Medication Gaps & Returning to Normalcy – Prodromal Indicators of an Episode for Keith Torkelson

Medication Gaps & Returning to Normalcy – Prodromal Indicators of an Episode for Keith Torkelson

 Feature Photo

Me Before and After

Abstract

In this study we address our recent Episode of Behavioral and Mental Health symptoms.  At the core as is usual de-regulation of our sleep and sleep medication.  We are now on Clozapine and Invega.  Clozapine is still indicated for our well-being including: Peace and Sleep.  This study also describes a move in our bed from BadBed to a BetterBed.  Our current bed at Harvest Retirement would be a GoodBed if it were affordable.  This report addresses gaps in our medication.  While managing our own meds since 1989 we never had gaps.  The gaps occurred at Leisure Circle Skilled Nursing.  We also have been unable to keep Emergency Backup Medication.  We hope the impact of this study is such that it contributes to for us an expedited Return to Normalcy.  We give Leisure Circle 3.0 Star Equivalents for their supports and services.  We give Samantha our social worker 5.0 Star Equivalents for her supports and services.

Mental Health

In this study we address delusions, mistaken beliefs, sleep-rest-peace, problems associated with Leisure, prodromal indicators of an episode and compare Invega with Clozapine.  We hope to never have a major hospitalization related episode again.

Define Delusion

“a false belief or judgment about external reality, held despite incontrovertible evidence to the contrary, occurring especially in mental conditions. He began to experience hallucinations, delusions, anxiety, and agitation along with dizziness and nausea"

 

Define Mistaken Belief

“The wrong idea or misconception. A mistaken belief, especially one based on unsound arguments.  The wrong idea or misconception.”

Sleep and Medication Advocate

We have obtained the commitment of Dr. AS Kline to act long-term as our sleep and medication advocate.  We roughly want her to enforce a treatment plan that works best for us.

Doctor On-call

We had Doctor Daniel Chue MD at Leisure.  He wasn’t very helpful.  In 75 days he only saw me once.  In addition he denied me Clozapine.  Because I do not know his middle name I cannot track him down.  Doctor Chue follows us to Harvest.  The residents say he isn’t very helpful.  In the long run if I return to Harvest he might have to take over our case.

Table – Sleep, Rest and Peace

We lived with a consumer of mental health service Ted for over 2 years.  He impaired our sleep, rest, and peace.  He just wore us out.  He exhausted our coping.  He was angry, manic, a gambler and had personal problems with us.  The first hospitalization in this episode was January 2024.  The following are Sleep / Rest Scores: Ted at Shank’s = 33.3%; Dang at Leisure = 12.5%; James at Harvest = 86.8%.  Lower scores are problematic.  Dang was actually a good roommate yet the environment at Leisure drove his score down.  The environment at Leisure was torturous for us.  We went about 7 occasions of inadequate sleep medication thus we did not sleep.  Next we score problems we picked up while at Leisure.

Table – Post Leisure Problems

High scores are problematic.  We compare our problems post Leisure with 2022 a reference year.  We stayed at Leisure 75 days bedridden.  Again, we suffered at Leisure: Gaps in Sleep medication, sleeplessness, lack of peace and complications.  On 20240717 (W) we scored our problems.  Before Leisure in 2022 we scored 19.4% whereas after Leisure we scored 63.9%.  Higher scores are problematic.  We actually got worse in the hospital.  The problems were associated with Sleep deprivation and Noise.

Table – Prodromal Indicators of an Episode

Prodromal Indicators are important to us for preventing an episode.  On 20240717 (W) our prodromal indicator score was 46.9%.  Higher scores are problematic.  Like I said we got sicker while at Leisure.

Table – Invega Sustenna side effects

Last we compare Clozapine our mainstay with Invega Sustenna monthly injections.  We use Invega side effects as a reference.  Our Invega Adverse Reaction Score is 72.5% for Invega and 12.5% for Clozapine.  Higher scores are problematic.

