Mandated Treatment Preferences by
Keith E Torkelson M.S. for Doctor Rimal B Bera
Advanced Directives
Difficult to Apply in Actual Clinical
Situations by Keith Edward Torkelson (M.S. Pathology)Advanced Directives
High Weight Up Front Method (HWUFM)
Jump to High Weight Documents
Outline
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Item
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Detail
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Abstract
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Executive Summary
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Introduction
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Client Driven Treatment Preference
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High Weight Up Front
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HWUF
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Penetration Checklist
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Treatment Preferences
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Application
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Agreement Sheet
[HARD COPY VERSION]
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Risk Management
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Consumer Driven Titration Schedule
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Community Partners
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Method
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Sell Concept to Doctor
Results and Indications
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Medication Safety Net
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(MSN-MSG-Beta)
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Linkage Checklist
New Doctor Priorities
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Beta (Test with Doctor RB Bera)
20180103-W:
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MD Assignments
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FYI
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Relative Competency Assessment
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20171214-TH: Sound Mind Symptomatic
Screener
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Prevention
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By Planning in Advance
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Daily Titration
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Specifications &
Requirement
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Experimental Outcomes
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Experimental Bunny Rabbit
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Approved Medications
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[NO LONGER APPROVED]
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Darrell Steinberg
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Programming Language
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20171205-TU:
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Symptomatic Intervention Screen
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Table of Contents – Treatment
Preferences for Keith E Torkelson
Last Reviewed: 20171214-TH:
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Introduction
Treatment Plans (TPs) Promoted by
National Institutes of Health
In the following excerpt from a
refereed article you will see a notion promoting consumer driven treatment
preferences and sharing has been developing since before 1998. In the article Patricia Flatley Brennan
describes a bit about the Treatment Preference Movement.
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Introduction - Improving Health
Care by Understanding Patient Preferences (Brennan, 1998)
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC61299/
J Am Med Inform Assoc. 1998 May-Jun; 5(3): 257–262.
The Role of Computer Technology
Patricia Flatley Brennan, RN, PhD, FAAN and Indiana Strombom, RN, MS (c)
J Am Med Inform Assoc. 1998 May-Jun; 5(3): 257–262.
The Role of Computer Technology
Patricia Flatley Brennan, RN, PhD, FAAN and Indiana Strombom, RN, MS (c)
Abstract
“If nurses, physicians, and
health care planners knew more about patients' health-related preferences, care
would most likely be cheaper, more effective, and closer to the individuals'
desires. In order for patient preferences to be effectively used in the
delivery of health care, it is important that patients be able to formulate and
express preferences, that these judgments be made known to the clinician at the
time of care, and that these statements meaningfully inform care activities.
Decision theory and health informatics offer promising strategies for eliciting
subjective values and making them accessible in a clinical encounter in a
manner that drives health choices. Computer-based elicitation and reporting
tools are proving acceptable to patients and clinicians alike. It is time for
the informatics community to turn their attention toward building
computer-based applications that support clinicians in the complex cognitive
process of integrating patient preferences with scientific knowledge, clinical
practice guidelines, and the realities of contemporary health care.”
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Treatment Preference Penetration
Checklist – Living Action Items
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Table Last Reviewed: 20171208-F:
Minded Medication Notion: Last
Reviewed: 20171208-F:
Agreement Sheet - Applied
Prevention Through Advanced
Planning
Dr. Rimal B Bera agrees that we
discussed my Treatment Preferences Document
Client Signature:
_________________________: Date: _________________
MD Signature:
___________________________: Date: __________________
Witness Signature:
______________________: Date: ___________________
20140901-M: I am willing to take
the following medications:
20171209-SAT: Updates
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Medication
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To be taken under these
circumstances
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Note
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Clozapine
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Essential for sleep
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Effective since 2006
Episode 2012 associated with
gap in Clozapine
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Ativan
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Improve quality of
sleep/dreaming
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Take only when awakened during
Clozapine mediated sleep
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Restoril
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Better yet expensive Alt to
Ativan
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Lithium
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Optional
Some doctors favor it others
don’t
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Since 1989 more doctors have
avoided it that prescribed it
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Lorazepam
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Ditto Ativan
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Case Notes
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Only medications with a generic available
Only medications with a generic available
Never interrupt Clozapine and the
Clozapine Process (Cycle)
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Notation - Not Honored
During the summer of 2014, we met with Doctor Lee our psychiatrist and he indicated that our treatment preferences would not be honored. He indicated that he would not honor them in an inpatient setting.
