Feature Image – Dug’s Meds
Our feature image shows the
prescription and other Over-The-Counter (OTC) preparations for one of Keith
“Buster” Torkelson’s friends and at one time shared room roommate. Buster’s friend, Doug K who Buster fondly
calls Dug, reported that this lot of preparations was his best psychotropic
(cocktail) mix ever. Buster’s friend has
since passed away. We here at
Mentalation Solutions Group (MSG) get the impression that Dug Died Too Young when
he died suddenly in his 50s. Dug was
treated for an Anxiety Related Disorders (ARDs). Dug’s situation was complicated with Housing (closure
and pending sale of the house) and Sleep issues. After Dug moved away he could never find a
good fitting bed. In the picture we
count some odd seven (7) prescription bottles.
When we took the photo we just wanted to document medication management
with real people. Buster knew some of
Dug’s prescriptions were for psychotropic medications because he overheard Dug
renewing them over the phone and at the pharmacy. At least three of the seven medications in
the photo are psychotropic. One for certain
was a Benzodiazepine (BZD). Before Dug
died he ran into BZD associated problems.
Dug was a Brand New Day client.
RIP Dug.
Post Title
Psychotropic plus Medication
History for Keith “Buster” Torkelson MS as Associated with OCHCA prompted Psychiatric
Advance Directive (PAD)
Blog
Psychiatry for Dummies
Source Filename
PHR_Xeno_4.0.1_Medication_History_17121101_Develop
RBB V2021
MSGBase > PAD Associated Filename
LS_AHCDirective_PAD Worksheet
V2021 Working
This document goes hand-in-hand with Keith “Buster” Torkelson’s July 30, 2021 (F) Psychiatric Advance Directive (PAD) Build 20210727-PAD. In the process of writing Buster’s PAD we here at Mentalation Solutions Group (MSG) felt that two areas need a bit more fleshing out: Housing and Medication. Here MSG and Buster address the real history for Buster about medications for resolving Behavioral Health Disorders.
Histories: How Buster DBA Keith
Started
In this report we present the
most up-to-date version of Keith “Buster” Torkelson’s psychotropic medication
history. We here at Mentalation
Solutions Group (MSG) wondered what encouraged Buster to log his medications in
the first place? Roughly from 2001-2003
Buster was being treated by Kaisers Permanente’s doctor David Dobos. At the onset of their association Dr. Dobos
took possibly the most thorough history of any of Buster’s numerous Behavioral
Health Doctors (BHDs). It is very likely
during the Dr. Dobos’ term that Buster began to log his medication
history. In 2009 Buster enrolled in and graduated
a Mental Health Worker’s Paraprofessional course (CTP). The training took 160 of in class instruction
to complete.
Psychotropic Medication List (PML)
For the CTP class Buster pulled
his history and updated it. From
approximately 2009-2017 Buster was helping out with OCHCA MHSA Technological
Needs Component (TAC). From 2009-2010 one
of his TAC assignments was working with Personal Health Records (PHRs). It is very likely that Buster updated his
Psychotropic Medication List (PML) for his PHR presentations. Currently we here at Mentalation Solutions
Group (MSG) are updating his medication history is to go with Buster’s
Psychiatric Advanced Directive or PAD.
It is possible that MSG has published Buster’s medication history
before. This version is far from
complete yet it is the most refined PML yet.
To fill in the gaps it would take on Buster’s part a good deal time
record digging.
