2018-2019 COPD Season By and For Keith “Buster” Torkelson, MS Brand New Day Teladoc Benefit Pulls Through

Lead Information

Dedicated to:

Mike Oathout & Kurt S Olson

Mike O is a sample of Brand New Day driven care.  Kurt O is a friend of Keith “Buster” Torkelson.  Keith met Kurt back around ninth grade (1973).  Whereas Kurt appears to have smoked continuously since 1973 Keith took a three (3) year pause beginning in 1983.

Mike Oathout - Gravely Ill - Brand New Day Client

Pneumonia and Flu

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Friend Kurt Olson - Smoking

In Memory of:

June Elizabeth Torkelson & Mike McMahon

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Buster's Mother - Role model for smoking

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Friend - Mike McMahon - Smoker Died Too Young

[INSERT TWO PHOTOS – HEALTH VS DECLINING]

Partners

Parent Document Metadata >

Global_Health_COPD_For_2019_20181107_Hope V2019

By Avey Asus

Updated September 12 (W), 2019

Approved by Mentalation Solutions Group

Expert Keith E Torkelson, MS – Torkelson Pathology

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Key Acronyms

Acetaminophen (APAP)

Doctor In Charge (DIC)

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

Lead Information

Table - PCP – Care - Report Header

Pertains To Buster/CDM Unilateral V Partnership

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Specification		Entry	Note
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Client		Keith “Buster” Torkelson
Practitioner		Chester D Mojica MD	CDM
Specialty		Primary Care Physician	PCP
Date of Appointment		20190725-TH	The Billy Appointment
Time of Appointment		11am
Duration of Appointment		7 minutes	PC states “I don’t have time”
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Lab(s) Associated with Appointment		20190711-TH	Quest DX patient portal MyQuest
Specific Area within Appointment		COPD Status Teladoc Follow-up
Lab makes material available in time for appointment		Yes Via MyQuest	This is a 5.0 stars service
Nature of Appointment		Interim Routine Lab	IRL
Invoiced for Appointment		No	Accountability issue
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Satisfaction with this component of appointment		No	Poor bedside manner again No satisfaction survey
Insurer		Brand New Day (BND)	Medicare Advantage Plan Medi-Medi Special Needs Plan Wraparound Care
Was there a COPD related error?		Moving past the liver error
What was bothersome?		BND Rewards program Health Information Transfer error	Doctor’s office failed to send colonoscopy and physical exam completion documents to BND
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Last Reviewed: 20190905-TH:

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Executive Summary – Request 4 Funding (R4F)

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Request for Funding – Residential Treatment Program – Smoking Cessation

This report deals primarily with the health of Keith “Buster” Torkelson MS.  Buster’s insurer is Brand New Day (BND).  Buster’s Primary Care Physician (PCP) is Chester D Mojica MD.  Buster’s Behavioral Health Doctor (BHD) is Rimal B Bera MD.  Both of these doctors hold office hours at Central City Community Health Center (CCCHC) in Garden Grove California. The presenting problem that we address here in this report is Buster’s Chronic Obstructive Pulmonary Disease (COPD).  After a particularly severe COPD season (2018-2019) we uncovered a need to request funding or pro-bono service to address this upcoming COPD season.  We are Mentalation Solutions Group (MSG).  I am Avey Asus!  We would like BND to look into paying for and enrolling Buster in a Residential Recovery Home that addresses cigarette smoking.  MSG finds that Buster would benefit from a three month program: Detox, Clean Living, and Transitional.  While in the program Buster needs to keep his current bed where he is living.  Finally, Buster would need to check in on his belongings once a week.  The remainder of this report addresses Buster’s 2018-2019 COPD Season experiences.  We begin by evaluating a few doctors’ with regard to their individual virtuosity.

List of Matrices – Tables – Special Topics

Table - PCP – Care - Report Header

Matrix - Subjective Result Up Front (SRUF) - BSA Virtue Update

Table - 20190822-TH: Table - Repeating Themes

Table - Cast of Characters - Protagonists

Table - Cast of Characters – Antagonists & 1 CONTROL

List - Comorbid Conditions – Co-occurring Disorders (CODs)

2018-2019 - Table – Current Concerns as Related to COPD

Matrix - COPD Phases – Roughly in Order (Apply to Prevention)

Table – Records - Modality – Procedure – Resource – Centered about COPD

Table – Over-The-Counter (OTC) Preparations - COPD Coping Strategies

Table – Timeline (STR) - The Allergy Phase - Structured Temporal Reconciliation (STR)

Table - Behaviors & Coping Behaviors Centered about COPD

Table - Ability To Cope with COPD and Related Issues – IF Exceeded – Ask For Help

2018-2019 - Matrix - Coping with COPD – Aerobic Mitigation Effort Scores (AMES)

20190619-W: Table – Smoking and COPD – Aerobic Mitigation Efforts – New Baseline

Table - Adjustment & Control Respites – Centered About Mikel Roby

Table - 2018 – Respite Sampling about CODP Season

Table – Major Milestones – 2018-2019 COPD Season

Table - Major Milestones – 2018-2019 COPD Season

Table - Performance Challenges (PC) – Closing and Episode

20190830-F: Table of Complicating Factors When Resolving COPD

Table - Determining Special Topics – Discussion Special Topics – For Prevention Report

Table - 20181102-F-ON: Peak Intensity (Near DEATH) – Compounding Symptoms

Appendix - Reference (Standard) – Executive Summaries - Sharpening the Knife

Abstract

BSA Virtue Update

We here at Mentalation Solutions Group (MSG) keep tabs on the virtuosity for our Casts of Characters.  Virtuosity evaluation was a skill that Buster developed as an Eagle Scout.  The standard Boy Scouts of America (BSA) tool for virtuosity has 12 items.  We pulled several records with scores between 20180103 to 20190725.  We tabulated some eleven (11) different scores.  The scores center about the virtues of Buster’s PCP and BHD.  In all incidences we calculated Star Equivalents (SEs).  We found virtuosity scores ranged from 2.2 to 4.9 with 5.0 being superb.  In this pod of eleven (11) scores Dr. Jeffery A Nagel PhD (JAN) scored the best.  Dr. Nagel earned himself the 4.9.  For the set of score we share in this report Dr. JAN is the high CONTROL.

Renting A Shared Room Roommate (RASR) Comparison

Buster rents a shared room.  Even in the best circumstance Renting A Shared Room (RASR) can be very challenging.  As of September 6 (F), 2019 his shared roommates are persistently and severely ill.  Mikel is about thirty (30) years old.  We already published a paper on Mikel.  We include the link to this report below.  The second roommate is William.  William is about sixty (60) years old.  William suffers neurological problems.  He may also have Behavioral Health Issues (BHIs).  Both Mikel and William are for all practical purposes “Mute”.  Last COPD season before Mikel came along Rochester was in the room.  Rochester is a Vietnam Vet that suffered traumatic brain injury.  Rochester’s COPD symptoms: Snorting – hacking – coughing prohibited reliable rejuvenating sleep in Buster’s room.  Lack sleep and PEACE in the room made it very hard for Buster to manage stress.  COPD can severely impact sleep for those that find difficult to sleep through COPD noises.  Buster (then Keith) shared a room with Lawrence David Chan (LDC).  They were both successful as shared roommate while attending UC Davis.  We give the LCD – Buster partnership an A.  LDC is the RASR roommate CONTROL.  During the 2018-2019 COPD-Season Buster’s shared roommates earned themselves Cs and Ds.  The most serious thing that Buster’s shared roommates did was impairing Buster’s sleep with COPD noises in the night AKA “Quiet time”.

