Brand New Day HMO: February 2018

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Interim Lab Testing for Central City Community Health Center by Keith E Torkelson, MS – Outcomes Report

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Keith E Torkelson, MS CCCHC 2018 First Quarter Lab Report - Drive-by Lab Follow Up Hosted By Central City Community Health Center
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Abstract

Our follow-up visit to our Primary Care Physician (PCP) – Chester D Mojica’s Office came off very well. We awarded both the clinical and clerical elements 5.0 Star Equivalents. We used our Vitals Driven Quick Score Method. Upon reflection our appointment went “Perfect”. This is a first since our association began in 2012. After processing information associated with our PCP transactions we discovered the most import element about this round of encounters is related to Health Record Management (HRM). Brand New Day is our insurer. We had cause to access our BND owned and operated Patient Portal.

Medical Records – Lesson Confirmed

We have been monitoring BND’s Patient Portal since we were referred to it in 2014. It has and still is error prone. We have previously suggested a solution about BND and our Volunteer Work Host (VWH) the Health Care Agency of Orange County. Doctors have tendency to stick fast to the records they can see. Our solution will reduce errors. Consumers need access to a read-only version of the Electronic Health Record that the doctor references. We had hoped that the results from this round of lab work would completely support our Celery Diet Protocol. Our Blood Glucose Levels (BGLs) are inconclusive. Thus our Celery Diet Protocol is inconclusive. For the most part we find this set of Interim Lab Testing to be warranted. We will be addressing the results from time-to-time throughout this year (2018).

Clozapine Management – Clozapine Complication

Right in the middle of drafting this report we faced a crisis about getting our routine medication Clozapine. On February 14, 2018 we said to ourselves we need to call about getting our Clozapine. We said it looks like it should be uneventful. On February 15 we call the pharmacy (Gilbert Drugs). They said they could not deliver the prescription as it was written. We stressed out for four (4) day trying to work it out. Fortunately on 20180215 they sent us an emergency supply. We will address more about this incident in another paper “…Determination…” The reason we classify it as a crisis is because it took substantial coping that yielded little and in the end we had to ask for help.

List of Tables & Figures

All are tables unless they are labeled figures.

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Graphic
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Accountability - Dug Who Died Too Young – In Memoriam
ProSumption Planning and Outcomes (DOA = 20180220-W)
Vitals Plus Quick Score for: MD and Teams of the Day
STR Method – Phase 5 of 5 and 5B
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Figure - Brand New Day (BND) Patient Portal Update - Referral
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CBC Scheduling – Emerging Problem
New CBC Baseline Proposal for Bethany – A Solution
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Figure – Sample Gantt Chart
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TimeTable - Denial Of Payment (DOP) – Associated Key Events
STR Method – Phase 1B of 5
Priority - Outcomes From Drive-by Lab work (F2F)
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Figure – Test Names as Provided by MyQuest Patient Portal
Figure – Lithium Level Over Time
Figure – Daily Cycle of Lithium (Example)
Figure – Mood Assessment (M3)
Figure – Glucose Level Over Time
Figure - White Blood Cell Count Over Time
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WBC Accounting
Figure - Absolute Neutrophils Over Time
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Table – List of Tables and Figures: Last Reviewed: 20180223-F:

Table – Accountability - Dug Who Died Too Young

Special Feature & Dedication & Inspiration

Honoring Another Wounded Warrior – Dug Discovery

Features of One Who Died Too Young (Mid-Late 50s)

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Server	Dug’s Satisfaction	Dug Being Respected & Honored
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PCP	No	No
Life Coach	No
Case Worker	No	No
Psychiatrist	SoSo
Landlord	No	No
Buster D Right	Yes
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BND	No	Yes - Ozie
CCCHC	No	No Mention
MSG	Yes	Yes - Here
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Table – Service Profile & Satisfaction for Dug who Died Too Young (Circa 2013): Last Reviewed: 20180220-TU:

How is it – Dug?

What follows is a brief (Vignette) on Douglas Keith. I met him in late 2008. We shared a room. He discovered that the landlady was in trouble with the house, which was listed on the inter-net for sale. Even on a good day Doug had some signs of Anxiety. When an eviction notice was posted on the front door to our rental, Doug became Pro-active. He moved to a new house nearby our original house. This move did not take to well. He moved to another house near Brookhurst and LaPalma. He was lucky to get a single room for the price he had been paying for a shared. This looked good until a hit and run driver collided with him breaking his femur. The break was so severe he was granted immediate approval for surgery. So now Mr. Anxious is suffering Pain.

