MEDICATIONS
- Apixaban — ONE 5mg tablet per dose, not two — DVT
- Aspirin — STOP 14 Aug
- Clopidogrel 75mg — stent
- Atorvastatin 40mg + Ezetimibe 10mg
- Clindamycin PAUSED 20 Aug — MDT 31 Aug decides
- Quviviq 50mg — no script on file
ONGOING CONCERNS
- Antibiotics paused 20 Aug — MDT 31 Aug (osteitis, CRP rose)
- Anaemia — likely bleeding polyp, colonoscopy overdue
- ECG "old infarct(s)" flag — unread, need source
- Aspirin stop date — confirm after imaging
MEDICAL HISTORY
- 3-vessel CAD — revascularised (2× PCI)
- Hypertension, gout, hiatal hernia
- R hip replacement 2018
- Septic arthritis + osteitis, L knee (2026)
- DVT L calf (2026)
- Scalp psoriasis
SOCIAL HISTORY
Le Fournas, Sablet · married, 2 children · retired (telecoms) · squash, cycling, gardening · no tobacco · alcohol dropped sharply since hospitalisation (baseline ~2 beer + 2 wine/day)
Details →
FAMILY HISTORY
- Father + brother — cardiac disease
- Mother — leukaemia
- Sister — colon cancer, current
RISK FACTORS
- Hypertension, age 75, male
- Family cardiac history
- No diabetes, no smoking
- LVEF 80% — preserved
ALLERGIES
No known drug allergy (confirmed twice in records).
ADR: piperacillin/tazobactam — hepatotoxic reaction, avoid in future. Details →
ADR: piperacillin/tazobactam — hepatotoxic reaction, avoid in future. Details →
REMINDERS
- Lipid recheck 4-6wks post-PCI
- DTP, pneumococcal, 2nd shingles dose
- Get Quviviq properly prescribed
- Colonoscopy re-referral (family hx)
TICKLER — NEXT UP
- 31 Aug — Orthopaedic MDT, decision point
- Mon & Fri — CRP checks during antibiotic pause
- ~Oct — DVT follow-up doppler
1. Outstanding Health Issues
Open items as of 7 August 2026
✓ Stage 2 PCI complete — full revascularisation achieved
Both remaining lesions (left main + mid-LAD) treated in one session on 6 Aug via rotational atherectomy + two stents. Discharged home 7 Aug. This closes the main cardiac issue that's dominated the last six weeks — what's left below is follow-up and optimisation, not acute crisis management.
| Issue | What's needed |
|---|---|
| ECG — machine read "old infarct(s)" | Couldn't pull readable text from the 6 Aug ECG PDF (likely a scanned image, Drive tools wouldn't extract it) — see note in Cardiovascular panel below. Need the actual printed interpretation lines or a photo of the strip to give a real read rather than guess. |
| Statin dose — target vs current 20mg on hospital paperwork | You've already uptitrated to 40mg + added ezetimibe, which is the guideline-correct move — see Cardiovascular panel for the reasoning. Repeat lipid panel in 4-6 weeks to confirm target hit. |
| Persistent anaemia — worsening, not just plateauing | Hb now 89 (12 Aug), down from 93 (3 Aug) and 102 (27 Jul) — lowest of the whole admission, and the trend is now downward again rather than stable. Worth actively investigating (source of ongoing blood loss? marrow suppression? nutritional?) rather than just repeating FBCs and watching, especially on triple antithrombotic therapy until 14 Aug. |
| Knee swelling / compression bandage | 6 Aug discharge bandage extended to mid-thigh — helps both the DVT and the residual cutaneous knee swelling. Reasonable to continue mid-thigh length rather than reverting to below-knee, given the dual benefit. |
| 🚨 Antibiotics deliberately paused 20 Aug — decision point 31 Aug | CRP rose (23.1, up from 14.6) despite the corrected clindamycin dose. Knee aspirated today (serosanguinous, only 10ml) for culture/cytology — clindamycin paused ~2 weeks to get a clean, reliable result ahead of an orthopaedic MDT on 31 Aug, which may decide on surgery for the bony erosions. Interim safety net: bloods today + Mon/Fri, self-monitoring, re-admit if worse. Do not resume clindamycin without direction from that team. |
| Anaemia — mixed picture: inflammation + genuine iron deficiency | 20 Aug workup: low TIBC/transferrin (inflammation-suppressed) plus raised soluble transferrin receptor (specific for true iron deficiency, unaffected by inflammation) — so this is anaemia of chronic disease from the osteitis, with a real iron-deficiency component on top. Won't fully respond to iron alone until the infection is controlled. CT reassuring for GI/GU, PSA normal — a small bleeding colonic polyp remains a reasonable contributor to the deficiency component; colonoscopy re-referral below still genuinely relevant, not just a background "someday" item. B12/folate both normal. |