Interventions

During the 2018-2019 COPD Season Buster asked for help more than five (5) times.  For the most part all interventions fell short about what was needed.  Buster saw his PCP a few times.  His PCP wasn’t very helpful.  His PCP’s bedside manner floundered once again.  He doesn’t seem to have the time or skills to be of any real assistance.  At one point Buster activated a BND benefit.  This is the telehealth Teladoc service.  For her help we award our Teladoc doctor, Annie Nguyen MD, 5.0 stars for excellent service.  In sum we asked a minimum of four (4) people for help this COPD season.

Physical Exam 2019 – Annual Wellness Exam

We first contracted with our Primary Care Physician (PCP) back in 2012.  This year is our seventh (7^th) annual physical exam with our PCP.  Our PCP for Buster does not practice a partnership approach.  Most all exchanges in an appointment with our PCP are unidirectional.  Buster’s demonstrates the authoritarian parent approach.  For this years’ physical things were spread out enough so Buster really didn’t know when his physical began and ended.  We have yet to have our Spirometry Test run?  Spirometry is one capacity we use for closing out our COPD Performance Challenges (COPD-PC).

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Product - Number of Reports in Scope Approximately 10

Rather than keep moving ahead with new material here with this report refer to many reports that we have already published.  In the scope of COPD we have somewhere around ten (10) in print. 

Performance Challenges

In the face of not being able to quit smoking Buster helps himself not feel like a failure by addressing his Quality Of Life (QOL).  As an indicator of QOL with respect to COPD - Buster tracks his Aerobic Mitigation Efforts.  On June 19 (W), 2019 he scored a new baseline score.  September is historically Buster’s intersession about COPD.  His new Aerobic Mitigation Effort (AME) score is 50.0%.  Our current version of our AME instrument has seventeen (17) items.

Liver Complication

This COPD season introduced something new and improved.  We detected that Buster had overused Theraflu Nighttime.  The indicator of Theraflu overuse is Buster’s elevated liver enzyme lab results.  We have already written and published a report on COPD and Buster’s liver health.

Link to Liver Report

[Product INSERT LINK TO LIVER REPORT]

Acetaminophen (APAP) - Drug-induced liver injury (DILI) – Vehicle Theraflu Nighttime Overdose – Complication of COPD - By Keith Torkelson for PCP Chester D Mojica MD

https://brandnewdayhmo.blogspot.com/2019/09/feature-image-dr.html

Keith E Torkelson MS - Date Chartered 9/4/19

Performance Challenges (PC) – Closing and Episode

We finally determined that this 2018-2019 COPD Season ended on August 30 (F).  Born out of this season, we have drafted a 16 Item COPD complicating factors assessment tool.  Applying this assessment yields what we call a COPD Episode Resolution Score (ERS).  On the 30^th August 2019 Buster earned himself an 80.0%.  On this scale higher scores are better.

Prevention

We here at MSG have our next COPD related report in the works.  This report will focus on early intervention and preventative measures.  Near the end of this report we list some Special Topics.  We have scheduled to deliver our COPD Preventions Report (CPR) before our PCP runs our next Metabolic Panel (MP).  The Metabolic Panel includes testing to detect liver pathologies.  In addition our Prevention report will include our Request For Funding (R4F) in the form we will try to sell Brand New Day (BND) or any other agency that will buy into our plan.

Episode Index

Ever since significant signs of COPD appeared in November of 2018 Buster has been preoccupied with managing the symptoms.  As things appeared to be improving Buster was thinking the 2018-2019 COPD Episode was ending.  In reality he really did not get back on track until August of 2019.  The key event as far as getting a head on things was being prescribed antibiotics.

Lead Information

Matrix - Subjective Result Up Front (SRUF) - BSA Virtue Update

Matrix - A Measure for “Scout” Quality and Virtues

Stats Calculated and Compiled by Keith “Buster” Torkelson MS

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Time Stamp	DOW	Practicing	%	SE	Note
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20190403	W	RBB	43.3	2.2	Crash appointment
20190725	TH	CDM	60.0	3.0	Liver is normal appointment
20190427	SA	RBB	62.5	3.1
2016-R		CDM	62.5	3.1
20190108	TU	CDM	62.5	3.1
20180310	SA	RBB	64.2	3.2
2017-R		CDM	71.7	3.6
20180103	W	RBB	78.3	3.9
-					Cutoff
20180103	W	BSL	84.2	4.2
20190205	TU	CDM	85.0	4.3	CDM of to a better start Higher than the objective rater give him
20190427	SA	JAN	97.5	4.9	Public Health Officer
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Date Compiled: 20190830-F: DOW = Day Of Week: SE = Star Equivalents

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Results - BSA Doctor Mojica

Metadata > Assess_Virtues_BSA_18110702 KET on CDM

Should your doctor be your friend?

We here at Mentalation Solutions Group (MSG) evaluate friendships using our Boy Scout of America (BSA) virtues assessment.  Our cutoff for good quality friends is 4.0 Star Equivalents (SE).  A person who is a good friend in one instance may not be a good friend in another.  In the table above Doctor Jeff A Nagel PhD (JAN) scored the highest virtue wise.  This was largely due to the fact that he gave us an hour to share (time spent) in our last face-to-face (F2F) meeting.  This meeting occurred in March of 2019.  We discussed housing fixes for the disadvantaged peoples in the “OC”.

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Introduction

Table - 20190822-TH: Table - Repeating Themes

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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##	Theme		Here	Note
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01	BHDs – RBB			A Doctor In Charge
02	Boundaries			For Dr. RP Singh
03	External Quality Review (EQR)		X
04	Family Involvement		X	Joyce M Brown
05	Housing Advisory Board COPD & Housing		X	Updates for Rep Lou Correa Director Jeff A Nagel
06	MHSA Innovations Jeff A Nagel PhD			Public Health Approaches
07	HEALTH - PCP – CDM		X
08	Protective Factors		X	Marginal
09	Psychiatry 4 Dummies
10	QOL & COPD		X
11	Satisfaction		X
12	Sleep		X	SleepAbility
13	Social – Communicating – Relating			Disadvantaged and Homeless Mending Social Poverty
14	Technology for Recovery Telehealth		X	Blogging Teladoc
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Last Addressed: 20190902-M: MSG Housing Repeating Themes

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Protective Value of this Report

Since 2012 we here at MSG have published more than one-hundred reports.  Our intent was to share information about Buster’s hardships so that our readers may avoid or mitigate the impact of similar hardships.  We have so many reports in the works that it is unlikely we will finish them all.  The protective value of this COPD report for others is that by applying some of our materials and methods they may better manage you own COPD issues.  For Buster personally reporting helps him complete things.  What we learned here will help him better care for himself this year.  What he knows now will help him defend both against his disease and disappointments with his Primary Care Physician (PCP).  We would like our insurance to help Buster out with a smoking cessation program.