During the summer of 2014, we met with Doctor Lee our psychiatrist and he indicated that our treatment preferences would not be honored. He indicated that he would not honor them in an inpatient setting.
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Bullet Points
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Medications Management & Risk
Management
Mindful Medication – MSG Notion
Consumer Driven Titration
Minimizing Risk of Fall and/or Panic
In a Loss of Control Setting
Mindful Medication – MSG Notion
Consumer Driven Titration
Minimizing Risk of Fall and/or Panic
In a Loss of Control Setting
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Key Issue – Risk Mitigation
Minimizing risk of medicine
related harm and/or injury. After our
failed Invega Experiment (2012), I would like to commit to Clozapine for the
long run. In addition, I would like to
titrate my own dose to avoid intense discomfort and falling down. My current titration that maximizes my
personal safety is as follows:
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Time
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Dose of Clozapine
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Note
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Total Dose
(mg)
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630pm
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50-mg
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50
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700pm
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50-mg
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100
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730pm
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50-mg
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Not being too dizzy is the
usual case
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150
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800pm
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If not too dizzy
50-mg more
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Thus my usual daily dose of
Clozapine
200-mg as prescribed
Sugar consumption in the
evening influences nightly dizziness
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200
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800pm-400am
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If awakened during the night
Lorazepam PRN
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0.5 Max/Night
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Modified Timing
In an independent “thriving” in
the community (least restrictive) Two Major Events require personal
modifications to my daily titration schedule and timing.
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Karaoke (5pm – 1am) – Tend to
sleep in
Yoga Class (4pm – 8pm)
Yoga Class (4pm – 8pm)
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FYI – “Lorazepam oral tablets are
available in strengths of 0.5 mg, 1 mg, and 2 mg. Your doctor may prescribe
lorazepam to be taken 2 to 3 times a day for conditions such as anxiety,
or once daily for conditions such as insomnia. When you first
start lorazepam, your doctor may slowly increase your dose to avoid side
effects.” Mar 17, 2014
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FYI - Advance Care Planning - NCBI - NIH
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Method – Results and Indications
Client Driven Treatment
Preferences Still Too Liberal
Back in 2002 RC Kolarik indicated that Treatment Preferences (TPs) would be difficult to apply in actual clinical situations. On 20141119 we presented our Behavioral Health Treatment Preference to our Behavioral Health Doctor BS Lee for his impression. He indicated that in an acute psychiatric treatment facility our TPs would not be honored. We publish this now with a hope for our futures. For the first time we have a doctor that we went shopping about. His name will be Rimal B Bera. The most important lesson to pass on here is Clozapine works do not experiment with us any further.
Back in 2002 RC Kolarik indicated that Treatment Preferences (TPs) would be difficult to apply in actual clinical situations. On 20141119 we presented our Behavioral Health Treatment Preference to our Behavioral Health Doctor BS Lee for his impression. He indicated that in an acute psychiatric treatment facility our TPs would not be honored. We publish this now with a hope for our futures. For the first time we have a doctor that we went shopping about. His name will be Rimal B Bera. The most important lesson to pass on here is Clozapine works do not experiment with us any further.