[INSERT PHOTOS OF DOUG]

Here is "Dug" when we met him

Dug's rule was our room is for resting

Count them seven prescriptions for Dug

Dug is having an Anxiety Attach

We are transporting him to the ER

Dug's provider was Brand New Day

We thought BND should cut us a check for servicing their member

Revised Treatment Plan

He began a treatment plan that included Self Medication. His closest friend, Richard Hively, had moved out of state. On and off Doug suffered symptoms for COPD for he was a daily smoker of cigarettes. Somewhere around 2013 we ran into Doug at the BND-CCCHC Complex. We forgot to mention when we lived with him he was a bit overweight. In 2013 we complimented him on the weight loss – “Doug you are looking really good! Within a year Doug was dead. I told Richard that I think he may a suffocated due to COPD and/or had a heart attack. Doug was not very happy with the services and supports provided by The BND/CCCHC Complex. In the end Doug “Dug” Died Too Young.

Most Current

20180221-W: CBC and Lab Follow-up both scheduled for 830am. We had a letter ready for Bethany regarding re-alignment of our Routine Monthly CBC lab. Jocelyn at the counter said, “She is in the back”. We decided to address the scheduling issue we Jocelyn. She understood our need and re-aligned our CBC lab. Next CBC is set for March 7 at 1015am.

Leveraging the Labs

We can leverage our: BGL, Lipids, and CBC lab results in our Celery Diet Project and our study about Dental Service for 2018. For us, this interim lab and the results is generated are both a distraction and motivation. We will see that our report from Quest Diagnostics about Blood Glucose Levels (BGLs) indicated we are slightly elevated. The Doctor on the Day for our follow-up was our Primary Care Physician, Chester D Mojica. He indicated that the results in front of him did not indicate an elevation. We will follow-up in our report about Energy Assessment. In addition we are going to modify our Celery Diet Protocol (CDP).

1-Day Dosage Intensity

February 21, 2018 was a very challenging day for us: We had two events with Central City Community Health Center (CCCHC) and one event with our Dermatologist. We normally only score one Health Related Engagement (HRE) to cover at activities on the same day. Yet since these two were in different locations we could the CCCHC HRE and the Dermatologist HRE separately as one each.

Summary Encounters

First: Routine CBC > CBC Re-alignment > Next Follow Up On Labs > Migrate to new location > Dermatologist. We give each of the events a Quick Score equaling 5.0 Stars with 5.0 being best.

A Few Acronyms


AcroCode	Meaning

DOA	Date Of Appointment
PCP	Primary Care Physician
CDM	Dr. Chester D Mojica (PCP)
STR	Structured Temporal Reconciliation

Table - ProSumption Planning and Outcomes (DOA = 20180220-W)

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ProSumption – Plans	Hopes	Outcome
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1-Results Check MyQuest for Results	20180219-TU Made Available
2-Results MyQuest Review and Process	ProSumption 20180221-W with Dr. Mojica	Some Variation

Apply Vitals Plus to Clinical	No burdensome events	QSM = Perfect
Flawless Routine CBC	Not Necessary	Rescheduled
Get Doctor DDD True Name	Ask Martha	Dr. Kelly
Hardcopies (PRN)	Scheduling for Counter Lab for Doctor of the Day	Jocelyn got it right
HEALTHMAN Status	MeritMan StrongMan
Mental Results	Moderate Distraction
Photos as Appropriate & PRN	Counter Staff	Still None
Publish Follow Up Report
Shared Decision Making Grade	CDM	Better

Profile Doctor Kelly

“doctor Kelly with central city community health center”

20180221-W: We asked Martha (RN) the name of the Doctor that served us for the DriveBy Lab. We believe Martha said Doctor Kelly. We could not find a Dr. Kelly associated with CCCHC online. So we still have to promote her as Dr. DDD.

[INSERT DOCTOR KELLY AVATAR]

Ghost in the Machine - Dr. Kelly's Avatar
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Self-defined ProSumer

We are working on the qualities that make a ProSumer. In its’ latest incarnation it is twenty (20) items long. The overarching quality of a ProSumer it to prepare and make the most on one’s Meaningful Engagements. Another feature is that one publishes their findings with faith that they might benefit the community at large. We find that wellness takes planning for a Good Orderly Direction. YaKnow! We don’t know where we are going yet we sure are getting there fast.