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Physical Activity & Stress

In this report we outline preventative strategies against COPD for the upcoming 2019-2020 season.  Buster cannot go into smoking re-hap unless he retains the place he lives at the present time.  We call this concept HomeShield or BedShield.  We have better defined those persons and thing that can help Buster avoid the level of harm he suffered last COPD season.  Buster remains under the protection of his PCP.  We believe Buster can step up his aerobic engagements in that "physical fitness provides considerable protection against stress".  To ward off infection he will take the following As Needed (PRN): B vitamins, multi-vitamins, and omega fatty acids.  Finally to protect his liver he will avoid Acetaminophen (APAP).  The manner that reporting helps protect Buster is that it helps him cope and manage stress.

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Teladoc Update

“keith torkelson teladoc”

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201904 > Teladoc Benefit Practical - Brand New Day HMO

http://brandnewdayhmo.blogspot.com/2019/04/brand-new-day-teladoc-benefit-practical.html

Apr 4, 2019 - Brand New Day – Teladoc Benefit Practical – Central City Community Health Center - This report addresses the client Keith Torkelson.

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Introduction

Table - Cast of Characters - Protagonists

20190826 – Table - Intervention Resources

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Subject		Note	Detail
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Gloria Shanks (Casita)		Interventionist	Skills have improved over time
Mel Shanks (Casito)		Muscle Interventionist
Keith “Buster” Torkelson		Self-help Specialist	External Quality Review Officer
Joyce Maxine Brown		Family Interventionist	Talk therapy
Chester D Mojica MD		Primary Care Physician
Annie Nguyen MD		Telehealth – Teladoc Doctor	Made a good impression
Mikel Roby		Rent A Share Room (RASR) Roommate	Permits SleepAbility
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Date Last Reviewed: 20190902-M: Labor Day

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Introduction

Table - Cast of Characters – Antagonists & 1 CONTROL

20190826-M: Table – Sharing A Room Roommate Comparison – In The Face of COPD

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Abbrev	Character		QGM	Note
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LDC	Lawrence David Chan (ChanMan) CONTROL		A	Example of a Protagonist Model RASR roommate When we lived with him 1983-1984 we did not smoke cigarettes
RC	Rochester Cannon (Basalt)		D	Very ugly Antagonist Caused intentional harm and interfered intentionally with Buster’s sleep He quit smoking more than 7 years ago 2013-2019 he still suffered COPD symptoms
MO	Michael J “Mike” Oathout (Speedy)		D	A client of Brand New Day Hospitalized for Pneumonia and Flu 20171030 Beginning summer 2019 his COPD symptoms have waned a bit
WS	William “Bill” Shrader		C	Non-smoker Has Tourette’s Syndrome and has fits & tics of COPD noises
TF	Theodore “Ted” Francis		C	Housemate – Shot Caller Quit smoking Intentionally made this year’s bout all the worse
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Last Reviewed: 20190906-F: QGM = Quick Grade Method

[MIKE Os HOSPITALIZATION]

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Mike O in Hospital - Pinterest Link Image

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Buster visiting Mike O in FV Hospital

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IV Medications for Mike O while he is in Infectious Disease Ward

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We thought that Mike O stood a chance of dying

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Introduction

History

This year as Buster began to develop more and more symptoms of Chronic Obstructive Pulmonary Disease (COPD) we settled on a mistaken belief.  Our mistaken belief was that we deserved to suffer because Buster is stupid enough to smoke cigarettes.  In general until we get prescribed antibiotics we treat ourselves with Over-The-Counter (OTC) preparations.  Our fav for years has been Theraflu Nighttime (TN). We use TN because it helps us feel better during the day and helps us sleep during the nighttime.  We have been seeing our Doctor In Charge (DIC) since the summer of 2012.  We cannot find anywhere in our medical records that he has prescribed us antibiotics.  More often than not with every COPD session we come upon antibiotics incidentally.  For example in the season of 2017-2018 it was our Dentist that prescribed antibiotics.  The dentist did this in association with a surgery (implant) we had.

Coping By Respite

Back in fall of 2011 Buster attended Cypress College.  We took two classes for a total of 8 units.  One of the classes was Crisis Intervention Management (CIM).  We earned our “A”.  On and off, more on, we continue to development our crisis intervention skills.  The latest incarnation for defining intervention is: We recognize two types of intervention.  The first is when one has (gets) to ask for help.  The second is when one has (gets) to leverage financial resources saved from emergency planning.  This last period of COPD had us both asking for help and expending savings. 

Developing Options with Significant Others

Metadata > 07_Respite_Mikel_Roby_19081304_Records

Episode Summary

Some episodes are hard to pinpoint when recovery begins.  For the “Cold & Flu” season 2018-2019 we thought that Buster was improving when he actually was not.  Here at Mentalation Solutions Group (MSG) our records indicate that a reasonable point for the onset of Buster’s COPD Chronic Obstructive Pulmonary Disorder (COPD) was November 2, 2018 (F).  In hindsight we now know that recovery began the day after Buster was prescribed a course of antibiotics.  We close this year’s COPD episode on August 30, 2019 (F).  On August 30, 2019 Buster met his predefined Performance Challenges (PCs).  It took quite a long time for Buster to achieve his SingAbility Performance Challenge.

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How is it SingAbility?

Keith “Buster” Torkelson has sung since he was a kid.  He grew up in a family of singers: Sisters Lanaii, Candace, and Christine. His oldest brother Craig also sang and played the guitar.  His number two brother Kevin did not sing much growing.  Yet now Kevin enjoys Karaoke.  Keith identified as an amateur singer up until he completed with an “A” grade Popular Vocal Training at Orange Coast College (OCC).  He also took Classical Singing at OCC.  Across a total of 12-16 units Keith’s singing GPA is 4.0.  Later on Keith completed University Choir at UCD Davis.  His singing ability is greatly influenced by COPD.  This year we thought that he was not going to meet his annual SingAbility Performance Challenge.  On Saturday September 14, 2019 Keith singing as “Rex in Affect”” will take the stage to test his vocal systems.

