. Not crises — just stuff to keep eyes on.

Tics — limited current relief

Per Dad, 5/27 call

NAC 300 mg/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.

Suicide-risk watch — first weeks on Cymbalta

Through 2026-06-05

The FDA black-box warning for suicidal ideation (SI) is most active in the first 14 days of an SNRI like duloxetine. Started 5/22 → window closes 6/5. Confirm daily SI check-ins with his counselor through that date.

Blood thinners — step-down timing

Gated on Watchman implant date

Aspirin + clopidogrel (dual antiplatelet therapy, or "DAPT") is a time-limited post-Watchman protocol — typically 45 days to 6 months, then it steps down to aspirin alone. We need the Watchman implant date to know when that transition happens.

Zyprexa — blood sugar + cholesterol risk

Insulin 57, A1c 5.8 at baseline

Olanzapine (Zyprexa) is the worst atypical antipsychotic for insulin resistance and lipid changes. A continuous glucose monitor (Dexcom Stelo or 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.

Recent updates

Rico (TRT Director of Nursing) introduced by Lynn — CC'd on family thread for Phase 2 continuity 2026-05-27
Call with Dad — eager for Phase 2, tics biggest complaint, requesting Good Sam scans (notes) 2026-05-27
Full doctor's orders received + dashboard refactored 2026-05-27
Lynn 5/22 update — Dad "feeling well, clearly-headed, progressing positively." TRT plan locked in (~30-60 days) 2026-05-22
Cardiovascular block locked in (atorvastatin + metoprolol + clonidine taper) 2026-05-26
Clopidogrel added — post-Watchman DAPT 2026-05-25
NAC started for tics 2026-05-23
Duloxetine started — SI window opens 2026-05-22