Medication and Diagnoses - Disclosure
Secondary Purposes
What we say…
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Purpose |
Note |
Detail |
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- |
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1-Overarching
Theme Experimentation |
Trial
and Error |
The
experiments documented here especially the early one’s cost Buster and his
family quite a lot of out-of-pocket |
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Apply
Lived Experience |
|
Very
few things say lived experience as well as a medication and housing histories |
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Associated
with Adherence Proof |
Compliance |
In
defense of continuity since 1989 |
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Avoid
do over experiment |
Belief |
Maybe
it was me and I’ve changed so let’s try something that didn’t work before |
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Continuing and refining Blogging |
Psychiatry
for Dummies |
Another
chapter |
|
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Cost
Containment |
Stay
current |
Costs
incurred in the past are not recoverable unless these papers are helpful for
others |
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Develop
Medication Management Lesson |
For
Brand New Day |
Motivating |
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|
Develop
Psychiatric Advanced Directives (PADs) |
Core
purpose |
OCHCA
is promoting PADs |
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Improve
doctors’ digital presence and / or legacy |
Variable |
Some
doctors’ are better than others about their virtual image |
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Inform
OCHCA |
Set
for Fall 2021 |
Possibly
go on the record for completing the first PAD for the current movement |
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Leverage
time spent on Personal Health Record |
Technological
Needs |
Continue
work with county on MHSA Technological Needs |
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Reduce
medication errors |
Advocate |
Self-Advocacy
& External Quality Review |
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Reduce
stigma |
Real
Record Sharing |
Just
an MSG hunch – Confidentiality can be harmful |
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Share
Dobos practice model |
Profiling |
A
positive profile for the record |
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Share
Materials |
Medication |
The
most important materials for these experiments are psychotropic medications |
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Special
Attention to Intimacy |
Disparity |
Medication
and intimacy is not well reported |
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Structured
Temporal Reconciliation (STR) |
MSG
Product |
With
STR we have discovered some patterns with Buster’s mental health |
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- |
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Last Reviewed: 20210726-M:
MSGBase > Associated with >
11_Med_Mngmnt_15053101_Clozapine
V2021
Purpose of a Medication History
What Others Say
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Aspect |
Example |
Note |
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- |
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1-Patient satisfaction |
[SEPARATE] |
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Change in drug related clinical
signs |
Invega |
Experiment 2012 worsened
condition driving a hospitalization |
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Detect drug-related pathology |
Tegretol |
Tegretol caused several
problems including vision issues and sore wrists |
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Empathetic communication |
Behavioral Health Doctors Best
and Worst |
Worst - Chandler & DeSilva Best Dobos |
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Improve clinical decision
making |
Next big clinical decision |
Clozapine Contingency Plan
(CCP) |
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Prevent prescription errors |
CCCHC brief Action based errors or slips |
No prescription Wrong Amount Synchronicity & the
Clozapine Delivery Cycle (ClozDC) |
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Reduce patient risk |
Clozapine molecule needs
pharmacologic modification |
Retain drowsiness Eliminate dizziness & panic
factors |
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- |
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Last Reviewed: 20210726-M: CCCHC = Central City Community Health Center
Buster’s health provider for BHD and PCP
A record of Psychotropic Experimentation on a Human Subject
Consumer Subject = Keith “Buster” Torkelson MS
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DOI |
DOI |
Medication Xenobiotic |
MD Associations |
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- |
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Prolixin |
Pos. Dr. Arnold P. Deutsch &
Kaiser Dr. Alan Vu feigned & would
not prescribe Prolixin |
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1992 |
1993 |
Lorazepam |
UC Davis: Jeik (Spelling
Uncertain) |
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2006 |
2006 |
Restoril |
Singh & Bellman & Lee |
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2012 |
2017 |
Ativan (PRN) |
Bum Soo Lee |
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1989 |
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Haldol |
Graman & Dean/APD |
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Haloperidol |
Graman & Dean/APD |
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1991 |
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Navane |
Woodland Memorial & APD |
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Effexor |
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Paxil |
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2001 |
|
Serzone |
David Dobos |
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1989 |
1989 |
Klonapin |
Helen Krell |
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1989 |
2009 |
Benedryl |
1st 1989 in the ER Relieve side effects of Haldol |
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Lithium carbonate |
Himasiri DeSilva |
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2006 |
Present |
Clozapine |
Singh/Leno/Inglis/Vu/BSL/Bera |
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2006 |
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Depakene |
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Depakote |
Chandler |
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1990 |
2005 |
Ambien |
(*) Chandler (Potential Error) |
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Tegretol |
[SEPARATE] |
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Zoloft |
Kaiser/Dobos |
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2004 |
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Topomax |
Dobos & (**) The Dobos
Position |
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2003 |
2008 |
Seroquel |
Started by David Dobos |
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2012 |
2012 |
Seroquel |
Lee until Clozapine could be reestablished |
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2003 |
2003 |
Viagra |
David Dobos Resulted Viagra associated DUI
(****) |
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1963 |
2009 |
Antibiotics |
FYI [List] |
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1992 |
1993 |
Propanolol |
UC Davis Jeik (Spelling
uncertain) |
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- |
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Last Reviewed: 20210716-F: Count = 25 Trails: Few duplicates: DOI = Date
of Interval
(*) Chandler, David (Kaiser)
As you can see Buster was
prescribed Ambien since 1990. Dr.
