Patient Status
Shadia Osman Abdalgafar Elsaim
شادية عثمان عبد الجعفر الصائم
Age
61 years
Injury Date
28 Feb 2015
Location
Egypt (Cairo area)
Nationality
Sudanese
Weight
89 kg (2026-03-14)
Height
164 cm
BMI
Body Mass Index
33.1 (obese)
Primary Diagnoses
Severe Traumatic Brain InjuryPost-traumatic epilepsy with myoclonic seizuresBladder and bowel incontinenceBreast cancer (Invasive Lobular Carcinoma, 2022)Diffuse Axonal InjurySarcopenia
Crestor + Magnesium — Separate by 2+ Hours
Magnesium reduces rosuvastatin absorption by 54% when taken together.
Whey Protein + Depakine — No Longer Applicable
RESOLVED: Depakine is being tapered and will be stopped completely by ~7 Apr 2026 per Prof. Hosny. Separation rule no longer needed once Depakine is stopped.
Monitor Fluid Intake — Currently 2L/day
Current fluid intake 2L/day — monitor serum osmolality (279, borderline low). Consider 1.5L/day if SIADH confirmed.
Monitor Quetiapine Levels During CBZ Taper — No Longer Applicable
RESOLVED: Quetiapine has been STOPPED per Prof. Hosny (07 Mar 2026). No longer need to monitor levels.
Weekly CBC for ANC Monitoring
ANC 0.7 = Grade 3 neutropenia. Standard threshold for stopping CBZ is ANC <1000-1500.
Separate baclofen from protein meals/whey by 1-2 hours
Baclofen is being tapered (Prof. Hosny, 07 Mar 2026) and will be stopped by ~28 Apr 2026. Continue separation until baclofen is fully stopped. Current dose: 7.5mg AM + 10mg PM.
Monitor ammonia during protein step-up
RESOLVED: Dr. Ahmed Alous (13 Mar 2026) confirmed ammonia level is acceptable — was drawn from vein (venous), not artery. Venous ammonia is expected to be higher. Plus Depakine is being tapered/stopped, further reducing ammonia risk.
Medication Taper Schedule — Prof. Hosny (07 Mar 2026)
All changes start 17 Mar 2026:
QUETIAPINE: STOPPED immediately
DEPAKINE (Valproic Acid):
• 17 Mar – 7 Apr: 250mg evening only
• After 7 Apr: STOP completely
BACLOFEN:
• 17 Mar – 31 Mar: 7.5mg morning + 10mg evening
• 31 Mar – 14 Apr: 5mg morning + 10mg evening
• 14 Apr – 28 Apr: 2.5mg morning + 10mg evening
• After 28 Apr: STOP completely
ARICEPT (Donepezil):
• 17 Mar – 31 Mar: 5mg daily
• After 31 Mar: STOP completely
ESCITALOPRAM: START 10mg daily (mood enhancement)
Follow-up: Prof. Hosny — 7 Apr 2026
Neupogen (Filgrastim) Injection — If ANC < 0.5
Per Dr. Ahmed Alous (13 Mar 2026): Give Neupogen (Filgrastim) injection subcutaneously ONLY if ANC (Absolute Neutrophil Count) drops below 0.5 x10³/μL. Current ANC: 0.8 (Feb 28, 2026). Keep injection on hand. Monitor ANC with weekly CBC.