| 🚨 Apixaban dosing error, 22 Aug — watch for bleeding signs | Meds box prepared with 10mg (2×5mg tablets) per dose instead of 5mg, due to ambiguous "×2" notation on this dashboard — genuinely our formatting fault, now fixed everywhere. Caught same-day, PM dose skipped to compensate. Watch closely for 24-48h: bruising, blood in urine/stool, gum/nosebleeds, headache, dizziness, or swelling at the recent knee aspiration site. Given he's also on clopidogrel with active anaemia, worth flagging to his care team even without symptoms. |
| Serum clindamycin level — sample sent 20 Aug, result pending | Sent externally to Hôpital Paris St Joseph. Worth chasing if not back before the 31 Aug MDT. |
| Aspirin (Kardegic) stop date | Confirmed via Dr Quillot's 7 Aug outpatient ordonnance (handwritten correction on the letter): aspirin stops 14 August, not 13th as originally noted. Then drops to dual therapy (clopidogrel + apixaban) as the maintenance regimen. |
| Colchicine stopped — alcohol aversion query | See note under Medications — no established pharmacological link found; more likely a conditioned response from the illness period generally. |
| Quviviq — no prescription on file | Self-initiated by Philip ~16-17 Jul for insomnia + oxazepam withdrawal, 50mg confirmed. No script exists for Guy. Worth formalising with Dr Paur if he's staying on it. |
| Family history now on record — colon cancer (sister) | Changes the colonoscopy surveillance calculus — see Cancer Screening panel. |
| Immunisations behind | DTP not up to date, no pneumococcal vaccine ever, shingles (VZV) only 1 of 2 doses (2025) — see Immunizations panel. |
2. Treatment & Rehab Goals
Muscular strength — upper AND lower body
He's developed a noticeable postural kyphosis through this — likely a mix of deconditioning, time spent unwell/seated, and possibly some pre-existing thoracic stiffness. Rehab shouldn't default to lower-body-only (the reflex focus after a knee/DVT episode) — needs thoracic extensor and scapular strengthening (rows, prone extensions, wall angels) alongside lower-limb work, once cardiac clearance for exertion is given.
Cardiopulmonary rehab — build toward VO2max
Formal cardiac rehab referral is the right vehicle here — structured, monitored, progressive aerobic conditioning post-PCI. Given he's a squash/cycling person at baseline, he has a meaningful aerobic base to rebuild rather than starting from zero, but pacing needs to follow the rehab team's post-PCI protocol rather than jumping back into high-intensity squash immediately.
Skin — non-negotiables
Daily antihistamine (desloratadine/Aerius 5mg, as prescribed by the dermatologist) and emollient applied three times daily plus after every shower. This isn't optional/as-needed — consistent barrier support is what actually controls the itch-scratch cycle feeding the psoriasis, rather than treating flares reactively.
3. General Longevity Targets
| Domain | Target |
|---|---|
| Cancer screening | Colonoscopy re-referral (family history of colon cancer now known) + resolve the outstanding prostate LUTS workup. See Cancer Screening panel. |
| Immunisations | Catch up DTP booster, add pneumococcal (PCV/PPSV), complete the 2nd VZV/shingles dose. See Immunizations panel. |
| Cardiovascular | Risk factor review every 6 months — BP, lipids, weight, HbA1c/glucose, renal function. First one due ~Feb 2027, sooner if the 4-6 week post-PCI lipid recheck flags anything. |
| Neurological / mental health | Sleep quality, mood, and processing of what's been a genuinely stressful six weeks (own cardiac diagnosis + two procedures, on top of the knee infection). Fun and normal life matter here, not just symptom absence. Alcohol has dropped from a fairly regular 2 beers + 2 wine/day baseline to apparent aversion — worth keeping an eye that this stays a positive, comfortable change rather than something driven by anxiety or low mood; doesn't need intervention unless it starts looking like the latter. |
Current Status
20 August 2026 — Antibiotic "fenêtre" underway, MDT 31 Aug
🚨 Plan change — clindamycin deliberately paused for 2 weeks (antibiotic "fenêtre")
Following the CRP rise and confirmed osteitis, Dr Bayle performed a knee aspiration today (serosanguinous fluid, only 10ml drawn, sent for culture and cytology). Rather than keep treating on the current best-guess antibiotic while the picture is unclear, the plan is a deliberate 2-week antibiotic-free window — this is a recognised approach in chronic/relapsing bone-joint infection to get a clean, reliable culture, since antibiotics suppress growth on culture media even when infection persists, risking a false-negative if sampled on treatment. An MDT with an orthopaedic surgeon is booked for Monday 31 August to decide next steps (which may include surgery for the bony erosions/geodes) once the picture is clearer.