Med Continuity Gaps History (Sample)

Medication Gaps – Least Restrictive

For year 2024 medication gaps caused us several nights of sleeplessness that worsened our condition.  There were about seven (7) medication gaps at Leisure Circle Skilled Nursing.  This is the primary reason we only give Leisure 3.0 Star Equivalents.  Our Long Term Bed Match Score was 13 differences across 17 items.  Higher scores are less favorable.  This means that our Leisure bed was not a good match for us.  We performed a Lock-down Comparison Score or Index.  We compared Westminster Therapeutic Residential Center (WTRC, 2006) with Leisure (MAY, 2024).  Higher scores are favorable.  WTRC earned a quality score of 92.9% whereas Leisure earned a score of 35.7%.  We stayed at WTRC over four months had no medication gaps. 

Priority – Sleep Security Systems

Our number one priority wherever we go or are is Sleep and whatever contributes to it.  We have faced too many sleepless and sleep challenged nights in 2024.  Today, June 5, 2024, we were searched at Leisure Circle related to smoking cigarettes.  We declared everything and the searchers seized our Sleep Security System of Emergency Backup Medication (EBM).  Now we are all anxious about the search and seizure process and our Sleep tonight.  They had repeatedly shorted us on our nighttime Sleep medications and we were making due with our backup Ativan.  They have shorted us more than seven (7) nights with our Sleep Medication.  Not only do we feel bad about “jacking” their system we feel bad to have to tell Samantha our social worker what and why we did it.  We are here all anxious with no recourse but to suffer Leisure’s error prone medication management system. 

Medication Gaps - Bring to Samantha’s attention

About a month ago, we brought issues with medications to Samantha’s attention.  We were having alternating problems with keeping a continuous supply of our sleeping medications Restoril and Ativan.  The procedures between running low, ordering, getting doctors approval, pharmacy to fill, delivery and distribution creates gaps were we the client miss doses of these most important medications.  In just over 60 days here at Leisure Circle we have been made to miss more than 6 doses.  That is associated with more than 6 miserable sleepless nights.

Medication Management – Making progress

We get anxious not knowing if our medication will be sustained as prescribed.  This has been a daily ordeal for the med nurses and me. See May 9, 2024 (TH) Update.  Fear gap in medication(s).

1989-2023 No Gaps

When we managed our medications there were no gaps.  We never missed our monthly CBC lab test.  At Aliso Ridge the medication was mismanaged that we were up 72 hours straight.  We made a mistake thinking we could get by without Clozapine.  At Global we had sleep problems also.  Finally at Leisure there were about 7 gaps.  Gaps are associated with sleeplessness.  The additive sleeplessness this year 2024 has injured our brain.  We will discuss our symptoms of brain damage later in this report.

May 7, 2023 (TU=PM)

Continue Clozapine Detox

The Leisure contracted Psychiatrist says Clozapine is not an option anymore because it is in the same class as Invega both anti-psychotics.  He also said “Sleep is important.  He prescribes us trazadone for sleep.  Trazadone only aggravated our Anxiety and kept us awake.  This year 2024 we were taken cold turkey off Clozapine three (3) times.  The first time was at Aliso Ridge and we agreed to it.  At Aliso Ridge we were up for 72 hours sleeplessness coming off Clozapine.  We call withdrawal from Clozapine with inadequate sleeper medication Clozapine Hell.

Trazadone

On May 7, 2024 (TU) the doctor prescribes us trazadone.  We hoped it would do what it was prescribed for: Sleep.  On May 9, 2024 (TH-PM) there is still no trazadone.  For us Trazadone was ineffective.

Stopping Clozapine Error

Why stop Clozapine after more than 10 years?  Beginning December 2023 we were looking for an alternate for our primary medication since 2007 Clozapine.  At the dose we have been taking there is a risk of falling.  On one occasion we did fall and broke a front tooth.  Later the tooth area was repaired with an implant.  Since March 2024 we have agreed to monthly Invega injection.  Invega does not substitute for Clozapine.  Currently, July 18^th, 2024, to augment Clozapine at night I am taking Ambien and Lorazepam.  The greatest factors in Controlling Anxiety and staying out of the hospital are: Sleep, Rest and Peace.