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Introduction

List - Comorbid Conditions – Co-occurring Disorders (CODs)

20190830-F: Table of Comorbid Conditions When Resolving COPD

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Condition		Meaning	Detail
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ADD		Attention Deficit Disorder	NCOC
ADHD		Attention Deficit & Hyperactivity Disorder	NCOC
AD		Anxiety Disorder
BD		Bipolar Disorder
CF		Chronic Fatigue
LT		Low Testosterone Comes normally with age	NCOC
OCD		Obsessive Compulsive Disorder Seeking control efforts
SI		Sleep Issues SleepAbility
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Last Reviewed: 20190906-F:  NCOC = No Chance Of Controlling

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Introduction

2018-2019 - Table – Current Concerns as Related to COPD

Presenting Problems

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Current Concerns		Risk
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1-Sleep		Recurrent
2-Error by Rimal B Bera		Any error that interferes with sleep
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Acetaminophen		Anything containing acetaminophen ruled out for the 2019-2020 “cold” season
Allergy		Primary source of allergens William removed from sleeping quarters
Antibiotics		2012-2018 coincidental resolution(s)
In Room & Housemate Symptoms		Based on the different medications prescribe Buster’s housemate for the 2018-2019 COPD season there we multiple respiratory disease agents in the house this year
Chantix		Activation and Anxiety
COPD		Resistant to Solution 2019 season pre-emptive strike
Hospitalization		Example – Mike O
Invega Experiments		Daniels – Lee – Mr. MR
Multiple Disease Agents		12 people  in the house Over half suffered CODP symptoms
Performance Challenge(s)		SingAbility & Intimacy Performance Score (IPS)
Respiratory Infection		Entry that Teladoc “Doc” Annie Nguyen MD entered in the case notes
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Last Reviewed: 20190906-F:

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Introduction – Situational Awareness - Options

How it that out situation has changed since our last report on COPD Management? 

COPD 2017-2018

[Product query = “keith torkelson COPD”]

[A Brand New Day Multi-week Course that demonstrated no measurable value]

James J Krueger MD COPD Course for Brand New Day

http://brandnewdayhmo.blogspot.com/2017/08/james-j-krueger-md-copd-course-for.html

Aug 19, 2017 - James J Krueger MD for Brand New Day by Keith E Torkelson MS - COPD Course Satisfaction Survey (Content Assessment).

Developing New Options

During Buster’s last episode COPD interrupted our sleep to an extent greatest in recent memory.  We now know that we need a Residential Treatment Program (RTP) specifically directed at smoking cessation.  Years ago (2012) Brand New Day placed “Buster” and paid for a RTP for quitting alcohol.  It was called the Anaheim Lighthouse and their program was called Living In Balance (LIB).  It was partially helpful in that Buster has not had any alcohol to drink since July of 2012.  Buster needs to retain his bed (SecureBed) while he is away.  Another minor change is than Buster wishes to try Niacin supplements to see if it changes his smoking pattern for the better. 

Teladoc To The Rescue

Mike O has been our control for Brand New Day interventions about COPD.  Buster Rents A Shared Room (RASR).  The health of his roommates’ impact Buster’s sleep.  Buster is attended by his Primary Care Physician (PCP) CDM MD.  Buster’s doctor: CDM has earned for himself a Virtue scores with a high degree of variation (CDVA - Comparative Doctor Virtue Assessment).  On again we used the Boy Scout America virtue assessment to capture Buster’s PCPC’s CDVA score.  What has changed is Buster doesn’t feel comfortable asking CDM for help.  In other words CDM has a low value for interventionism.  We demonstrate this with our Teladoc consult to Annie Nguyen MD.

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Results of Treatments

For the 2018-2019 COPD Season Buster employed his usual Over-The-Counter (OTC) preparation approach.  He was waiting for CDM to intervene with antibiotics.  In the past, Buster most likely Over-Dosed himself with preparations that contain Acetaminophen (APAP).  He just never had liver testing done to confirm it.  This season Buster Over-Dosed himself on Acetaminophen “As Measured By” (AMD) liver enzyme testing. 

Mistaken Belief Revisited

Buster also had a mistaken belief that he deserved to be sick because he was so stupid to still smoke cigarettes.  Then Doctor “Annie” came to the rescue!  After about a 15 minute phone consult she determined that Buster had a “respiratory infection”.  She prescribed Buster a course of antibiotics.  The first night after taking the first two doses Buster slept better.  This immediately improved Buster spirits.

Introduction

Matrix - COPD Phases – Roughly in Order (Apply to Prevention)

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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	Phase		CCP
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01	Intersession		CCP
	Mucous Progression
	Aerobic efficiency
	Fatigue
05	Complications
	Impaired Sleep		CCP
	Remedial
	Self-medication
	Family Involvement
10	Respite		CCP
	Interventions		CCP
	Infection		CCP
	Key Intervention
	Allergy
15	Performance
	Close Episode
	Prognosis
	Score Cast of Characters
	Prevention
20	Early Intervention
	Lessons Learned
	Causes		CCP
	Resource Levelling
24	Sell Residential Treatment Program
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Last Reviewed: 20190906-F:  CCP = Critical Control Point

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Intervention and Treatment History

Table – Smoking Cessation Efforts – Little Impact

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD

Buster has been smoking for quite some time.  From 1983 till 1986 he quit cold turkey.  This was while he was an undergraduate at UC Davis.  Since 1986 Buster has tried several times to quit smoking.  His motivation was in part due to the fact that his Most Significant Other Ever (MSOE), Joan, was a non-smoker.  Over the years Buster used the smoking cessation products: Gum, Lozenge, Patch, and more recently the patch.  On one occasion he was prescribed Wellbutrin.  Wellbutrin did not help him quite smoking yet it did make smoking more miserable.

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Allergic to Nicotine

Buster appears to be allergic to Nicotine.  All the remedies he tried except Wellbutrin contain Nicotine.  Buster develops itching and rashes when any of them touch his skin or mucous membranes.  In 1983 when Keith successfully quit smoking for three (3) years he did so cold turkey.  Later, Wellbutrin reduced the quantity of smoke ingested per day by making smoke less satisfying.  If Brand New Day would cover it Buster would give the Gum, Lozenge, and Patch a new trial.

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Method

Table – Records - Modality – Procedure – Resource – Centered about COPD

20190724-W – Table – Seeking & Asking for Help

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Coping Options		Used (X)	Value	Note
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Treat Self		X	SoSo	Consumer Driven Treatment (CDT)
Emergency Room		NU	NA	Considered until Teladoc pulled through
Urgent Care		NU	NA	Too sick to pursue this option Too far away from our locus of control
Chester D Mojica MD (PCP)		X	SoSo	20190305 (TU) Last chance to catch Buster’s need for antibiotics
Teladoc		X	Excellent	Date of Intervention March 21, 2019 (TH)
Landlord Intervention		X	SoSo	Various – See STR notes
Respite - Medical		X	Effective	Mock Hospital Method 20190319 (TU) Till 20190322 (F) We spent our money to save BND money
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Last Reviewed: 20190906-F:  Centered about Buster and CODP – NU = Not Used

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Methods – Reporting

Health Risk Assessment (HRA)

Earlier this year we submitted for Buster his annual Health Risk Assessment or HRA as solicited by Brand New Day (BND).  About a week or so ago (late August 2019) BND asked Buster to score and submit a second HRA.  The HRA survey underestimates the impact that sleep has on health and healing.  What follows is a link to one of our HRA process reports.

