Phase 2 · The Recovery Team · since 6/3 (~30–45 days)

He made it to residential.

Detox done. Now: connect with the new care team, transfer the Haven context, and hold the expectation gap (Dad wants home July 4th; Angela wants the full program + a long follow-on). 6/4 call →

This week

Concrete actions for Paul, Angela, and Joe.

Honesty conversation — landed well; keep it warm. The loving, honest talk went live on 6/4 and went well — Dad owned the pattern, ended grounded, wants to keep talking. No urgent after-care needed. Stay available, brief the new counselor for continuity, and 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 →
Get connected to the new TRT care team. The medical side has made contact — Alyssa (NP) called 6/8 with a full med update, and Albin is Dad's therapist. Still to do: meet the counseling side, learn the programming, and get the visit/contact policy. If Angela hasn't connected yet, Paul bridges her in. Same call as the after-care brief above.
Transfer the Haven context deliberately. Signed ROI + warm handoff so the new team gets: jail history + the "feels like jail" reframe, the integrity / "little white lies" work, kindling vulnerability, and the "taper done = healed" misconception. Don't let it restart from zero.
Push for a family / couples session through TRT. Right container for the expectation gap (Dad: home July 4th; Angela: full program + a longer follow-on, which she's pacing on therapist advice). Let the longer horizon surface there — supported, therapist-paced — not via Paul as messenger.
Let the clinicians own the "stabilized, not finished" talk. Dad believes the taper ending = healed. The reframe lands better from a doctor than from Paul, and protects Paul from being the bad guy. Decouple recovery from reconciliation: finish the program for him, regardless of the marriage outcome.
Request scans from Good Samaritan Hospital. Dad's direct ask (5/27) — EKG, MRI, CT from his April admission to adjust care. Two paths: Good Sam directly (long shot — privacy walls), and Lynn (more likely; probably in his Haven file). Carry this request 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); today's 6/8 update + BP 160+ watch are the fresh items.
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.
Sending Dad things? Ship to 3945 W Atlantic Ave, Delray Beach, FL 33444 — but give Albin (his therapist) a heads-up first; he retrieves packages and opens them with Dad together.
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 →

Watching for

Soft alerts on the medical side. Listed in current priority order. Not crises — just stuff to keep eyes on.

Flight into health → July-4th AMA risk

Per Dad, 6/4 call

Dad believes he's "healed" (taper done) and wants home by July 4th — textbook for the first transition, and exactly when leaving against medical advice is most tempting. The real danger isn't today; it's an early discharge where a psych med lapses (kindling). Let clinicians normalize the surge + own the "stabilized, not finished" message. 6/4 →

New-team handoff — context could be lost

Phase 2 intake, 6/4

New facility, new team, not yet met. The jail history, integrity work, kindling flag, and "feels like jail" reframe were all built with Stephanie/Lynn. Without a deliberate ROI + warm handoff, the new team sees ordinary program resistance and we restart from zero.

Blood pressure — running 160+

Losartan 25 mg trial started 6/8

BP has been high (160+ systolic). Alyssa added a low-dose ARB (losartan) on top of amlodipine + metoprolol to see if it stabilizes. Watch for: cuff readings on a schedule, whether duloxetine (which raises BP) is contributing, and the threshold to escalate. Recheck over 1–2 weeks. 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.

Mood / SI window — closed ✓

5/22 → 6/5, passed

The honesty conversation landed well on 6/4 (Dad owned the pattern, ended grounded), and the SNRI black-box SI window (5/22→6/5) has now passed without incident. After-care alarm stood down. Ordinary mood awareness continues; brief the new counselor for continuity. 6/4 →

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 — lightening up ✓

Down to ~4 active agents

Vistaril discontinued and trazodone stopped as of 6/8 — two off the old six. Melatonin + olanzapine + valerian + passion flower remain. Good direction off the fall-risk cocktail; keep consolidating as PAWS subsides.

Recent updates

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