Clozapine – Emergency Backup

This is built off of a notation about Aliso Ridge.  “Clozapine Detox without Clozapine with assistance from… ”.  This year 2024 we have been detoxed off Clozapine 3 times.  I call Detox from Clozapine = Clozapine Hell.  You go completely sleepless until some effective alternate is put in place.  The locations where we were detoxed are: Aliso Ridge, Global, and Leisure.  Since July 1, 2024 we are on a solid treatment plan that includes for sleep: One antianxiety (Lorazepam), one sleeper (Ambien) and one incidental sleeper (Clozapine).  With the exception of our Harvest roommate James playing his radio we have slept well here at Harvest while on our new and improved treatment plan.  We carry one day’s worth of Emergency Backup Meds (EBMs) with us.  We would like to get authorization to carry one or two days EBMs.  So far from June 20, 2024 to July 18, 2024 there have been no medication gaps here at Harvest

20240530-TH-First Drafted

In the table below we list features about sleep (S) we need.  We provide for these for any roommate also.  Below we score SleepAbility and SleepAble factors about three locations: Scoring Shank’s, Leisure and Harvest.  SleepAbility are the Host or our inherent and internal factors promoting sleep, rest and peace.  SleepAble are the Agent (roommate(s)) and Environmental factors permitting sleep, rest and peace.  An important factor in long-term site selection is cost effectiveness.  Harvest at just under $1,400 out-of-pocket is not cost effective.

Harvest - James Proof

We moved into Harvest June 20^th, 2024 (TH).  Our new roommate is a gentleman in his 70s James.  The only grievance we had with James is that he was playing his radio without the mandated headphones.  On July 15^th, 2024 (M) we brought it to his attention.  He has used headphone since or about 48 hours.  For a Sleep / Rest Harmony Score James score 86.8%.  Higher scores are favorable.  James is our proof that we can get along now with our roommate.  The radio he played 24/7 was interfering with our sleep.  Hopefully that is remedied.  We get a bit anxious that he may use it without headphones again.

20240509-TH – Leisure - Medication Management-Medication Gaps

For the reasons listed below some odd 7 incidences of running out of our sleep medications (Restoril and Ativan) occurred.  Each incidence was associated with sleeplessness.  By the 5^th occasion we were suffering noticeable burning in our brain.  The burning was associated loss of competencies and aggravated Anxiety.

Some responses from Leisure nursing staff

• Pharmacy did not deliver
• The order was not put in on time
• We do no not have it yet
• Will tell you when it comes
• Are you sure you want to take it the way the doctor prescribed it

Our coping – Emergency Backup Medication (EBM)

Once we discovered our Emergency Backup Medicine (EBM) with, Lorazepam (Ativan) and Clozapine, with our property we were empowered to get some sleep.  When Leisure shorted us we just took Ativan when they missed.  Eventually we worked Clozapine in to take the place of missing Restoril. This was working we were getting sleep and improving.  We thought we would be out of Leisure Monday the 3^rd of June.  This fell through and we were showing signs of snaking their cigarette smoking system.  We were searched twice and had to surrender our EBM.  Leisure confiscated: Our EBMs, lighters and our sewing kit.  None of these items were returned to us.  This was clearly a search and seizure.  Remember we were given to policy sheet describing what we could not have.

Continuity Problems Persist

Now, we were back to trusting Leisure’s continuity and wouldn’t you know it for June, 5 (W), 2024 overnight they had no Ativan.  The doctor prescribes us Ativan to sleep.  We have a sleep disorder at the core of our health issues.  We were made to stay up all night.  Staying up all night on so many occasions here at Leisure has impaired our recovery and confidence that we can make it on the outside.  You would figure they would want to graduate us as a success.

