Phase 2 · The Recovery Team · discharge July 3

Two weeks to discharge.

After a tense mid-June stretch — BP spiking, tics flaring, a near-walkout — Dad's committed to finishing TRT through his July 3 discharge. BP is stabilizing now that TRT found + fixed an under-dosing error. Open now: what Phase 3 looks like, and the family aligning on the path home. 6/4 call →

This week

Concrete actions for Paul, Angela, and Joe.

Family / couples session — still chasing. Right container for the relationship work + the path-home gap. Unclear whether TRT offers it — thought they did, but need to confirm; raise it with Pete when reachable. This is the open item on the counseling side.
Request scans from Good Samaritan Hospital — blocked on an ID number. Dad's April-admission EKG / MRI / CT. His name + DOB alone don't pull anything up; need his patient medical record number (MRN) to request the records (distinct from a dosing "PRN"). Haven or TRT may have it on file — ask them. Carry to the new team too.
Carry forward the standing medical asks. EKG on file from April ER, Watchman implant date, gabapentin / kindling-prophylaxis, NAC dose escalation, and a neurologist for the tics — now more urgent (tongue tics causing self-injury) and an outside referral (TRT has no in-house neuro; needs one who takes his insurance). These route through Alyssa (TRT med lead). Freshest items: the neuro referral (self-injury tics) and the post-ER BP follow-up (150–160; med-change copy pending). See the 6/8 update.
Sending Dad things? Still ship to 3945 W Atlantic Ave, Delray Beach, FL 33444 through July 3 — give his therapist a heads-up first (was Albin; confirm the new point-person with Pete). Recent sends: phone case, beard trimmer, hat. Next up: a couple more shirts.
Phase 3 prep — Apollo Beach providers + two active calls. Found Dad's existing home doctors via the CVS pull — psych (Tiffany Joseph) + cardiology (Bay Area Heart Center). Two calls now: (a) Tiffany for his actual prescribing history (resolve the conflicting use accounts) + psych continuity/referral, (b) cardiology to re-up the lapsing clopidogrel + metoprolol. Insurance verification has the longest lead time. Care team → · Phase 3 prep →
TRT-transition loose ends. Get Pete's direct contact + the visit/contact policy, re-confirm the Haven handoff reached him, and get the post-ER BP med-change copy from Dad/TRT so the chart reflects the real regimen.
Honesty conversation — done; landed well. The loving, honest talk went live on 6/4 — Dad owned the pattern, ended grounded, wants to keep talking. No urgent after-care needed. Stay available and brief Pete (new therapist) for continuity; when his "what does success look like" frustration comes up, route it to the family/couples session rather than working it through 1:1. 6/4 call →
Connected to the new TRT care team. Alyssa (NP) on meds; the therapist is now Pete — Dad started with Albin in early June, but TRT reassigned him mid-June (not the right fit), with the first Pete session ~6/22. Care team →
Haven context transferred. Verified with Albin last week — the new team has the jail history + "feels like jail" reframe, the integrity / "little white lies" work, kindling vulnerability, and the "taper done = healed" misconception. Didn't restart from zero.
"Stabilized, not finished" — largely landed. Dad's now committed to finishing TRT through the July 3 discharge. It got tense mid-June: BP spiking, tics flaring, feeling the meds "weren't doing anything," and he nearly walked out. He escalated to TRT leadership, whose internal review found his BP meds had been under-dosed (unclear yet whether the order itself was too low or administration didn't match it). He went to the ER, was stabilized, and returned the same day — BP's run 150–160 since.
Chart allergies — verified on file. Double-checked while pulling his medical records: all three are charted — aspirin (historical childhood, tolerated post-CABG Nov 2023), epinephrine (not a real allergy; childhood reaction was Kounis-syndrome anaphylaxis), shellfish (anaphylactic, cardiac-arrest history).

Watching for

Soft alerts, in priority order. Not crises — just stuff to keep eyes on. Resolved items are tucked at the bottom.