Table - Vitals Plus Quick Score for: MD and Teams of the Day

More ProSumption Results (20180221-W)

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ProSumption – Results	Character(s)	Yield
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Delivered above expectations	Jocelyn (Perfect)	CBC Schedule Re-alignment
Vitals Quick Score	Chester D Mojica (Perfect)	5.0 Stars
Vitals Quick Score	Jocelyn (Perfect)	5.0 Stars
Hardcopies (PRN)	Jocelyn	Appointment Card
Vitals Quick Score	Dermatology Associate - Crystal	4.5 Stars Issue – Freeze Times Too Short

Table – Vitals Quick Score for Transactions Dated: 20180221-W

Impression at Noon - HRE = “Perfect”

By noon February 21, 2018 we were leveraging a BND Subsidy. In this case the subsidy is our Silver and Fit Gym Membership with 24-Fitness. We working our legs we were reflecting about the morning we determined that by 1030am we had had a “Perfect” morning.

Glitch Found Yet Ignored

While trying to confirm the BGL results that CDM had to reference we went online. Brand New Day has a member patient portal. We have already set up an account with BND’s Patient Portal. We used our Wi-Fi subsidy that is included at home with our rent. We logged in and could not find up to day lab results. We logged on today, February 22, 2018, to look for labs again. Still not there. Yet we did find a referral that we did not recognize. We first thought that BND is trying to rip-off Medicare with a ghost service. We fleshed a bit deeper and yes the referral (Radiology-Chest X-ray) in question was very likely generated by Dr. CDM. We did discuss cigarette smoking.

Sent Home With Fecal Kit

A bonus from the encounter with Dr. CDM is that he ordered a Fecal Kit for us. In years passed we had to remind them to do this. In another incarnation, our Fecal Sample Collection (FSC) was arranged in a Health Fair. Last year the Fecal Tech told us she needed to watch us poop. Doing things right often is a smoother and gentler approach.

Table - STR Method – Phase 5 of 5 and 5B

Phase 5 of 5 for this DriveBy Lab study will address our Follow-up Appointment scheduled for February 21^st, 2018 @ 9am.

Ready for Discussion & Disposition @ Follow-up with Doctor of the Day

Actual Outcomes From Drive-by Lab work (F2F)

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Test	Warranted	Outcome	Disposition
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Urine	Not Really	Negative for Everything
CBC	Hope to Leverage	Routine Elevated WBC and PMN	Next routine CBC set for 20180221-W would like to use this CBC as our new baseline Scheduler Jocelyn understood and took appropriate action
Lipids	Not Really	In Range a bit better than last time	Sustain
BGL	For Us	Slightly Elevated again	Maintain diet that had us in range before Step up exercise with jogging Dr. Mojica indicated that his results looked OK
Lithium	Yes	Low as usual yet even lower We keep forgetting that this is a trough level	May address with Dr. Bera to up Li+ by 300mg/day
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Table – Utility of a DriveBy Lab 20180202-F with Doctor DDD and Team Martha - Projections

201802021-W @ 9am Follow Up with Doctor of the Day (CDM)

Taking Celery Up A Notch

Considering the Blood Glucose Level (BGL) results provided by Quest Diagnostics we intent to take up a Celery Diet up a notch.

Phases 1-4 In Legacy Report

[DITTO] FYI - Legacy Report In Scope – Parent Appointment

Central City Community Health Center Interim Fasting Lipid Appointment February 9th. 2018 – Satisfaction – Annoying – Frustrating for Our Principal Keith E Torkelson – A Step Back in Progress 2012-2017.

http://brandnewdayhmo.blogspot.com/2018/02/drive-by-lab-appointment-hosted-by.html

Drive-by Lab Appointment Hosted By Central City Community Health Center

FYI - Overview of Brand New Day Provider Portal

https://bndhmo.com/providers/ipa/overview-of-brand-new-day-provider-portal/

Jan 5, 2017 - Overview of Brand New Day Provider Portal. Brand New Day uses a portal called Cerecons to delivery data to our contract IPA's, providers, and members with the intention to assist our providers more effectively provide efficient care for our members.

