Doctor Visits

Follow-up visit. Ammonia level is fine — was taken from vein (venous), not artery. Venous ammonia is expected to be higher than arterial, so result is acceptable. Prescribed: Neupogen (Filgrastim) injection subcutaneous — to be given ONLY if ANC (Neutrophil count) drops below 0.5 x10³/μL.

Check CBC monthly; if ANC drops below 0.5, may give G-CSF injection to boost it

Consultation completed. VP of ILAE, Cleveland Clinic fellowship. Recommendations: 1) STOP Quetiapine, 2) Depakine 250mg evening for 3 weeks then stop, 3) Baclofen gradual taper over 6 weeks then stop, 4) Aricept 5mg for 2 weeks then stop, 5) START Escitalopram 10mg daily for mood. Follow-up in April 2026.

Second opinion consultation booked for Saturday March 7 at Zamalek clinic. VP of ILAE, Cleveland Clinic fellowship. Review: CBZ taper plan, Depakine increase to 500mg BID, AED optimization for post-traumatic myoclonic epilepsy, persistent neutropenia (ANC 0.8). Bring consultation summary PDF.

- ammonia increase is not important since rest of liver functions are normal - tapper CBZ in 4 months - increase Depakine to 500 mg morning and night measure CBC in 5 months

1. Do NOT use Tavnic (levofloxacin) for infections — it interferes with seizure medications 2. Return in 3 weeks (~Mar 5) with new CBC — suspects low ANC may be Tegretol-related

Reviewed reports. Missing ~80% of back teeth (some removed, some broken). Doctor suspects possible infections underneath remaining broken teeth. Needs CBCT Arch scan to evaluate. Dental implants recommended but requires oncologist confirmation first due to extra radiation from CBCT.

After mammogram, chest X-ray, abdominal & pelvic ultrasound — repeat imaging every 6 months

Glasses prescription exam. OD: Sphere 0.00, Cylinder 0.00, Axis 0. OS: Sphere 0.00, Cylinder 0.00, Axis 0. IPD Far: 67. Visual Acuity: OD 0.9, OS 0.6 P. No corrective lenses required. Adequate visual acuity for basic function.