Chandler was the lead psychiatrist circa 2005 for Kaiser Permanente Orange
County. In one and possibly two
appointments Buster notices at least two stacks of about one-hundred consumer case
files. Buster said: “Like wow what are
you doing”? Dr. Chandler indicated he
was auditing all of Kaiser Permanente Behavioral Health cases for Orange
County. About one appointment later Dr.
Chandler cold-turkey’s Buster of Ambien.
We feel Dr. Chandler had targeted “Sleepers” as medication to phase
out. Buster’s ensuing deterioration in
sleep caused immediate problems at home with his Most Significant Other
(MSOE). After a lag time of about one
year Buster was back in the hospital. He
still did not understand the gravity that sleep had on his Behavioral
Health.
Dobos & (**) the Dobos Position
We here at Mentalation Solution
Group (MSG) learned from Dr. Rimal B Bera as well as other sources that Behavioral
Health Doctors have variations in their practices. Buster should have known this from Dr.
Deutsch (APD) back in 1990. APD
specialized with improving what he called the patient medication “Cocktail” by
titrating doses down from hospital level doses to more tolerable doses. APD would say: “You are overmedicated”. Another thing that APD did was take calls
during Buster’s 50 minute appointment.
Buster was privileged to overhear APD solving real world psychotropic medication
problems. Around 2001 Buster was enrolled as a full-time student at CSU
Fullerton. At the same time he was
seeing Kaiser’s Dr. David Dobos (Dr. “D”).
Together Buster and Dr. “D” made regular medication changes so Buster
could meet the demands of college. After
a bit Buster was fine tuning his medications over the weekend. The first time he did he reported back to Dr.
“D” I did such and such. To Buster’s
surprise Dr. “D” said: “Sometimes the patient knows best”. A few years back we scored many of Buster’s Behavioral
Health Doctors (BHDs). We expected Dr.
Ravinder P Singh with her initiation of Clozapine to come out on top. To our pleasant surprise it was Dr. “D” that
comes out on top.
Viagra David Dobos MD – Resulted in a DUI (****)
Later in this report we will
address intimacy and psychotropic medications.
In 2003 Buster was being prescribed Seroquel which contributed to a bit
to impotence. Since 1999 Buster has graded
his medications by how satisfied his Most Significant Other Ever (MSOE) was. To say the least she could get grumpy. At one time Dr. Dobos prescribed for Buster Viagra. He even asked doctor if it is normal for a
male in their 40s to lose their sex drive.
Doctor said: “No that is not normal”.
At some point soon after starting Viagra Buster suffered a Viagra
Associated Driving under the Influence (DUI).
Many people don’t know that with medications such Benadryl or Viagra is
in your system while you are driving can get you a DUI.