Resource – BND Cerecons Aerial Patient Portal

On 20180221-W: We found a need to surf Brand New Day’s Patient Portal to confirm our Blood Glucose Level (BGL) Results. Once again we found the errors we pointed out to Brand New Day are still extant. We first accessed our BND Portal Site back in 2014. It is still the same old error prone APP. The lab work we were searching for was not up-to-date.

Advocate

We cannot advocate for everything that hinders our progress. If we turn BND into CMS we risk being dropped. Yet CMS should know of how providers satisfying Meaningful Use can check it off without a Quality Audit. Yet, because we are company people we will hold back our Salvo.

Figure - Brand New Day (BND) Patient Portal Update - Referral

Patient Portal Discovery and Confirmation

20180221-W: Referral Not Discussed

On February 21, 2018 at our follow-up appointment Dr. CD Mojica briefly mention our cigarette smoking. I told him this year we are going to make better sense of it. We agreed we would see each other at our Physical Appointment later this year. While on-line accessing Brand New Day’s (BND) Patient Portal we found that Dr. CDM put in a referral for us. Once again we did not discuss any Chest X-rays. We are waiting for the Paper Version to come in the mail from BND. If we do not follow through on this appointment we stand a change of being labeled “Non-compliant”. We have some trauma issues to work out about Chest X-raying.

HealthTeck - Argument for Direct Read Only Access

We will mention this idea at lease one more time before the end of this paper. We formally addressed this issue as a member of the Technology Advisory Committee a leg of the Health Care Agency of Orange County. After discovering the magnitude of errors in Brand New Day’s Patient Portal: We recommend again, rather than a separate Patient Portal the clients’ need access to the Electronic Health Record. There access is to be Read-only and Gated with Permissions. This will save money and improve accuracy.

Table – CBC Scheduling – Emerging Problem – Medication Gap

Actions and Requests at Follow-up Appointment

20180221-W: Complete Blood County (CBC)-Clozapine Schedule (Timeline)

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TimeStamp	Description	Note	Age of CBC (Days)
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20171216-SAT	Clozapine Bottle
20171227-W	CBC - Routine
20180115-M	Clozapine Bottle		19
20180124-W	CBC - Routine
20180209-F	Interim Fasting Labs	Interim CBC

20180221-W	Lab Follow up	CBC Scheduled
20180215-TH	Clozapine Bottle		22
20180219-M	Clozapine Bottle		26

20180221-W	CBC Scheduled

20180315-TH	Next Clozapine		30
20180321-W	CBC – Old Routine
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Table – An Argument for CBC Re-alignment for Emerging Needs

Outcome (Risk) – Clozapine Complication

By March 15, 2018 The interval between Lab Work and Pharmacy distribution of Clozapine will reach thirty (30) day. In this case our Pharmacy (Gilbert Drugs) will not accept the Lab Work. If they do not accept the Lab Work they will not dispense our Clozapine. Not having Clozapine can be life threatening. The best part about this DriveBy Lab is that it yielded CBC results. The result could and were used to reset our Clozapine Cycle. See the table with the Solution below.

Table - New CBC Baseline Proposal for Bethany – A Solution

New & Improved


TimeStamp	Description	Note	Age of CBC (Days)

20180209-F	Interim Fasting Labs	Interim CBC
20180215-TH	Clozapine Bottle		22
20180219-M	Clozapine Bottle		26
20180221-W	Lab Follow up	Cancel CBC
20180221-W	CBC	Schedule New CBC
20180221-W	Interim CBC Results	Jocelyn Sending them to Gilbert
20180222-W	Schedule Re-aligned CBC	Jocelyn

20180307-W	Next Clozapine @ 1015am	Anything greater than 15 days is risky Pharmacy very likely to refuse results	Would have been 30

20180307-W	CBC – New Routine
20180315-TH	Next Clozapine	Anything 15 days or less offers a Comfort Zone	8
20180404-W	CBC
20180412-TH	April Clozapine		8

20180221-W: Upgrading our monthly CBC lab cycle to meet emerging need. A Re-alignment

ProSumption – Asking for Help – CCCHC Clerical

We were prepared to share this information with Bethany our psychiatric nurse. We arrived for our 9am appointments early. This gave us the opportunity to sell the idea with Jocelyn at the counter. Jocelyn agreed with us and both canceled the CBC scheduled for today and made our next CBC for March 7, 2018. The model above does not take into elements that Dr. RB Bera is in control off.