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[HRA Product - LEGACY]

“keith torkelson HRA”

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201904 > Health Risk Assessment (HRA 2019.01) for Brand New Day HMO

http://brandnewdayhmo.blogspot.com/2019/04/health-risk-assessment-hra-201901-for.html

Apr 9, 2019 - Keith Torkelson about Brand New Day's annual Health Risk Assessment - Keith accessed a resource that BND provides called Teladoc.

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Cross-over Behavioral Health

201804 > Referral and Linkage Part-II – Keith Torkelson Partners with Rimal B Bera

http://clozapinerx4ecstasy.blogspot.com/2018/04/referral-and-linkage-part-ii-keith.html

Apr 2, 2018 - Rimal B. Bera, MD Evaluated by Keith E Torkelson MS as a Doctor On-Call (2016) – Information about Teladoc members only talk to actual doctors.  MSG is also looking into telepsychiatry for Buster.

Methods – Leverage Work Done

[COPD Product - LEGACY]

Google Search > “keith torkelson COPD”

Digital Appointment & COPD

Double XX – Digital Appointment – Addressing ... - Brand New Day HMO

https://brandnewdayhmo.blogspot.com/2018/09/double-xx-digital-appointment.html?showComment=1557770680517

This is a great in depth report!

Sep 10, 2018 - Digital Appointment – Addressing COPD Protections – By Keith Torkelson, MS - External Quality Review

Google Search > “keith torkelson COPD”

COPD & Housing Quality

HEALTHMAN_By Keith Torkelson MS_UCD Educated Pathologist

https://healthman2059.blogspot.com/2018/05/mental-health-association-orange-county.html

May 4, 2018 - Other than being a report about Housing Resources it also addresses the issue of COPD and housing the disadvantaged.

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Google Search > “keith torkelson COPD”

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COPD Protections & Protective Factors

2018 – For and By Keith Torkelson MS - AnimaCules

http://ktork46.blogspot.com/2018/09/?view=sidebar

Digital Appointment – Addressing COPD Protections – Chester Diokno Mojica MD – By Keith Edward Torkelson, M.Sci - This is basically a hub including links to our other reports (n=6).  We start the hub of with a photo of a PCP triumph for Buster when he was Keith.  In all the six (6) reports are fairly diversified.

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Methods & Applied Materials

Table – Over-The-Counter (OTC) Preparations - COPD Coping Strategies

Date Interventions

2018-2019 Season

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Preparation		Helpful	Note	Detail
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AlkaSelzer		SoSo
Cough Suppressant		SoSo	Without codeine	Likely cough syrup with codeine would have been helpful
Generic Tussin		SoSo	ETOH Free
Theraflu Nighttime		SoSo	2018-2019 season 20180907-F First documented use	Contains Acetaminophen (APAP)
Tylenol #3		Yes	Incidental From dental surgery 3rd world RX Manage Principle	Opioid (narcotic) pain reliever (codeine) and a non-opioid pain reliever (acetaminophen)
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Last Reviewed: 20190906-F:

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Method

Table – Timeline (STR) - The Allergy Phase - Structured Temporal Reconciliation (STR)

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Preparation		Note	Detail
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20190308-F		CVSHealth Sinus PE + Allergy	Chlorpheniramine Maleate - Antihistamine Phenylephrine HCl  - Nasal decongestant
20190508-TU		Theraflu Nighttime	Season mop up - last documented use
20190517-F		Holmes “aer” Filter Series With ionizer	Target $37.70 Address: dust, grasses, molds, and dead skin cells
20190602-SU		Ready in case Allergy Relief	Fexofenadine HCl 180mg - Antihistamine
20190905-TH		FreeStyle Freedom Lite	Blood Glucose Monitoring System Mop up BGL = 91
20190905-TH		Allergy Status	AMB - 20190819-TU CBC All normal - Mast Cells not tested Basophils normal
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Last Reviewed: 20190903-TU:

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Methods

Table - Behaviors & Coping Behaviors Centered about COPD

COPD Sub-Episode 20181101-TH to 20181106-TU:

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Behavior		Helpful	Note
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Eat Chocolate		No	Buster’s chocolate consumer is trending downward
Take Power Bath		Yes	While on respite
Take Therapeutic Bath		Yes	While on respite
Apply Vicks Vapor Rub		SoSo	This was Buster’s mother’s COPD fix
Address roommates COPD symptoms		No	Last season over half of the members’ in Buster’s household suffered severe COPD symptoms
Respite		Yes	Amazingly we came up with the resources for respites as needed (PRN)
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Last Reviewed: 20190906-F:

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Methods

Table - Ability To Cope with COPD and Related Issues – IF Exceeded – Ask For Help

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Intervention		Helpfulness	Note
Ask PCP		None	Failed to detect situation PCP discusses bringing our BND care coordinator on board (*)
Ask PCP Stand-in		Listened to our concerns	She said to wait and see
Ask Landlady		Little help with sleep More help offering OTCs	OTC and Sleep Buster’s primary interventionist
Ask Teledoctor		Excellent	Prescribed effective medication the infection component
Ask Life Coach Care Coordinator		None	(*)
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Last Reviewed: 20190906-F:

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(*) PCP Comment on Care Coordinator

Unfortunately at our follow up lab appointment our PCP they mentioned our Brand New Day (BND) care coordinator AKA life coach.  Our PCP said unless we bring our care coordinator on board he could not help us.  Buster fired his BND care coordinator back in 2016.  We here at Mentalation Solutions Group (MSG) have been coordinating Buster’s care ever since.  Back as early as 2012 Buster had Oswaldo Escalante as his care coordinator.  After Oswaldo left Brand New Day back in 2014 BND has failed to match Buster with a new care coordinator that meets Buster’s needs.

[INSERT BILLY FOR CDM]

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Grimm - Mandy - Billy present the "Billy Award"

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For his performance thus far this year (2019) we here at MSG give Buster’s PCP “The Billy Award”.

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Metadata > Source Document > Assess_Partnership_RDA_16070202_Gibbs V2019

Outcomes For Resource Development Associates - Modified Partnership Assessment

MSG-RDA-PV (16 Items)

Matrix - Calculations – Yields Health & Human Services - Partnership Value (HHS-PV)

Partnership Values	Gibbs FY2015/16	Escalante FY2013/14	Kline FY2015/16
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Your Partnership Overall	0.5	4.5	4.5
Leadership Elements	1.5	3.5	4.0
Satisfaction With Partnership	2.5	5.0	4.5
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Total Score	4.5	13.0	12.5
Items Scored – MAX Score	16	16	16
Partner Value (HHS-PV) =	28.1 %	81.3 %	78.1 %
Star Equivalents =	1.4	4.1	3.9
Disposition	Kill Partnership & Level Resources	Lost Resource	Sustainable Resource

Table - Resource Development Associates (RDA) – Modified - Date Finalized: 20160821-SUN

Instructions for Scoring

Qualitative		Binary	5.0 Star	Percentage
Yes – Favorable – Strength		1.0	5.0	100%
So-So – Average		0.5	2.5	50%
No – Deficit		0.0	0.0	0%