Begin Addressing the Sleep Issue
Treating Depression (2000-2003)
Then Anxiety (2004-Present)
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DOI |
DOI |
Medication Xenobiotic |
MD Associations |
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- |
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2000 |
2003 |
Melatonin |
Self OTC |
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2000 |
2003 |
Valerian |
Self OTC |
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2000 |
2003 |
Saint john's wort |
Self OTC |
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2006 |
|
Choline |
Self OTC |
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- |
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2004 |
|
Wellbutrin |
David Dobos |
|
|
1988 |
1988 |
Aspirin |
Clark for Rabies' AR |
|
|
2009 |
2011 |
Resperidone |
Alan Vu |
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Benedryl |
Self OTC PRN |
|
|
2012 |
2012 |
Invega |
Daniels > R Waknine &
Bum Soo Lee |
|
|
2012 |
Present |
Clozapine |
BSL/Bera (***) Clozapine Gap |
|
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- |
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Last Reviewed: 20210716-F:
(***) Clozapine Gap
After the client qualifies for
treatment with Clozapine the doctor initiates a titration schedule and
Clozapine associated lab work. For a
term ¼ of the full target dose is prescribed and lab work is performed weekly. After the lab tests come out favorable for a
short term the dose is increased and lab work performed every two weeks. After the lab work comes back favorable for a
small term again a full dose of Clozapine is prescribed and lab work is
performed once a month. Full dose plus
monthly lab is sustained unless unfavorable lab results are reported. During this orientation process if labs come up
unfavorably the consumer is not a good candidate for Clozapine. If there is gap in the Clozapine delivery
process the treatment schedule is reset.
Back in 2012 Buster suffered a gap with his new and improved treating
physician trying a hopefully superior medication. This medication experiment was associated
with a fairly lengthy hospitalization.
Buster lucked out because for some reason his hospital doctor, Bum Soo
Lee, did not T-Con him. While in the hospital
Buster checked the patient status list in the nurses’ station. Over half of the psych ward inmates were in
the process of being “Conserved”. Buster
finds it is harder to set things right (recover) when he is agrees to conservatorship. Currently Buster is not on LPS
Conservatorship.
Treating Anxiety (2009-Present)
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- |
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DOI |
DOI |
Medication Xenobiotic |
MD Associations |
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- |
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2009 |
2011 |
Resperidone |
Alan Vu |
|
|
2006 |
2006 |
Clozapine |
Ravinder P Singh |
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2006 |
2007 |
Clozapine |
Belman (Sustains Singh’s experiment) |
|
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2007 |
2007 |
Clozapine |
Andrew Inglis (HCA) |
|
|
2007 |
2012 |
Clozapine |
Alan Vu Hopes for a progressive doctor |
|
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2012 |
2012 |
Invega by Injection |
Daniels & Lee Associated with Medication Gap
& Crises |
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|
2012 |
2017 |
Clozapine |
Bum Soo Lee (BSL) & Meier |
|
|
2012 |
2017 |
Lithium |
BSL |
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2012 |
2017 |
Lorazepam |
BSL |
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- |
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2017 |
Note |
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BSL Retires |
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2018 |
Present |
Clozapine |
Rimal B Bera (RBB) |
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2018 |
Present |
Lithium |
RBB |
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2018 |
Present |
Lorazepam |
RBB PRN |
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2018 |
Present |
Melatonin PRN |
Self – Response to Sam I Am A Clozapine Contingency |
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- |
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Medications that caused little or no impotence
Over half the remainder where associated with impotence issues
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- |
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Medication |
PRIxV |
Sleep Benefit |
Satisfaction |
Note |
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- |
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Wellbutrin |
0.0 Actually enhanced |
Actually activating |
No |
Interfered with enjoying
cigarettes |
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Lithium |
0.0 |
0 |
No |
Shaking hands (Tremor) |
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Seroquel |
2.0 |
+ |
Moderate |
Moderate Bizarre Nightmares |
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Resperidone |
2.0 |
0 |
No |
Globally Ineffective Implies Invega not effective They have related structures |
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Clozapine |
1.0 |
+++ |
Good |
Middle of the night
irritability and risk of fall |
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- |
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Last Reviewed: 20210724-SAT:
PRIxV=Psychotropic Related Impotence Score
Our Psychotropic Related
Impotence Score ranges from 0.0 – 5.0 with lower values being favorable. For much of Buster’s treatment period (1998-2016)
Buster got to coordinate his medication about satisfying his Most Significant
Other Ever (MSOE). With each change
Buster and his MSOE revised their intimacy schedule. A few medications such as Zoloft were
associated with a PRIxV of 4.5. We
reserve a PRIxV of 5.0 with permanent impotence. For all practical purposes Zoloft was
associated with reversible complete physical impotency. We report Buster’s current medication
Clozapine as having a PRIxV = 1.0. As
mentioned earlier, at different times Buster was prescribed: Viagra and later
Cialis.