Figure – Sample Gantt Chart

Figure – Sample Gantt Chart (MSG, PMADS)

Four Variables (Three Gantt Lines/Bars) – Task Entanglement

We can usual juggle three (3) tasks in one day. In general the Tasks per day indicates increased complexity. On 20180215-TH we were assaulted by what we call the Clozapine Complication. For five (5) days we were pre-occupied about a gap in our core medication. We were juggling Three CBC aspects: CCCHC, Quest Diagnostics, and the Pharmacy. We put our Dental Treatment Plan (DTP) and our Living Arrangement Study on hold. We missed our weekly Conference Call. And we have yet to factor our Behavioral Health Doctor (BHD) into the Freya.

Cost Containment – Person Served

Our records show that for last year (2017) we participate in 78 Health Related Engagements (HREs) with Brand New Day (BND) and their Network Providers. The biggest event was Retina Reattachment Surgery (Doctor Rol). We had gone blind in our left eye and we are very grateful for BND helping us out. After three months JAN-MAR (2018) we can predict our HRE rate (Events/Days). We had hoped to decrease costs this year with a Goal of 25% decrease in the cost for serving us.

Table - TimeTable - Denial Of Payment (DOP) – Associated Key Events


TimeStamp	Activity	Note

20170725-TU	Lipid Follow-up with Physician’s Assistant
20170914-TH	Pre-Physical Fasting
20171003-TU	Routine CBC & Non-informed Consent Flu Shot
20171010-TU	Physical	20171108 Denial Of Payment

20180209-F	IFL Appointment DriveBy Lab
20180221-W	Routine CBC Scheduled Follow Up on DriveBy Lab Scheduled

TimeTable – Key Events Associated with Our DriveBy Lab Appointment Dated: 20180202-F: Last Reviewed: 20180212-M:

Denial of Payment – Be Aware!

We put this in because Brand New Day has a history of Denying Payment for services rendered by Central City Community Health Center (CCCHC). The CBC performed with our DriveBy Lab was out of cycle. Our medication, Clozapine, requires monthly CBC testing. In the past HealthNet our insurer Denied CBC payment. Without a secure supply of our Clozapine we eventually ended up in the Hospital.

[INSERT DENIAL LETTER]

Interim Lab and Follow Up Audit Results

We take lab work seriously. If lab work was not super important than we order it in the first place. Much of what we experienced and learned participating with this DriveBy Lab will soon be behind us when we publish this report in a manner befitting “Closure”.

Table - STR Method – Phase 1B of 5

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Service Element	Phase 1 20180209-F Note – FIT Kelly MD	Phase 1B 20180221-W Actual Chester D Mojica MD
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Nature of Appointment	Unilateral/Annoying	Earned Value Much better Actually “Perfect”

Arrive Early	We do this religiously We had perfect attendance for 2017
In On Time	9am for a 9am Appt	9am for a 9am Appt
Weight	142 @ 5’7.5”	142 @ 5’7.5”
Blood Pressure	125/77	121/79
Temperature	Insignificant	Insignificant

STR Method – Phase 1 of 5: Associated with Our Appointment: 20180202-F: Last Reviewed: 20180112-M: We remain Satisfied with Our Numbers!

FIT=Feeling – Impression – Thought

Follow-up Preparation

Basically, our follow up preparation is to complete and publish this report. We will also prepare: “Whatever It Takes” to Satisfy our Criteria as a Meaningfully Engaged ProSumer.

How is it an Interruption (IRQ)?

When we signed on to participate in this Interim Lab the Appointment Card Code (ACC) indicated IFL. We were instructed to come fasting. We thought it was just for testing our Lipid Values. We said OK this will not get us off track. The we were given a battery of test that required discernment. We felt it best to focus on this a bit. Our new treatment plan with our dentist was put on the back burner. Between the Sample Collection Day and the follow up we were hit with a crisis that was heading to a gap in our life-sustaining medication. At the moment Martha pulled some odd 4 tubes and a urine vial we knew we were facing an interruption or IRQ). IQRs can disrupt system stability.