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Methods

2018-2019 - Matrix - Coping with COPD – Aerobic Mitigation Effort Scores (AMES)

Date Compiled: 20190619-W:

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

	Time Stamp		CALC (SUM/Items) =	AMES %	Note
	20180907-F		12.5/17.0	73.5	Motivations were different
	20190104-F		10.0/17.0	58.8
	20190619-W		8.50/17.0	50.0	New baseline for 2019-2020 COPD season

Time Series - Last Reviewed: 20190724-W: Aerobic Mitigation Effort Score (AMES) – High Values are Favorable

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Included

20190619-W: Table – Smoking and COPD – Aerobic Mitigation Efforts – New Baseline

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[HELD BACK AS RECORDS]

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Retained as Records in Separate Document

05_DA_Aerobic_Mitigation_Efforts_AME_19090201_COPD

20190104-F - Table – Smoking and COPD - Mitigation Efforts

20180907-F - Table – Smoking and COPD - Mitigation Efforts

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Methods

20190619-W: Table – Smoking and COPD – Aerobic Mitigation Efforts – New Baseline

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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##	Aerobic Effort		BND Subsidy	Pend (X)	Gravity Value	20190619 QUANT
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01	Acupuncture			X	SoSo	0.50
02	Chase the Bus		Yes		Low	0.00
03	Costal Breathing (Mindful)				SoSo	0.75
04	Diaphragmatic Breathing (Mindful)				High	0.75
05	Exercising Chest Muscles (Mindful)				High	0.75
06	Intimacy				SoSo	0.50
07	Jogging				Low	0.25
08	Karaoke				High	0.75
09	Labor				SoSo	0.50
10	Reduction Daily # of Cigarettes				Low	0.00
11	Sleep		Yes		High	0.50
12	Super Deep Tissue Massage			X	High	1.00
13	Swimming (Breath Holding)		Yes	X	Low	0.25
14	Theraflu Evaluation			X	High	1.00
15	VAPE				Low	0.00
16	Walking				High	1.00
17	Yoga		Yes		Low	0.00
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	CALC (SUM/Items) =					8.50/17.0
	Aerobic Mitigation Effort Score (AMES) =					50.0%
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Scored: 20190619-W: Last Reviewed: 20190906-F: High Values are Favorable – BND = Brand New Day

Metadata > 01_Assess_COPD_18010908_Risk Update

Methods – New Approaches “copd and ocd”-

In hoping to find a new approach to address “Busters” cigarette smoking and annual COPD we looked into addressing the Obsessive-Compulsive aspects.  It is unfortunate that his doctors and literature indicate that the COPD damage done is irreversible.  Buster really enjoyed running in his heyday.  With a research pass we could find nothing regarding managing his OCD issues that could help better manage his COPD.  His Primary Care Physician has yet to provide any evidence that he has any Clinical Pattern to successfully resolve Cigarette Smoking Disorder (CSD).  The literature does indicate that having comorbid mental disorders with COPD is complicating.  Buster is diagnosed with Bi-polar disorder yet in reality he manages his conditions as if they were a combination of anxiety and sleep disorders.  These complications may be why others around Buster have successfully quite smoking and Buster cannot.  Some of Buster family members that quit smoking cigarettes are: Older brother (2) Kevin, older sister (2) Shari, and older sister (3) Candace.  Buster has two family members that cigarettes never posed a problem: Oldest sister Lanaii and forth (4) sister Christine.

FYI – Reference

Mental disorders in chronic obstructive pulmonary disease (COPD)

https://www.sciencedirect.com/science/article/pii/S0954611107005045

Methods – Indirect Ameliorating

For Buster we try many methods to feel better in the face of respiratory infections.  One is to address our symptoms of Chronic Fatigue Syndrome (CFS) with good quality sleep and time outs (rest) during the day.  Addressing CFS is one of our goals when on respite.  We also use our Aerobic Mitigation Efforts (AMEs) to varying degrees of intensity.  To cope with all the hurdles between us and improved health we use our Structured Temporal Reconciliation (STR) Method.  We have yet to organize our notes and share STR as a promising practice with our readers.  Remember key to a direct approach is coming to terms with an MD that prescribes us antibiotics. 

Over-The-Counter (OTC) Preparations

We use Theraflu Nighttime as an indirect approach to reduce the suffering about COPD symptoms.  This year we discovered that we cannot rely on Theraflu next year.  Every time we record in our COPD STR a date for Theraflu that means we started a course of six (6) packets.  At peak that meant Buster was taking up to twenty (20) individual doses in one month.  Theraflu Nighttime contains Acetaminophen (APAP).  This was important because doctor Mojica (CDM) prescribes us a very low dose of aspirin.  Because CDM is not game for discussion we did not ask him if we should discontinue the aspirin he prescribes.  From some of the alternate OTC preparations we were receiving a substantial amount of aspirin or Acetaminophen.

Annual Physical – Report Complexity

Each year we receive a Physical Exam with Team CDM.  With our reports we try to cover a wide range of topics.  We here at MSG have made a good effort this year for reducing the length of our reports.  For us twenty (20) pages is too short - fifty (50) pages or more is too long.  This report as it stands is approximately forty-five (45) pages.  COPD is one of our biggest issues.  Delivering a comprehensive COPD report has us over-paged.  With the text combined with images we will overburden our publisher tool – Blogger.  FYI - When you overburden Blogger it has a tendency to crash.

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Metadata > Global_Health_Annual_Physical_19070414_Testing

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Last Appointment and Lab Results

Buster’s last liver enzyme tests were run roughly on July 11, 2019. 

Results

Addressing The Liver Complication

[Product - INSERT LIVER LINK]

Acetaminophen (APAP) - Drug-induced liver injury (DILI) – Vehicle Theraflu Nighttime Overdose – Complication of COPD - By Keith Torkelson for PCP Chester D Mojica MD

https://brandnewdayhmo.blogspot.com/2019/09/feature-image-dr.html

Keith E Torkelson MS - Date Chartered 9/4/19 – In general our PCP declares our “liver values are normal” when actually one liver enzyme test was elevated.

Material & Method - 2019 Respites

20190114-M Till 2019017-TH - Panic Respite

On January 14 (M), 2019 “Buster” began what was planned as a HEALTH Respite.  It lasted until Thursday the 17^th of January 2019.  On the evening of January 15 (TU), 2019 “Buster” suffered a severe panic attack.  We call this episode a HEALTH respite marred by Panic.  Using an older classification scheme we call it a WATER-TIME-LAW judgment respite.  Buster’s Disturbing Panic Episode (DPE) lasted for about one hour when we thought we may impulsively become “Road Kill on the 22 Freeway”.  This is an example of how one can lose ground when you need to gain ground.