Phase 3 direction — unresolved, needs settling before July 3

Top priority · discharge in ~2 weeks

The biggest open question is what comes after residential. The standard medical step-down is at-home intensive outpatient (IOP) + a real care team. The long faith-based residential programs being weighed (6+ months, work-based, no medical staff, medication-averse) don't fit Dad's medical picture — and he won't accept them. The family isn't aligned yet and the clock is short; getting to a shared, workable plan is the most urgent item on the board. Watch the handoff itself too: don't let any psych med lapse across the transition (kindling). The case for IOP over a long residential program →

Blood pressure — improving (150–160)

Under-dosing found + fixed mid-June; post-ER

BP ran 160+ and triggered the mid-June crisis. TRT leadership's internal review found his BP meds had been under-dosed (unclear yet whether the order was too low or administration didn't match it); an ER visit stabilized him same-day, and it's run 150–160 since — better, but still elevated. Still to get: a copy of the resulting med changes (asking Dad) so this chart reflects the real regimen. Watch: cuff readings on a schedule, whether duloxetine (raises BP) contributes, threshold to escalate. meds →

Tics — escalating to self-injury (raw tongue)

Per Dad · needs movement-disorder neurology

Tongue tics are now bad enough to leave his tongue raw — self-injury, which raises the urgency. The Oct 2025 baseline shows why: his tics were de facto held by Xanax for ~30 years (now gone), while a dedicated tic med (haloperidol, "Treat Tourette's") sat untaken — so there's never been an intentional tic regimen. Olanzapine was relabeled into the gap; NAC is a token dose. Strongest case yet for the outside neuro referral: a modern agent (aripiprazole / VMAT2) over olanzapine, CBIT, and botox for the tongue tic. Flag the self-injury to Alyssa to move the referral up; ask about a soft dental guard in the interim. Neuro-visit prep →

Ventricular-arrhythmia history — QT caution

New — Oct 2025 baseline · amiodarone (stopped)

The Oct 2025 list shows amiodarone prescribed for ventricular arrhythmias (stopped over vision problems) — deeper than the AFib we'd logged. It raises the bar on every QT-prolonging med he's on (olanzapine, duloxetine) and on any tic antipsychotic a neuro might add. Worth a baseline EKG + a flag to cardiology before adding or swapping psych/tic meds.

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.

Resolved — 4 items

AMA / "flight into health" risk — eased. Near-walkout mid-June (BP + tics), defused; Dad's committed to finishing through the July 3 discharge. Residual trigger: a return of the "this isn't working" feeling — and any unplanned med lapse (kindling).
New-team handoff — done. Care team met (Alyssa on meds, Pete therapist) and the Haven context transferred — didn't restart from zero.
Mood / SI window — closed. Honesty talk landed 6/4; the SNRI black-box SI window (5/22→6/5) passed without incident.
Sleep stack — lightened. Vistaril + trazodone off as of 6/8; down to ~4 agents off the old fall-risk cocktail.

Recent updates

Week of 6/22 — therapist swap, BP crisis resolved, committed to finishing. Therapist reassigned Albin → Pete mid-June (first session ~6/22). A tense near-walkout (BP + tics) defused when TRT leadership found + fixed a BP under-dosing error; an ER visit stabilized him and BP's run 150–160 since. Dad's now committed to finishing TRT through the July 3 discharge. Checked off: honesty talk, care-team connect, Haven-context transfer, chart allergies. 2026-06-22
GeneSight pharmacogenomic results back + interpreted. CYP2D6 intermediate → duloxetine runs high (don't escalate; lower or switch). CYP2C19 ultrarapid → clopidogrel works (not a non-responder). UGT2B15 poor → Ativan/oxazepam accumulate, Xanax/Klonopin gene-clean. Olanzapine + MTHFR fine. (full read) 2026-06-16
Oct 2025 pre-crisis med baseline added + reconciled. Corrects olanzapine (was 5 mg for Depression/Sleep — not crisis-initiated), surfaces a ventricular-arrhythmia history, and reframes the tics: never an intentional regimen — Xanax was the de facto suppressant, haloperidol untaken. ADHD + migraine meds since dropped (baseline) 2026-06-09
Alyssa (TRT NP) med update. Losartan added for BP 160+, GeneSight drawn, Vistaril + trazodone off, indications clarified; benzo taper confirmed complete (now managing PAWS). Shipping address + Albin logistics confirmed (notes) 2026-06-08
Moved to Phase 2 — The Recovery Team (residential/PHP). Detox complete. Expectation gap with Angela; "am I healed?" reframe; decouple recovery from reconciliation; honesty conversation (4 points) delivered live and landed well — owned the pattern, ended grounded (notes) 2026-06-04
Call with Dad — work pull (taxes/IRS), device-access boundary at TRT, integrity admission, jail history shared with Stephanie (notes) 2026-05-30
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