Table - Priority - Outcomes From Drive-by Lab work (F2F)

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Test	Warranted	Expected	Note (Actual)
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Urine	No	Negative for Everything
CBC	Redundant Duplicate Service	We hope within Range Next routine CBC set for 20180221-W	Help us detect and solve an error about our routine scheduling for lab work
Lipids	No	Even better than last time	Yes we improved a bit
BGL	For Us	Even better than last time	CDM says good Our results indicate we are elevated again
Lithium	Yes	Low as usual	Even lower – we forget this is a trough value
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Table – Utility of a DriveBy Lab 20180202-F with Doctor DDD and Team Martha – Discussed: 20180221-W with Doctor of the Day –Chester D Mojica MD (PCP):

Figure – Test Names as Provided by MyQuest Patient Portal

Figure - 20180222-W: Summary of Labwork (Source Quest Diagnostics – MyQuest Patient Portal): Collection Date: Consumer Keith E Torkelson, MS.

HEDIS Satisfied

As we indicate in our parent to this publication our HEDIS was satisfied until our next physical. This driveby lab work yeilded interim results across more than 50% of the HEDIS Criteria. In the and our annoyances (AnnoyMan) have grown into appreciation (MeritMan).

[DITTO]

FYI - Legacy Report In Scope – Parent Appointment

http://brandnewdayhmo.blogspot.com/2018/02/drive-by-lab-appointment-hosted-by.html

Drive-by Lab Appointment Hosted By Central City Community Health Center

Figure – Lithium Level Over Time

Figure - 20180222-W: Lithium (Blood) Level Line Graph (Source Quest Diagnostics – MyQuest Patient Portal)

We ask?

Distraction V Serendipitous [SPELLED] - Danger or Opportunity

Figure – Daily Cycle of Lithium (Example)

Figure – A Reference Frame for Lithium Cycling

Lithium Level Cycling

Our Lithium Level came in a bit low even for us. We take our Lithium daily as prescribed as 600mg total per day. We will address the value for Lithium in a later paper. For now we are ready for our Behavioral Health Doctor (BHD) to wish to increase our daily dosage. As one increases for us our Lithium levels our hands tend to shake more. Hand Shaking can be stigmatizing when we our co-volunteer workers.

Lithium Distraction – Bera Diagnostics

We thought having our Lithium Level to be a distraction. Yet we are drafting a Diagnostics report for our new Behavioral Health Doctor (BHD) Rimal B Bera. We take the timeliness of our Lithium testing as an indicator that our Diagnostics report move up in our list of tasks for this Winter Quarter 2018. Doctor Mojica did not address our Lithium Result at all. It would have been nice to discuss Lithium with him from the PCP Perspective.

Do I have bipolar or anxiety?

FYI – “But some people experience feelings of anxiety or depression or suffer mood swings that are so severe and overwhelming that they interfere with personal relationships, job responsibilities, and daily functioning. These people may be suffering from an anxiety disorder, bipolar disorder, or both.”

Once Again - Do I have bipolar or anxiety?

“Your M3 score is a number that will help you and your doctor understand if you have a treatable mood disorder, like depression, anxiety, bipolar disorder, or post traumatic stress disorder. You can even monitor your score to see how your mental health is changing over time.”

Link - Lithium Management - Testing

What's My M3: Bipolar Test - Depression Test

https://whatsmym3.com/

Date taken: 22 Feb, 2018 – Method Online

The M3 Score: How disruptive are your symptoms?

Scores of 33 or greater mean that your life may be impacted by a mood disorder.

Figure – Mood Assessment The 3 Minute Test (M3)

Figure – M3 Mood Test Score and Interpretation: Online Assessment Taken: 20180222-TH:

Mood Assessment – Commentary

The reason a mood assessment was rolled up on deck is that the DriveBy lab tested our Blood Lithium Level. We are preparing a paper on Diagnostics for our new Behavioral Health Doctor (BHD). The online “What My M3” assessment had a few promising features. Containing some odd twenty-seven items (questions) makes it a little better than a Screening Tool. The M3 is automatically scored, and it returns the results and interpretation back to the test taker (Closing-the-loop). The down side is that we wanted a discrimination that could differentiate between: Anxiety and Mania. What this does indicate is that we are progressing nicely about managing our extremes.

FYI - Mental Disorders - Mood Disorder - Depression - Anxiety

http://www.mentalhealthamerica.net/conditions/mood-disorders

What Are Mood Disorders?

“Mood disorders are a category of illnesses that describe a serious change in mood. Illness under mood disorders include: major depressive disorder, bipolar disorder (mania - euphoric, hyperactive, over inflated ego, unrealistic optimism), persistent depressive disorder (long lasting low grade depression), cyclothymia (a mild form of bipolar disorder), and SAD (seasonal affective disorder).”