Method – Combined Coping and Intervention

Table - Adjustment & Control Respites – Centered About Mikel Roby – Male Age 30

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Time Stamp		Budgeting	Days	Impact on Mikel
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20190114-M Till 2019017-TH		Scrimp and Family	4	Before Mikel Panic Respite
20190521-TU		Mikel Roby moved in		Room Share: Buster – William – Mikel
20190611-TU Till 20190614-F		Scrimp and Save	3	No Change for Better or Worse
20190730-TU Till 20190806-TU		Family Subsidy	7	Returned and he was Worse
20190813-TU				1pm Final Observation
20190813-TU Till 20190815-TH		Scrimp and Save	½ TU Full W ½ TH	Landlady not taking to Mikel and his ways May possibly be gone
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Last Update: 20190813-TU:

Respites V Hospitalization

March 20 (W), 2019 was the closest that Buster came to seeking help in the Emergency Room (ER) for help with his COPD.  Fortunately Brand New Day has the Teladoc Benefit.  On March 21 (TH), 2019 Buster arranged services with Teladoc.  At about 3pm Annie Nguyen MD called Buster for a phone consult.  Doctor Nguyen determined that Buster was far along with a respiratory infection.  She prescribed a course of antibiotics.  When Buster woke up the next day after taking a dose the night before his hope was restored about his health.

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[Ditto - INSERT MIKE O PHOTO]

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Mike O Before Hospitatization

When he could hold his own in the community

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Just for Fun - "Mike" the Nuke

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Results

Table - 2018 – Respite Sampling about CODP Season - Respites

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Time Stamp	Note	Detail
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20180923-SUN	Till 20181003-W Basalt interfering with Buster’s sleep	HEALTH Respite
20180929-SAT	Zep COPD Noises Addressed @ 520pm	Aggravates “Busters” condition
20181002-TU	Till 20181005-F Motel 6 Overnight	Adventure Respite
20181125-SUN	Update	HEALTH Respite COPD & Allergy
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Last Reviewed: 20190903-TU:

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Results

Table – Major Milestones – 2018-2019 COPD Season

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Time Stamps	Note	Detail
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20190108-TU @ 1130am	CBC Appointment (Extended) Altered Standard Routine In @ 1130 Out @ 130pm	Told CDM that we didn’t need him How is it we don’t CDM for help Update BSA Assessment He asks about our go to guy when we need help
20190114-M	Till 20190118-F @ M6ON Respite	07_Respite_Basaltic_18092401_Records V2019
20190321-TH	Key Event (TBP) Teladoc Phone Consult	Episode extended Prescribed and started on antibiotics for Respiratory Infection “Annie Nguyen MD”
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Last Reviewed: 20190906-F: CDT = Consumer Driven Treatment: TBP = Treatment By Partnership

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Results

Table - Major Milestones – 2018-2019 COPD Season

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Time Stamps	Note (Milestone)	Detail
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20190324-SU	CDT	Theraflu with Acetaminophen
20190424-M	CDT	Theraflu with Acetaminophen
20190404-TH	Publication	Teladoc Report I
20190508-TU	Last round of Theraflu
20190619-W	Table Smoking and COPD	Mitigation Efforts New Baseline
20190719-F	Receive MyQuest Lab Results	Via email Liver Outcomes Remarkable About two months after last Theraflu
20190724-W	Liver Lab Applied Liver Physiology	Our causation elimination indicates Theraflu containing Acetaminophen has highest likelihood for damaging Buster’s liver
20190725-TH	Key Liver Appointment	Follow up on labs with CDM CDM tanked the Appt His bedside manner “sucks” again CDM missed call on Liver Lab
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Last Reviewed: 2019083-F: CDT = Consumer Driven Treatment: TBP = Treatment By Partnership

Result

Table - Performance Challenges (PC) – Closing and Episode (Apply to Prevention)

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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##	Performance Challenge		20190830 (F) Status	QUANT	Note
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01	Duration of sleep		SoSo	0.50
02	Intimacy		Pass	1.00
03	Jogging		SoSo	0.50
04	Making Health Related Engagements (HREs)		Pass	1.00
05	Manage COPD related Panic		Pass	1.00
06	Motivated to workout at gym		SoSo	0.50
07	No Froggy Voice		Pass	1.00
08	One week away from home		Pass	1.00
09	SingAbility		Pass	1.00
10	Strength & Stamina		SoSo	0.50
	CALC			8.00/10
	COPD Episode Resolution Score =			80%

Last Reviewed: 20190906-F:

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Rough Duration of Episode – Applying the SingAbility Challenge

November 2, 2018 (F) till 20190830 (F)

We closed the 2018-2019 COPD Episode with 80% resolution.  Buster “Rex” will test his SingAbility on September 14 (SAT), 2019 at the club.  Buster is avoiding anything with Acetaminophen (APAP) in it.  We hope Buster’s liver labs come in normal later this year.

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Result

20190830-F: Table of Complicating Factors When Resolving COPD

Discovery and Awareness

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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##	Complication		Note
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01	Aunt
02	BHD
03	Chantix
04	Clozapine Pipeline
05	Dissatisfaction
06	Fitness
07	Impulse
08	Interruption (IRQ)
09	Mother
10	Motivations
11	Primary Care Physician (PCP)
12	Population of smokers
13	Proof of Concept
14	Protective Factors
15	Situational Awareness
16	Things Tried

Last Reviewed: 20190906-F:

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Legacy Results

[Product - INSERT LINK TO TELADOC REPORT]

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“keith torkelson teladoc”

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201904 > Teladoc Benefit Practical - Brand New Day HMO

http://brandnewdayhmo.blogspot.com/2019/04/brand-new-day-teladoc-benefit-practical.html

Apr 4, 2019 - Brand New Day – Teladoc Benefit Practical – Central City Community Health Center - This report addresses the client Keith Torkelson – Overall we are Satisfied with the Teladoc Benefit.

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“keith torkelson COPD”

[A Brand New Day Multi-week Course that demonstrated no measurable value]

James J Krueger MD COPD Course for Brand New Day by Keith E Torkelson, MS

http://brandnewdayhmo.blogspot.com/2017/08/james-j-krueger-md-copd-course-for.html

Aug 19, 2017 - James J Krueger MD for Brand New Day by Keith E Torkelson MS - COPD Course Satisfaction Survey (Content Assessment). – Overall in 2017 we were not impressed with BND and our PCP’s management of CODP.

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Discussion - Quest Diagnostics – “MyQuest”

More than two years ago about March 5 (SUN), 2017 we established an online account for Buster with Quest Diagnostics.  The service (patient portal) is called MyQuest.  We have reported on this before.  The search phrase: “keith torkelson myquest” will bring up several of our reports that include MyQuest.  Online we could not find any report dedicated solely to MyQuest.  In general we are very pleased with the MyQuest Patient Portal.  We have used it in real-time for our Colonoscopy process and with our Ophthalmologist.  For our last appointment with CDM he stated that our liver values are normal.  We knew in advance that we had one high value about Buster’s liver.  How is it that we did not mention for CDM that he normal interpretation about Buster’s liver was wrong.  This we base on the lab results we received directly from Quest Diagnostics?  The answer is he is a unilateral practitioner.  He doesn’t apply the progressive principle of “Partnership”.  Moving ahead!