Definite Brain Burning & Damage

To begin a sleep deprivation cycle we awoke at 7 am June 5 (W), 2024.  Sleeper meds were finally administered June 7 (F) at 1am in the morning.  They said it was emergency medication.  If they had emergency medication before why let us go sleepless on some odd 5 nights.  We could sense that hour by hour we were suffering the worst brain burning (damage) yet.  We were up more than 40 hours.  The whole time we were dwelling on how we broke the rules while coping for our own well-being as well as how stupid we were becoming.  When we were compensating for the gaps our own way we were making noticeable progress.  Our family indicated we were making progress.  At this point every medication cycle is wrought with uncertainty and stress.  In 75 days there were about 7 medication gaps.

20240605-W-ON without Ativan up 42 hours straight

First night without backup we were given no routine Ativan that night (June 5, (W) 2024) for overnight.  This led us to involuntarily stay up over June 5^th and past June 6^th.  We include the awake-time calculation below.  Without Clozapine our sleeping from June 6^th to June 20^th 2024 was very light.  In sum we had periods of medication deprivation at Aliso, Global and Leisure.  In the beginning at Harvest I wasn’t on a sound treatment plan.  We found it necessary to augment with Clozapine.  Since July 1^st, 2024 we have followed our inclusive of Clozapine sleeper treatment plan.  I still need to work on daily Anxiety management. 

Break Policy – Guilt

When we were was admitted we were given no policy information by Leisure.  On admission they let us keep our lighter.  Because no-one else had a lighter we knew that using our lighter was probably wrong.  Using our EBMs to help us sleep was a choice we don’t regret.  What bother us was I let Samantha Down while she was gone.  Samantha was our Leisure social worker.  We had some one-on-one meetings and I grew quite fond of her.  Below is a note to Samantha regarding sharing our transgression.  On June 7 (F), we gave a letter to Sam’s Assistant

2024-6-5-W-Samantha
Who is Samantha?
Leisure Circle Skilled Nursing Social Worker (Our friend)
20240610-M-Samantha Returns
June 5^th, 2023
Search and Seizure

Given to Samantha

“I was smoking between breaks

So they searched us

Found our Emergency Backup Meds

They skipped our meds so many times

That I took control back

With our own meds to sleep

They were unknowingly dropped off because I keep Emerg Meds all over

Now I am at the fate of the Med Mgmt. System again

I don’t have much faith right now

I missed you while you were gone

Didn’t mean to cause trouble

Sorry I broke any rules”

6-5-24 Keith Torkelson

Kline’s visit to offer Advocacy

On June 6 (TH), 2024 the Kline’s visited we had on our to-do list many things.  We hadn’t planned to spend so much time for them advocating for our Medications.  With this visit they found out firsthand the medication challenges we have been facing at Leisure.  After hours of resistance we got our medication, after being awake for some odd 38 hours, at 1am June 7, 2024.  The current medication problem began the morning of June 5, 2024.  The medicine we were given was not routine: The nurse said it was Emergency Medication.  Charley our brother-in-law pushed it to the limit and pulled through for us after hours of helping.

20240606-TH-Shopping-ALFs-Graduation

Earlier Samantha had directed us to Harvest Retirement.  For the day on our list was shopping for Assisted Living Facilities (ALFs).  At the last second we were re-directed to Sea Crest in Fountain Valley.  Sea Crest was located at a good corner for us yet when we visited it had too many undesirable features.  Epi is the new owner.  After Sea Crest we decided to go look at Harvest.  About a month ago Samantha mentioned Harvest, which we toured: Charley, Lanaii, and Keith.  We agreed that Harvest is a better fit.  We found Harvest as compared to Seaside livelier, smoking area user friendly, less depressing, cleaner, more orderly, as well as the sales rep Betty is more empathetic.  Eventually on June 20^th (TH) we graduated Leisure and were via our friend Kulle from Leisure to Harvest.  Our first two nights at Harvest our roommate was gone.  We were still relying on an ineffective treatment plan.