[INSERT PHOTO OF MSOE JOAN]
Buster and Buster’s Most Significant
Other Ever (MSOE)
Brief on Diagnoses
One might wonder what Keith
“Buster” Torkelson MS is being treated for.
We checked online to see if we had published a report on
Diagnostics. We could not find a clear
example. Thus, we will briefly address
Buster’s diagnoses. As you can see
Buster has partnered with quite a few Behavioral Health Doctors
(psychiatrists). Right out of the gate
circa 1989 Dr. Deutsch modified Dr. DeSilva’s bi-polar diagnosis to
Schizoid. While being treated by Dr. Deutsch
Buster landed a full time job, lived with his parents, had great nutrition, and
sustained restful rejuvenating sleep. He
demonstrated resilience and Dr. Deutsch approved him in writing to return to UC
Davis as a Veterinary School Freshman. Buster
was also linked with an on-campus Behavioral Health Doctor (BHD). In the table below we share some of Buster’s
self-assessment scores. Buster has been
diagnosed with over half of these ailments (areas) by since 1989 by his
BHDs. Doctor Rimal B Bera (RBB) is
Buster’s current BHD. RBB has Buster
down as Bi-polar.
Tentative Differential DX List
Internet Query “keith Torkelson diag”
MSGBase > Query “bera”
Form_MSG_Psychiatry_Diagnostics_18011101_RB_Bera
V2021
Diagnostic Error Rates
While researching diagnostics we
came across materials on Diagnostic Error Rates (DERs). We haven’t had time to catch up on our DER
related reading. Yet, with the presence
of DER writings on the internet indicates that diagnostics in psychiatry is not
error free.
Conditional Health Fitness Score (ConFit %)
Our ConFit evaluations address
only anxiety and related annoyances such as Chronic Fatigue Syndrome. Last time Mentalation Solutions Group (MSG)
scored a ConFit for Buster was back in January of 2016. At this time we awarded Buster DBA Keith s
ConFit of 52.3% where low scores are favorable.
Associated File >
Assess_ConFit_Score_16031403_Calculations
Behavioral Health Fitness Score (Index)
Below we score Buster’s
Behavioral Health Fitness (BHF). The
range between the average and the worse is 32% and 55%. It is likely that Buster’s BHF is closer to
55%.
MSGBase > Associated File >
10_Assess_BHFS_16010701_Indexing V2018
Findings from Diagnostic Assessment Cluster
DX-Battery-03C-20160208 - Low is Favorable
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## |
Area |
Assessment Details |
Date of Last Application |
NLZD % |
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01 |
Rest Disorders |
Sleep Disorder Self-Test |
20160120 |
SE |
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02 |
Schizoid |
Schizophrenia Screening Test |
20151208 |
0 |
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03 |
Mania |
TRC-ECM |
20160114 |
14 |
|
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04 |
Mood Swings |
Mood Swings Questionnaire |
20160114 |
17 |
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05 |
Rest Disorders |
Insomnia Sub-scale |
20160120 |
18 |
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06 |
Depression |
Burns Depression Checklist |
20160114 |
27 |
|
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07 |
Depression |
Personal Health Questionnaire-9 |
20160114 |
33 |
|
|
08 |
Trauma |
Trauma Symptom Checklist |
20160107 |
35 |
|
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09 |
ADD/ADHD |
Adult ADHD Self-Report Scale |
20160115 |
36 |
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10 |
PTSD |
After The Injury |
20160120 |
47 |
|
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11* |
Anxiety |
Beck Anxiety Inventory |
20160114 |
48 |
|
|
12* |
Chronic Fatigue Syndrome |
Chronic Fatigue Syndrome Risk
Assessment |
20160105 |
54 |
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13* |
PTSD |
PTSD Screening Scale |
20160112 |
55 |
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- |
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CALC |
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=384/12 |
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Behavioral Health Fitness Score
(BHFS %) = |
2016 January |
32% |
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- |
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Conditional Health Fitness Score (ConFit %) = |
20160208 |
52 |
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- |
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Table – Results for Exhaustive
Diagnostic Assessment Investigation – Yields a ConFitScore of 52%. 20160208-M:
Results Matrix for Chapter-03C Study.