Upcoming Alerts
Prof. Hassan Hosny — Neurology / Epileptology
Prof. Hassan Hosny — Neurology / Epileptology
Dr. Ahmed Alous — Internal Medicine
Dr. Hani Louis — Neurology
Dr. Ahmed Farahat — Oncology
Discuss recurring BP drops during physio with doctor
HIGHCheck with oncologist on CBCT scan
HIGHVisit dental clinic and do CBCT Arch scan
HIGHResearch dental implants for TBI patients
MEDIUMDo bone X-ray
MEDIUMCheck baseline labs for supplement protocol
HIGHImplement protein step-up protocol
HIGHSequential supplement introduction schedule
HIGHSwitch renal monitoring to cystatin C-based eGFR
MEDIUMCheck copper levels — may explain neutropenia
HIGHDEXA scan for bone density assessment
HIGHImplement CBZ taper per Dr. Hani Louis
BLOCKEDIncrease Depakine to 500mg BID
HIGHCheck Levetiracetam (Keppra) level
HIGHMedication taper Phase 1: Start all tapers
Overdue 26dMedication taper Phase 2: Aricept stop + Baclofen reduce
Overdue 12dMedication taper Phase 3: Depakine stop + Baclofen reduce
Overdue 5dMedication taper Phase 4: Baclofen further reduce
14 Apr — 1dMedication taper Phase 5: Baclofen stop completely
28 Apr — 15dLevetiracetam Level — Third AED - never checked. May be sub/supra-therapeutic
Morning Cortisol + ACTH — Post-TBI pituitary screening (25-50% of severe TBI)
IGF-1 — Most common post-TBI endocrine deficiency (GH axis)
Intact PTH — AEDs cause bone loss (11 years on AEDs!)
Bone Markers (CTX + P1NP) — Bone status: immobility + AEDs + menopause = triple risk
Urine Sodium — SIADH confirmation (serum osm 279)
D-dimer — DVT history - thrombotic risk
Serum Copper — Deficiency causes neutropenia (commonly missed!)
DEXA Scan — Bone density: 11 years AEDs + immobility + menopause
Some follow-ups are overdue — please schedule soon
Active Medications
View all →Tegretol
Carbamazepine · 300mg BID (600mg/day)
Active
Keppra
Levetiracetam · 500mg BID (1000mg/day)
Active
Depakine Chrono
Valproic Acid / Sodium Valproate · 250mg evening only (tapering to stop)
TaperingNO CRUSH
Quitapex (Seroquel)
Quetiapine · 25mg
Active
Lioresal
Baclofen · 7.5mg AM + 10mg PM (tapering to stop)
Tapering
Aricept
Donepezil HCL · 5mg (tapering to stop)
Tapering
Crestor
Rosuvastatin · 10mg
ActiveNO CRUSH
Cipralex
Escitalopram · 10mg
Active
Supplements
View all →Currently Taking (3)
Creatine Monohydrate (PureGanic Creaganic)T1
Whey Protein Isolate (Dymatize ISO100)T1
Magnesium Glycinate (NOW Foods)T1
Pending Doctor Confirmation (13)
Lactoferrin (Pravotin)T1
Vitamin B6 (Pyridoxine)T1
Vitamin D3 (VitaThrive 50,000 IU)T1
Folate (Methylfolate / 5-MTHF)T1
+9 more
Latest Lab Highlights
View all →01 Mar 2026
ANC Trend
Absolute Neutrophil Count (ref: 2.0-7.0)
Seizure History
View all →Days Seizure-Free
518
7 events recorded
10 Nov 2024(Night)
Possible sleep deprivationMild
20 Jun 2024(Morning)
Mild
15 Feb 2024(Morning)
Baclofen abrupt withdrawal (cold turkey) — recommended by local junior doctorSevere
Infection History
View all →Carbapenem-Resistant Organism Detected
Pseudomonas in sputum — extremely limited antibiotic options
UTI Episodes
5
7 total infections recorded
06 Mar 2026Commensals
Respiratory (Sputum)Normal flora — no pathogenic infection
17 Jan 2026Pseudomonas spp.
Respiratory (Sputum)10R
10 Dec 2025Pseudomonas spp.
Urinary7R
02 Aug 2025Escherichia coli
UrinaryESBL8R
Rehab Progress
Phase 1: Foundation4/23
Phase 2: Building0/13
Phase 3: Intensification0/9
Phase 4: Optimization0/8
Daily Schedule
View full →8:00 AMMorning
10 items
12:00 PMMidday
4 items
8:00 PMEvening
5 items
10:00 PMBedtime
2 items