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Looking Back: Where is the divide?

An interesting thing about episodic sickness is that one really doesn’t know the divide between sickness and health until the bout is over As Measured By (AMB) achieving some or all performance challenges. Buster believed he was getting better several times this “Season” when he really was not.  In hindsight the divide this year came on March 22 (F), 2019 when Buster got a rejuvenating night’s sleep with the Antibiotic in his system.  Again Dr. Nguyen MD had prescribed a best course of treatment the day before on March 21 (TH), 2019.  Then and only then did Buster begin to recover AMB resuming performance.  Basically everything after our Teladoc Phone Consult (TPC) on March 21, 2019 (TH) we classify with Results.  Teladoc is our most important Material and Method.  On April 4 (TU), 2019 we here at MSG began the process of re-leveling our resources about Health & Human Services.  What this means with respect to COPD: We are not going to wait for CDM to come aboard this upcoming “Cold & Flu” season.  We are planning leverage Brand New Day’s Teladoc benefit.  The time spent in a Teladoc consult far exceeds that of a CDM consult.

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COPD Symptoms and Sleep

Sleep is our specialty here at MSG in our Torkelson Pathology Division (TPD).  We have found inappropriate sleep to be at the core of Buster’s episodic illnesses.  We here at MSG and TPD have published several papers that address sleep and what we call SleepAbility.  Rather than go into sleep in depth we share the link to our last paper.  We have determined that not only the sleep of the COPD sufferer (Buster) yet the COPD symptoms of those that share a sleeping space complicates to seasonal episodes of CODP.

[SLEEP Product - LEGACY]

MAR 6 (2019)

Keith Torkelson’s SleepAbility Study 2019 Number I – A Right To Sleep (MSG, 201903) & Crisis Intervention – Health & Human Services Advisory - AnimaCules

http://ktork46.blogspot.com/2019/03/keith-torkelsons-sleepability-study.html

Discussion

Housing Advisory Board Orange County Division (HAB-OCD)

We here at MSG are devoted to contributing fixes about the housing needs of the disadvantaged peoples of the OC.  COPD is both a physical health as well as a mental health concern.  Below is a link to our paper regarding our SleepAbility Science Project (SASP) as well as the Right To Sleep (RTS).  We published this focal report on Wednesday, August 28, 2019.  We find that COPD is a substantial complication with regard to actualizing premium quality sleep.

Housing Advisory – Rent A Shared Room – Bully Management – By Keith Torkelson MS – Housing Advisory Board – Sleep Bullies - SleepAbility

https://housingadvisoryboard.blogspot.com/

5 days ago - It pertains to Keith “Buster” Torkelson MS and some of his housemates - Keith Torkelson's SleepAbility Study 2019 Number I – A Right To Sleep.

You've visited this page 2 times. Last visit: 7/16/19

COPD & Housing

Of course we need to mention our Housing Advisory Project in context of two individuals that can help us here at MSG make a sizable impact.  For Dr. Jeff A Nagel we would say COPD can impact Mental Health.  The more people at a location with COPD symptoms the harder it is for individuals and the whole house to sustain or improve both physical and mental wellness.  For California state representative Lou Correa we really at this time feel there is nothing in scope regarding COPD.  At this stage in our Housing Advisory Project we are focused on delivering resources that will “Fix” housing issues about the disadvantaged population.

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Lou Correa

COPD for Kids

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Our Friend - Dr. Jeffery A Nagel

COPD and Housing

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Discussion

Table - Determining Special Topics – Discussion Special Topics – For Prevention Report

COPD 2018-2019 Duration of the whole episode

November 2, 2018 (F) till 20190830 (F)

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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	Aspect		Note	Detail
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01	Breathing Costal V Diaphragmatic
02	Chronic Obstructive Pulmonary Disease		COPD
03	Mortality
04	Morbidity
05	Secreted Reports
06	Respite
07	Respite Index Value		RIV
08	Sleep
09	SleepAbility Science
10	Sleep Value Score		SVS
11	Rent A Shared Room		RASR
12	Asking for Help
13	Over-The-Counter Preparations		OTC
14	Obsessive Compulsive Disorder		OCD
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Last Reviewed: 20190724-W:

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Discussion – Product - Digital Appointment

201809 > MSG Legacy Paper Addressing COPD

Double XX – Digital Appointment – Addressing COPD Protections – By Keith Torkelson, MS

https://brandnewdayhmo.blogspot.com/2018/09/double-xx-digital-appointment.html

20190710-W: Page Views = 82: Date Chartered > 9/10/18

Our digital appointment product does not work very well with our PCP since he doesn’t “have enough time”.  During our last appointment when we were looking for a record in our planner about our eye exam our PCP said “I do not have enough time”.  The eye exam as well as our colonoscopy should have been in his records.  Starting about one (1) year or more ago we here at MSG were manually doing Health Record Transfers for our PCP to help him out with getting his Electronic Health Record systems going.  Now in 2019 our PCP has had enough time to get things running smoothly.  Brand New Day (BND) says he has yet to forward our colonoscopy records to them.  Our colonoscopy was on June 4^th, 2019 now three (3) months ago.

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[HELD BACK FOR PREVENTION STUDY]

Obsessive Compulsive Disorder Approach

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FYI - Key Event – Momentary Suffocation

Table - 20181102-F-ON: Peak Intensity (Near DEATH) – Compounding Symptoms

Information about Keith “Buster” Torkelson Account of Chester D Mojica MD (PCP)

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Challenge (Buster)
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November 2 (F) 2018 Friday fever sweats
All night long – Snort Hack Cough
Night of suffocation event
Popcorn – Acid Reflux + 100% nasal blockage
Reflux Paralyzes Hyoid Apparatus
Complication with diarrhea
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Last Reviewed: 20190903-TU:

Summary – Next Steps – Key Terms List

Promotions

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<<<<< WorldWafers >>>>>

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>>> One Health <<<

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Images @ the End

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We give ourselves the "Silver" Seal of Transparency

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Consumer Art

Dinosaur Dining at the North Pole

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Our friend Mike McMahon with his brother and father

Mike Died Too Young

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Doctor HD - A fieldwork gig for Med School

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Buster Dressed 4 Success at Fountain Valley Hospital

Mike Oathout in the Infectious Disease Ward (IDW)

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Buster with his long time friend Kurt O

We are at a friends that died too youngs

Viewing

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Public Health Promotion

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Another Agency on our Mission

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A Buster Mentor - Hans P Riemann

He knew how to run a practice

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Notation about the antibiotic Fix

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Lesson Learned & Take Away

No more Theraflu Nighttime

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This photo captures how Buster feels about his PCP

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Sample of Buster's Aerobic Activity

In motion over 2.5 Miles/Day!

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Even Dogs Suffer COPD

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Buster Baseline for 2019-2020 season

Exhaling Cigarette Smoke

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Buster's Family - Mom in skilled nursing

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Mom & Dad - The Greatest Couple in the  World

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999

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