On June 6 (TH), 2024 - Sacrifices

On June 6^th 2024 (TH) we also visited Julie Paulino our old landlord circa 2011.  Julie says when I stabilize and there is an opening I am welcome at Hillview again.  She quoted $700 month.  This would be cost effective and return many of the things we sacrifice while living at Harvest.

UMP=Ultimate Move Plan

Our ultimate move plan ends with us moving back to Harvest.  We hope that doesn’t occur for ten years or more.  Currently we are at Harvest.  We plan to wean down our storage then move it to Public Storage across the street from Harvest.  Then we will test Julies House for a couple nights.  If Julie’s works we will move in at Julie Hillview House.  We need to create a checklist or tool to detect if it is time to move back to Harvest.

Budget of Spending Money-Restrictive

Our Ultimate Move Process Checklist (UMPC) has some forty (40) items.  We were used to paying $700 per month for a Rent a Shared Room (RASR).  At Harvest our share of the rent is $1348 which cuts severely in to our spending money.  Right now we are hoping for $100 per month in spending money.  In terms of finances Harvest for us is not Least Restrictive.  Here at Leisure we have used many coping strategies to adjust.  Our goal is to have this report mostly done before our graduation and next move that is scheduled for June 3, 2024.  The scheduled move date fell through.  We actually did move until the 20^th of June 2024 (TH).

20240610-M-Samantha Returns

Samantha returns after she took two weeks of vacation.  I saw here in the afternoon yet did not say anything.  He assistant had our letter of guilt.  I tried repeatedly to get Benadryl added as an OTC med.  Now we are down to 3 Restoril.  The med nurse says the order was placed a couple days ago.  Since the intervention by Charley and Lanaii we have been reporting daily on meds to Lanaii.  So far OK. For June 5 through 7 LAK, CSK, and ASK are our Hero’s

20240611-TH-Nurse Admin & Harvest

This morning Leisure the Nurse Administrator at Leisure was still pushing Sea Crest.  I described for the third time the decision to go with Harvest and how Samantha recommended them about a month ago.  Now Samantha’s assistant is working with Betty at Harvest.

20240613-TH-Dear Nurse-Medication

We are down to only 1 Restoril.  Restoril is our other sleep medication.  Nurse says it is ordered.  Resulted in no continuity gap.

20240620-TH-Key Event - Transferred to Harvest

20240626-W-Linking with Our Psychiatrist

On this day we saw Doctor Bera.  Dr. Bera has been treating us for some odd five years.  Together we reworked the treatment plan exactly as we felt prudent.  Our presenting problem was back to concerns about Anxiety and Sleep Disorder.  We didn’t discuss psychosis or mistaken beliefs at all.

20240701-M-Treatment Plan and Harvest

It took five days of promoting to get put on our new (Bera) Treatment Plan.  In the interim in order to sleep we needed to augment the original plan so we could sleep.  On July 1^st, 2024 the new plan was implemented after they got “Doctors Orders”.

20240713-SAT

As we did for years starting July 20^th, 2024 we are going to carry emergency medication with us.  Why must I have emergency medication?  Having emergency medication helps us with our Anxiety.  I will have it if there is a Med Continuity Gap (MCG)

20240717-W

Reference: 10_BMBBS_Pro_Dromal_Indicators_24052805_Psychosis

Table – Finding Prodromal Indicators of Melt Down

Since 1989 we have suffered symptoms of all of these things

Long-term Medication Choices

Choosing the best Psychotropic Medications

What does Invega Do?

What does Invega do in the brain?

“Invega works by restoring the balance of two neurotransmitters in the brain: serotonin and dopamine. Serotonin helps regulate anxiety and mood, among other actions. Dopamine is important for central nervous system functions such as movement, pleasure, attention, mood, and motivation. Apr 27, 2023”

Does Invega calm you down?

