INDEX FOR THE YEAR 1993
Jan (no date) Protocol for the Administration of Ativan to Danny Muller,
says, quote: �Danny may be given 1 Ativan (1mg) only every 6 hrs to a maximum
of 3-4 /day for 3 days. If a longer regimen is needed, a doctor must be notified.
Staff may take Ativan with them on prolonged outings with Dan notifying Rolf,
Phil, Ken or shift leader as such�.
Jan. 3. Lab monitoring for the month of Dec 14 1992, all within
acceptable limits. Danny is now on 60 mg of Prozac and on 750 mg f Depakene
per day.
Jan. 15. His upsets seem to be for no obvious reason. Need a middle
ear examination?
Jan. 24. Lab monitoring OK. Recommendations: To Review
Danny�s case.
Feb. 2. Consensus of opinion: Depakene and Prozac are not helping with
his Rage, SIB and OCD. Considering using Inderal (Beta Blocker) and Catapres
(B-agonist).
Feb. 12. Schedule for slow discontinuation of Prozac and Depakene.
Dr. Huggins says, quote: �The PRN prescription for Ativan still stands�.
On March 1st discontinue Prozac and by March 15th Valproic acid is reduced
to 250mg.
March 22. Visit to Dr. Huggins, reason: Grand Mal Seizure around 8 p.m. the
night before made a hole on the wall with his head.
April 4. Lab monitoring OK after recent seizure.
April 13. Propranolol is slowly introduced and the supplements are
discontinued.
April 15. Annual Physical Exam.
April 23. Rage attacks and head bangs? No fully beta blocked.
June 23 Ativan 1mg is sent in home book �to be given as per criterion�
(Read above Protocol).
May 10th to September 19th Blood Pressure and Pulse Record Sheet Danny is
fully Beta Blocked at 120 mg. Dr. Huggins recommends Tegretol.
May 13. SIB behaviour, suspected illness. WIC Doctor finds right ear
infection and prescribed Amoxicillin.
May 14. Behaviour is better, now he gets �stuck� in transitions. Propranolol
is up to 120 mg.
July 18. Reassessment by Dr. Catherine Zahn. She says, in the use of
anticonvulsants for behaviour control and antipsychotics, quote: �I am reluctant
to confuse the picture by an addiction of anticonvulsants. On the other hand,
if major tranquilizers are being considered, these may reduce his seizure
threshold.�
Aug. 8. Lab monitoring and introducing Tegretol.
Sept. 30. He has been very slow and lethargic. Should we decrease Propranolol?
Dr Huggins answers: This is the side effect of initiating on Tegretol.
Oct. 3. Lab monitoring within normal levels.
Nov. 10. SIB behaviour, possible ear/throat infection. Found too much
earwax.
Nov. 12 He is a bit more compulsive, becoming tolerant to his
current dose of Propranolol?
Nov. 16 to Nov. 19. His rage is beginning to reappear increase Propranolol
to 160 mg.
Nov. 16 to June 2. Danny is fully Beta Blocked at 120 mg and
continue at 400 mg Tegretol.
Nov. 26. Danny is accepting redirections. We will hold the increase of dosage.
Dec. 12. Danny had another generalized Tonic-Clonic Seizure on Dec. 05. His
Tegretol would be increase to 200 mg and Propranolol decrease to 40 mg.
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