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[INSERT IMAGE]
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Medication Safety Net (MSN-MSG-Beta)
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Materials
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Associated Documents
Clozapine Practical_1.4_Treatment_Preferences_17013104
Linkage Checklist
PIP-Problem in Past
Clozapine Practical_1.4_Treatment_Preferences_17013104
Linkage Checklist
PIP-Problem in Past
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Referral
– Linkage Appointments - Checklist
RB Bera Priorities – January 3, 2018-W:
RB Bera Priorities – January 3, 2018-W:
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Linkage
Checklist
Work List – Linkage Action Plan – Last Updated: 20171211-M:
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SLA-Satisfaction with Linkage
Assessment
SLS-Satisfaction with Linkage Score
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Mhlth_Tx_Pref_Add-Additional_14100402
Classed as Risk Management
Initial: 20010718: Updated: 20141004:
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20171205-TU:
Symptomatic Intervention Screener (8 Item)
20010718:
Sustained: 20140901 – Intervention Criteria
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I, Keith Torkelson, in the event
that I become incapable of making decisions for myself, which means I am
exhibiting any of the following symptoms:
Symptom Screen Intensity Score
(SSIS)
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Symptom
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20171208-F
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2012-R
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01
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Depression with suicidal
ideation
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Absent
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Absent
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02
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Intense agitation noted by
bridge-burning anger
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Absent
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Present
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03
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Psychosis noted by intent to
harm others
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Absent
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Absent
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04
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Debilitating substance abuse
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Absent
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Present
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05
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Behaviors that lead to jailing
or imprisonment
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Absent
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Present
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06
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Extreme risk taking
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Absent
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Present
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07
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Intent to sell-the-farm
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Absent
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Absent
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08
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Behaviors that may compromise
personal integrity
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Absent
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Present
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Symptom Screen
Intensity Score (SSIS) =
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0/8
0%
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5/8
63%
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Table – Treatment Preference
related Assessment – Sound Being Score: Last Update: 20171214-TH:
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Reversibility
Not intended to give license for
irreversible, hard to reverse, harmful, neglectful or abuse acts. Not intended to give license for not
following Informed Consent policies.
Tough love is not helpful or does it promote recovery and
resilience. We conclude Mr. Torkelson’s
2017 Reality Testing was Intact.
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Sound Being Evaluation (SBE) = 1/
(SSIS)
[INSERT IMAGE]
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Remainder
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Treatment Preference – Versions
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TimeStamp
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Associated MD
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Impression(s)
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20010718
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Dobos
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Too Early – Too Liberal
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20140901
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BSL
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20141004
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BSL
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20141119
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BSL
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Not Honored @ Hospital
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20150419
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BSL
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20171206
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RBB
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Table – Component of Righting
Action Plan (RAP)
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Policy
“It Works Don’t Change It”
Medical Doctor Assignments
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Name (Dr…MD)
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Phone number
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Area of expertise
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Chester M Mojica
TheBTC
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714-643-7176
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PCP - Current
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Rimal B Bera
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714-643-7176
12511 Brookhurst St, CA
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Psychiatry
Pending Linkage
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Drafted: 20140901: Last Updated:
20171205-TU: Bera Added (First Appointment Scheduled for January 3, 2017)
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Special Topic - Liberal
Behavioral Health
Darrell Steinberg - Wikipedia
“Darrell Steven Steinberg (born
October 15, 1959) is an American politician who is the 56th and current mayor
of Sacramento, California since December 2016. He was elected to be mayor on
June 7, 2016 (avoiding a runoff). Before that, he was California Senate
President pro Tempore and the leader of the majority party in.”
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[INSERT MR STEINBERG’S PHOTO]
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[INSERT MR STEINBERG’S PHOTO]
Darrell Steinberg
Metadata:
08_Profile_Steinberg_16020701_Notes V2017
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20171212-TU: Darrell Steinberg
Programming Language (DSPL)
The Mental Health Services Act
(MHSA) and associated literature contain what we here at MSG have named The
Darrell Steinberg Programming Language.
Though it came into effect Circa 2004, the true power of it has yet to
be demonstrated. Still too many
providers, consumers, family members, as well as others committed to Health
& Human Services remain unawares.
With our current readership we feel our impact will remain small.
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FYI - 20171212-TU: Update
“Mental Health Services Act Full Text”
[PDF] - Mental Health Services Act - Sacramento County DHHS
(22 Pages)
Apr 1, 2017 - MENTAL HEALTH SERVICES ACT. As of April 2017.
This Act shall be known and may be cited as the “Mental Health Services Act.”