Contraindicated for Anxiety

“Invega is not approved to treat anxiety or depression. In some cases, the drug may be used off-label for these conditions. Keep in mind that, rarely, Invega may cause anxiety as a side effect.  So it is possible the drug may worsen this condition for some people. Jan 16, 2022”

Figure – Pharmacokinetics of Invega Sustenna

20240717-W: Reevaluate Invega Dosing - Adherence

When we agreed to take Invega it was due to our family wanting such.  We agreed to the highest dose of Invega.  We thought it was benign so we agreed to it.  Years ago starting 2017 we had proven how Invega was not right for us because Rispiradone had no effect on use.  Risperidone is the parent or actually what is in Invega.  From the graph above it looks like Invega over time can reach toxic levels.  I have known many people who did not do well on Invega (Mikel and Ted for example).  We are going to discuss the costs and benefits of Invega with doctor Bera.  The family thought my episode in part was caused by non-adherence.  This is wrong. 

Comparing Invega Sustenna with Clozapine

Below we compare Invega Sustenna to Clozapine.  We address problematic side effects.  The majority of them we took from the Janssen site below.

The most common side effects of INVEGA SUSTENNA® include:

FYI - Side Effects & Safety | Janssen Portfolio of LAIs - Invega

https://www.janssenschizophreniainjections.com/side-effects-and-safety/

What does clozapine do?

“Clozapine is an antipsychotic medicine that helps to adjust the levels of dopamine and other chemicals available in your brain. Clozapine reduces dopamine activity where it is too high, helping with symptoms like hallucinations.”

 

Why is clozapine so effective for schizophrenia?

“Clozapine produces lower and more transient D2/D3 receptor occupancy than most other antipsychotics. This allows the dopamine supersensitivity of the motor system to gradually resolve, and tardive dyskinesia to slowly fade.”

FYI

https://www.mayoclinic.org/drugs-supplements/clozapine-oral-route/side-effects/drg-20066859?p=1

Brainstorming

Preparation notes for psychiatrist appointment
Why am I on Invega?
Adherence
Psychosis related to medication
Sleep and Rest Disorder
Alternate non-benzodiazapine anti-anxiety medication
Potential Actions
Increase Clozapine to 150mg at night
Possibly swap Restoril in and Ambien out
Linking with Harvest Psychiatrist – Daniel Chue

20240801-TH-Milestone

We will have one month stable on Bera’s treatment plan in the face of suffering potential unwanted side-effects to Invega.

August 2024 Follow Up Appt with Dr. Bera

Summary

The following discusses the goals we have for August and September 2024. 

Briefs

1Presening Problems
Address prodromal signs
Argue for no Invega
Follow up with Dr. Bera
Keep writing and publishing
Leverage and adjust to car
Move ahead with move plans
No drinking
No medication gaps
Present at the Behavioral Health Advisory Board (BHAB) meeting
Publish photos of Joan
Regular visits to the gym
Renewing medication
Socialize with others including James
Spend our Calfresh
Talk to Harvest Psychiatrist
Work around Lorazepam

1Presenting Problems

We have been on a high dose of Invega Sustenna since March of 2024.  We agreed to Invega because we were reserved about Clozapine. As of July 25^th, 2024 (TH) we have had five (5) Invega injections.  At the present we are overly anxious.  Our problems with sleep have remedied since July 1^st, 2024.  On this date we started a new treatment plan.  We have trouble resting during the day.  We am showing signs of Akathisia among other side effects.  We want to discontinue Invega in favor of Clozapine and potentially Seroquel.

Address prodromal signs

Of course one of our highest priorities is vigilance about the prodromal signs of an episode.

Argue for no Invega

Yesterday, July 24 (W), with Dr. Bera we began our argument against continuing on Invega.  He lowered our dose.  We have a history of being 100% adherent with our mainstay Clozapine.  Back in 2012 doctor Bum Soo Lee swapped out Invega and Clozapine back in.  We were stable from 2012 to 2023 or eleven (11) years.  Invega was ineffective for us as well as a few other people we knew.  The side effects of Invega are intolerable.