Signature Test while on Lithium

Why we like our Lithium Dose Low

Our Fine Motor Skills are Better

See Here we Can Still Sew

Figure – Glucose Level Over Time

Line Graphs for Doctor

Figure - 20180222-W: Blood Glucose Level Line Graph (Source Quest Diagnostics – MyQuest Patient Portal)

BGL - Doctor’s Interpretation

Doctor Mojica indicated that his results did not indicate our Blood Glucose was elevated. Thus we disposed of these results. Potential causes for variation are: He was not looking at the most current lab report, Quest reported to us different results for the same event dated 20180210. We are trying to Prove our Celery Diet Protocol thus we are using the results indicate here in the graph above. With our sugar intake so low we suspect an Endocrine Rebound Effect (ERE). The culprit may be Glucagon [SPELLED].

Slightly Disappointing - Step Behavioral Fix Up A Notch

We had hoped our Blood Glucose Level (BGL) was even better than our September 2017 level. It isn’t and thus we are a bit disappointed. Our next BGL test should come with our mid-year Physical Exam. In the time being we are stepping up or Celery Diet Protocol (CDP) by adding an element: Jogging a minimum of three (3) days a week. Our presctiption for Lipid Control – Atorvastatin [SPELLED] cannot be ruled out at this time for complicating our sugar (carbohydrate) system. We think that the elevated sugar in our blood captured is the last BGL test may be of endogenous origin.

Member Mark Rates the BND/CCCHC Service Complex

Figure - White Blood Cell Count Over Time

Figure - 20180222-W: White Blood Cell Count (Source Quest Diagnostics – MyQuest Patient Portal) – Interpret: Actually Protective when Clozapine is in the Mix

CBC Doctor’s Interpretation

We showed these to Doctor Mojica. Results were unremarkable. Ever since we were privy to our CBC results back in 2007 we have suffered WBC counts that cycle. At first we though we may have Leukemia yet the physicians in charge never really made much about our Leukocytosis. What we think may happen is that at our stress increased the bacteria (Red Complex Bacteria) get the upper hand and our White Blood Cell System steps the army to fight. They only win about three times per year. Earlier this month (February) our dental confirmed infections in the roots of our teeth. He wants to treat us with very expensive antibiotic called Minocycline arestin (SPELLED)

FYI - Why would neutrophils be high?

“Any infection or acute stress increases your number of white blood cells. It is important to realize that an abnormal increase in one type of white blood cell can cause a decrease in the percentage of other types of white blood cells. An increased percentage of neutrophils may be due to: Acute infection. Feb 7, 2017”

Table - WBC Accounting

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WBC Character	Level	Note
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Total	Elevations	Periodic
Neutrophils	Elevations	Periodic – Mirrors WBC
Basophils	Normal
Eosinophils	Normal
Monocytes	Elevations	Periodic – Less Frequent than Neutrophils
Lymphocytes	Normal
-

Table – White Blood Cell (WBC) – Audit: Last Reviewed: 20180223-F:

Figure - Absolute Neutrophils Over Time

Figure - 20180222-W: Absolute Neutrophils (PMNs) (Source Quest Diagnostics – MyQuest Patient Portal)

Doctor’s Interpretation

We showed these to Doctor Mojica. For him this time around these results were unremarkable. We intend to apply our CBC results to our Dental Project 2018.

Discussion Items

At the end here we wish to discuss a few Items. First we comment about our periodic and cyclical Leukocytosis. We would like to sustain low values for the next quarter – Spring Quarter. Earlier this year Dr. Mojica associated our elevated Neutrophils with a crush toe injury. Since our Leukocytosis has been present for more that five (5) years we think it is associated with the health of our teeth. As we stated earlier we will take our Celery Diet Protocol (CDP) up a notch with periodic jogging. We are very happy that this round of intensive lab work revealed an emerging risk for us. We were able to re-align our CBC-Clozapine cycle before it became a crisis. Next and finally we close with our Conclusion and Takeaways. We hope you found this paper interesting and better yet useful on Your Recovery Journey.

Conclusion & Takeaways

Our principle conclusion is that it pays to work hard about righting our self. Advance planning is a primary feature of a practicing ProSumer. The Takeaway is that Patients-Clients-Accounts have direct read only gated access to their Electronic Health Records. Only in this fashion can the practitioner and patient truly be on the same page.