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[INSERT AN ANIMATION]
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Darrell Steinberg Programming Language (Applied)
Table – Excerpts from Darrell
Steinberg Programming Language (DSPL)
Last Reviewed: 20171208-F:
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Segue to Experimentation - Segue
– Invega – Brief
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How is it that we gave in to the
Invega Experiment?
Basically Clozapine side effects
can be so miserable and scary (panic) that Mr. Torkelson voluntarily agreed to
further experimentation. Clozapine also
has the risk of being pulled from his system immediately. Because mister Torkelson requires Clozapine
for health promoting sleep he has up until 2017 entertained a replacement for
emergency purposes. We will continue to
address experimentation with other reports.
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Clozapine Contingency - Fatality
This plan cannot be completely
laid to rest. At this time we do not
have a perfected Clozapine Contingency Plan (CCP). Note contingencies cut in immediately if our Complete Blood Count
(CBC) blood values tank setting in motion not being able to have it prescribed
anymore. Historically, our lab results
for more that half the year our CBC results indicate elevated cell counts. In a manner elevated values are protective
about Agranulocytosis.
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Summarize Clozapine Lessons
Learned
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Concern
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History Higher than 200mg
Case of Agranulocytosis (Elevated Neutrophils)
Minded Medication
Titration
Curative Value
Case of Agranulocytosis (Elevated Neutrophils)
Minded Medication
Titration
Curative Value
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Advanced Planning (Living Action
Item)
In the future we will include
linkage to current Advanced Health Care Directive (AHCD) & Power of
Attorney (POW). Our Brand New Day (BND)
Advance Health Care Directive will be updated this year (2014) to include
references to this document: Mental Health Treatment Preference.
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Decline Surgical & Other
Invasive Procedures [STILL STANDS]
20010718: I am not willing at
this time to have electroshock therapy or invasive nervous system procedures
(including lobotomy, lobectomy).
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20171214-TH: Important Note
[REWRITE]
Paradox: We DBA Tork
Reconstruction Company (TRC) started this document of TP during the summer of
2001. Back then we failed to finish it
and run it by our Kaiser supporters.
TRC really didn’t need it until the summer of 2004. Back in 2001 we were being treated for
double (depression complicated by ahedonia), a sleep disorder, and chronic
fatigue. As of 2014 we DBA Mentalation
Solutions Group (MSG) believe we are being treated for schizoaffective disorder
even though our primary complaints indicate: Anxiety, sleep disorder, chronic
fatigue, and traumatic stress disorder.
During the summer of 2014 our doctor, Dr. BS Lee, reviewed the latest
incarnation of our TP. He did not
support our pursuing our TP driven health care tool. The TP concept is a hard sell.
We hope it will help us avoid irreversible actions by those vested to
help us.
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20171209-SAT: Paradox Update
Going backwards some of the
actions taken by TRC and MSG’s primary family support person (LAK) in 2012 we
still have to reverse. All of them will
not be reversed (spiritual surrender).
I another process about advanced planning our trusted nephew is
beginning take over LAK’s responsibilities.
With her we don’t do well sharing documentation. Sleep Disorder is now our biggest
concern. Last go round in 2012 we were
taken off Clozapine for replacement with Invega. After not sleeping for three nights in a row our Principal had to
be admitted for acute psychiatric inpatient care. This change off Clozapine cost us about $30,000 in
hospitalization fees. Our intent for
maintaining transparency by sharing this document is to help others and us
Prevent Catastrophic Loss (PCL).
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Gray List of Approved Medications
[NO LONGER APPROVED]
Results of Participating as an
Experimental Bunny Rabbit (EBR)
Medications No Longer Approved
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2001 Record
20010718: I was willing to take
the following medications for the purpose of experimentation:
20171209-SAT: Update
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Medication
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Was to be taken under these
circumstances
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Note
Approval
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Zyprexa
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Moderate schizophrenia
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No
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Prolixin with Cogentin
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Intense schizophrenia
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No
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Neurontin
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Moderate to intense mania
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No
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Serzone
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Moderate to intense depression
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No
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Ambien (*)
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Mild sleep disorder
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No (Chandler Note)
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Benedryl
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To help with side-effects of
others and sleep disorder
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No
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Lithium
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Treat bi-polar (rapid cycle)
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OK
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Cogentin with any Primary
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No
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Drafted: 20010718: Last Reviewed:
20171208-F:
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2001 – Performance Orientation
In 2001 we were in a performance
orientation once again. We had been
accepted to and we attending the California State University @ Fullerton
Secondary Teaching Program. Doctor
Dobos rotated us through medications to meet the ever-changing needs we
encountered. Our GPA when we left the
program as 4.0.