DX-Battery-03C-20160208 About Buster DBA TheDAG participating member in
Graduate by DEATH Program (GBDP)
(*) = Used in ConFit calculation - Conditional Health Fitness Score
Reference – Vigorosity – GAIN Model
- Indexing Notion Source
Years ago now Buster was invited to serve and advise on the Orange County Health Care Agency’s (OCHCA’s) Technological Needs Committee (TAC). Geoff Henderson of Phoenix House (Substance Use Disorder service) made a showing early on before he decided not to participate. In one meeting Geoff mentioned an assessment tool (system) that Phoenix House was using with its’ consumers. The system is called Global Appraisal of Individual Needs or GAIN. Obviously, if Buster had free access to the GAIN software he would run a GAIN on himself. If and when we here at Mentalation Solutions Group (MSG) run a GAIN for Buster it will take substantial modification. Many of the GAIN scales could be helpful in Buster’s case.
FYI – GAIN Indexing
Matrix
– Model for Intensity – Last Applied: 20180131-W: Original Lead: Phoenix House - Geoff Henderson
phoenix house (Circa 2009). 20210727-TU
we just found out a couple of weeks ago that Geoff is retiring. We might take the time to discover Geoff’s digital
legacy.
Primarily Assessing Aspects of Providers
When we were looking for
material(s) that we published relating to diagnostics we found the following
report. We published it back on Friday,
August 4, 2017. For the most part it
deals with Mentalation Solutions Group evaluating Buster’s providers including
his insurer Brand New Day (BND).
FYI - Assessment Evaluation for Brand New Day by Keith E. Torkelson (M.Sci.)
http://brandnewdayhmo.blogspot.com/2017/08/assessment-evaluation-for-brand-new-day.html
MSGBase > Associated Document
Case Study
Report_13091401_Diagnostics V2021
What is a paper without a profile?
Here
we feature a very brief on Geoff Henderson of Phoenix House a Substance Use
Disorder program in Orange County California.
Online Query
“geoff
henderson phoenix house”
Phoenix House Orange County | (888) 686-3100 | Santa Ana
https://www.allbiz.com/business/phoenix-house-orange-county_3a-888-686-3100
Geoff Henderson is the primary
contact at Phoenix House Orange County. Phoenix House Orange County is located
in Santa Ana, California, and was founded in 2000. At this location, Phoenix
House Orange County employs approximately 25 people. This business is working
in the following industry: Social work. Annual sales for Phoenix House Orange
County are around USD 2,294,184.00.
A Professionals Legacy
As we mentioned earlier Geoff is
in the process of retiring. At last
check he was working for the Orange County Sheriff’s Department helping inmates
with SUD or Co-occurring Disorder (CODs).
He leaves behind a fairly good digital presence. On the other hand he leaves behind the local
opiate crisis. It would be nice if the
professionals such as Geoff would publish their lesson learned and
recommendations.
Digital Legacy – Profiling Geoff
Henderson
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Area |
QGM |
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- |
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Business |
Good |
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Photos |
Good |
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Methods |
SoSo |
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Publications |
SoSo |
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|
Operations Manual |
SoSo |
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|
- |
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|
20210727-TU: QGM = Quick Grade
Method
Some Images at the End
Sample Error Tree
Doctor Dobos’ Medication
Management Group
At least once a week any patient
wishing changes in their medication met as a group and gave their argument to
the med nurse. After the med nurse
collected the patient-driven information she whet to Dr. Dobos and presented
the changes in batch. Near the end of
the hour the med nurse would return with the doctor’s positions across the
board. This is one of the most efficient
medication management systems that Buster took part in since his diagnosis in
1989.
Monthly Medication Turnover
Pharmacy Buffer System [For Later]
Could be a Handful of Heartache
After getting off Invega Buster was back managing his medication without outside monitoring.
This is Buster’s best example of resilience
He has never been able to bounce back as well since 1989
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