Follow up with Dr. Bera

We followed up prematurely on July 24^th, 2024 with Dr. Bera.  We used to see Dr. Bera every three (3) months.  Now because of the injections we must see him monthly.  We wanted to focus on how well our sleeping concoction was working.  Instead, we contested the Invega.  He did not see it fitting to eliminate Invega.  We brought the miserable Invega induced symptoms of Akathisia to his attention.  We suggested swapping two meds our and Seroquel in.  He asked about our family’s position on Invega.  Today July 25^th, 2024 we spoke with our niece, a double doctor, about Invega.  She seems to think that since we have done well (since 2012) on Clozapine that Clozapine is the keeper.

Keep writing and publishing

We have a lot less motivation to publish than we used to have.  It is not quite as rewarding.  Yet, soon we will finish this paper and publish it.  The overarching theme is the nature of medication gaps.  We though our mental bothers was due to gap associated sleep deprivation yet I looks like Invega is the culprit.  Just for fun we are publishing photos of ourselves and Most Significant Other Ever (MSIE) Joan.

Leverage and adjust to car

On July 19^th, 2024 (F) our car was returned.  Thank goodness Invega doesn’t impair our driving directly.  The day our car was to be returned our brother-in-law locked the keys in the car while it was running.  This stressed us out quite a bit.  We are lucky our sister found money in the budget for gas.  The car has huge resource value.  Our first long drive was 7-22-24 (M).

Move ahead with move plans - Adjustment

It is time to begin putting our experiences at Leisure Circle behind us.  The most important steps are not having anxiety about Harvest having gaps with our medications and visiting Leisure.  We are adjusting to Harvest in the face of Invega associated problems.  We may have adjustment disorder symptoms. We had hoped to after a term move into Julie’s Hillview house yet last time we looked there was an Open House.  We have been looking into renting a room.

No drinking

We stopped drinking July 1^st, 2012.  While in Global Hospital without adequate sleep medication we dipped alcohol hand wipes.  We ran this slip by our sponsor and he said I am not accountable for things occurring in the hospital.  So I get to keep my 12 years.

No medication gaps

We need no medication gaps with Clozapine, Lorazepam or Ambien.  As we did for numerous years we carry Emergency Backup Medication (EBM) in the form of Clozapine.

Present at the Behavioral Health Advisory Board (BHAB) meeting

Part of our recovery is to resume presenting in front of the OC Health Care Agency BHAB.  Our sister said to wait until August.  On the day of our July presentation we had an Emergency Appointment with Dr. Bera.

Publish photos of Joan 635 right now

We have gathered 635 photos of Joan.  We will publish the in August.  It is hard to hold back and wait.

Regular visits to the gym

Since July 1^st, 2024 we have been using our free Planet Fitness membership.  We have been attending at a rate of once every two days.  We paused when our family The Kline’s visited.  We are working out pain in our left arm associated with Invega injections.

Renewing Medication

We would find it empowering if Harvest let me renew my medication yet they say they will do it.  This causes us rely on them when we are more reliable.  For renewing our medication we were cooperating with Harvest, yet, the pharmacy Gilbert Drugs sent our August meds all on their own.

 Socialize with others including James

We have been trying our best to be social in the face of anxiety.  Our relationship with Betty is decaying.  Our relationship with James our roommate is strong.  We call our sister each day.  We talk as much as we can with the smoker guys.  We try to keep up with Facebook and messaging.

Spend our Calfresh

Due to our high rent we qualify for a sizable food allowance.  We use our CalFresh to eat out periodically.  This is a much needed resource.

Talk to Harvest Psychiatrist

The Harvest contracted psychiatrist is Daniel Chue MD.  At Leisure in 75 days he only saw us twice and that was because we approached him.  Here at Harvest we would like to talk with him about Dr. Bera’s treatment plan.

Work around Lorazepam

From 2012 to 2023 we never took Lorazepam during the day.  In addition we didn’t take it daily.  Leisure sort of got us dependent on Lorazepam.  We take it nightly for sleep and about once every 3 days during the day.

Appendix

20240605-W-Search and Seizure