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Ambien (*)
Doctor David Royce Chandler (DRC)
On Routine Titrations
After stabilizing our sleep about
Ambien for some odd nine (9) years doctor Chandler in a role as chief audited
in totality Kaiser Permanente’s Orange County case folders. Most likely as a results DRC decided to not
renew our Ambien Prescription. We were
taking Ambien as it had been prescribe for nine (9) years. We were approved to ingest up to one (1)
tabled PRN per day. Although other
factors such as Family Conflict impinged on our sleep, without Ambien, we
almost immediately began losing sleep.
Eventually, we ended up in the Hospital for what we call: Episode
2004. Doctor Deutsch (MD-Psychiatry)
taught us for an effective and safe reverse titration no less than one month is
required and stepping down is wise.
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Quick Objective
Dr. David Chandler, MD | Anaheim,
CA | Psychiatrist - Vitals
20171214-TH: Dr. David [Royce]
Chandler, MD, rated 3/5 by patients. 2 reviews.
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Black List of Medications – Brief
Version
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20010718: I am not willing to
take the following medications:
Results of Participating as an
Experimental Bunny Rabbit (EBR)
20171209-SAT: Efficacy Update
Medication
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Side Effects
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Efficacy
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Barbiturates
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Sleep which was desirable
(Prescribed 3 day over whole life)
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Medium-High
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BZDs
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(e.g. Ativan, Xanax, Klonopin,
Restoril)
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Moderate
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Haldol
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Intense and Not Tolerated Well
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Low
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Invega (*)
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Didn’t meet my needs –
associated with catastrophic losses
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None
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Navane
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Intense and Not Tolerated Well
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Low
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No narcotic
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Addiction potential
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Low
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Tegretol
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Liver toxicity
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Low-Medium
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Zoloft
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Sex dysfunction
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Low
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Initially Drafted: 20010718: Last
Reviewed: 20171214-TH:
Invega (*) – Issue
Out of Scope (IOS)
“I’m going to put you in a
place better that ever”
(Daniels MD, 2012)
Daniels Performance
Doctor Daniels performance is not
available on the world-wide-web. As far
as we are concerned she is a Digital Ghost.
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Experimental Bunny Rabbit (EBR)
Outcomes
Co-Share with Minded Medication
Knowledge (MMK)
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20010718: I am not willing to
take the following medications:
Extended Version
20171206-W: Results – EBR –
(LiveX 1989-2013)
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Medication
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Reason to avoid
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Note
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Haldol
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Intense, debilitating
side-effects including Tardive Dyskinesia (TD)
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Past Medication (First – 1989)
TD – Partially Reversed
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Navane
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Ditto
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Tegretol
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Liver toxicity
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Mimics Carpal Tunnel Symptoms
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BZDs
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Addiction potential challenge
“What Ifs”
(E.g. Ativan, Xanax, Klonopin)
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20171214-TH:
Change of Heart
Willing to use PRN at Nighttime
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Zoloft
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Sex dysfunction
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Serious Conflict with Joan (MSO)
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Benztropine
(Cogentin)
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Blurred vision – Cannot read
Cannot Perform if Reading is
Required
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Impossible to maintain a
literacy and learning curve
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Invega
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Philosophical Issues
|
Experiment Failed
Cost (Loss) approximately
$30,000 Medical Fee
|
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Depakote
|
Un-tolerable Side Effects
|
Including weight gain up to 200
pounds
Current weight 145 pounds
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Risperidone
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Ineffective
|
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First Drafted: 20010718: Last
Reviewed: 20171214-TH:
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Benztropine [SPELLED]
WGFA-Won’t Get Fooled Again!
CIS-Consumer Inappropriately
Served
LiveX-Lived Experience
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