⚠ Interim monitoring during the antibiotic-free window
Bloods today (including iron), then again Monday and Friday (CRP) until the MDT. Self-monitoring for fever/worsening at home — if things clearly deteriorate, re-admission rather than waiting for the next scheduled check. Guy is on board with the plan. The reasoning: skipping the window now would just delay both a reliable culture result and any surgery for the bony erosions, while risking the same underlying uncertainty later with less time to act on it.
✓ GI/GU reassuring on CT — anaemia is a mixed picture, not simply a bleeding polyp
The CT done during the recent hospital stay was reassuring for the abdomen/pelvis generally, and PSA has previously come back normal (1.39 µg/L, Nov 2025 — comfortably under the <4 threshold). The 20 Aug comprehensive iron/anaemia workup shows a genuinely mixed picture: low TIBC and transferrin (both suppressed by inflammation — the classic anaemia-of-inflammation signature) alongside a raised soluble transferrin receptor (a marker specific to true iron-deficient erythropoiesis, unaffected by inflammation). So this reads as anaemia of chronic disease/inflammation from the ongoing osteitis, with a genuine iron-deficiency component layered on top — likely won't respond fully to iron alone until the infection itself is controlled. Given he's on aspirin/clopidogrel/apixaban, a small bleeding colonic polyp remains a reasonable contributor to the iron-deficiency component — CT is reassuring against a mass but isn't sensitive enough to exclude a small oozing polyp, which still reinforces getting the overdue colonoscopy done (see Cancer Screening panel). B12 (372) and folate (9.9) are both normal — supplementation appears adequate.
✓ Immune function reassuring — the Nov 2025 hypogammaglobulinaemia flag doesn't hold up
A protein electrophoresis from Nov 2025 had flagged possible hypogammaglobulinaemia, raising a question about immune deficiency as a contributor to his infection susceptibility. Full immunoglobulin quantification on 20 Aug came back normal — IgG 14.77 g/L, IgA 2.88, IgM 1.11, all within range (IgG toward the upper end, consistent with a normal reactive response to ongoing infection rather than deficiency). Free kappa/lambda ratio (1.09) is also normal, arguing against anything clonal. Reassuring on a question that had been sitting open.
⚠ Serum clindamycin level — sample sent, result pending
Sent externally to Hôpital Paris St Joseph on 20 Aug as part of working out why CRP plateaued despite treatment. Result not back yet — worth chasing if it hasn't surfaced by the 31 Aug MDT.
✓ Full revascularisation achieved — both stages done
Stage 1 (29 Jul): RCA stented, ORSIRO 3.5×30mm. Stage 2 (6 Aug): left main (distal, calcified) treated with rotational atherectomy (1.5mm burr) then a XIENCE Skypoint 3.5×33mm stent; the procedure also found significant new mid-LAD stenosis (50-70%) which was treated in the same session with a second XIENCE Skypoint 3×38mm stent, using a kissing-balloon technique to protect the circumflex origin. Procedure ran ~1.5 hours prep-to-finish. Discharged home 7 August — no complications recorded, "revascularisation myocardique complete" per discharge diagnosis.
⚠ Compression bandage extended to mid-thigh — worth continuing
This morning's bandage was wrapped up to mid-thigh rather than below-knee. Beyond the DVT indication it's prescribed for, this is also helping the residual cutaneous swelling around the knee — reasonable to keep it at this length rather than reverting shorter, given the dual benefit.
⚠ Medication changes made post-discharge
Atorvastatin increased to 40mg/day total (20mg discharge dose + 20mg added), ezetimibe 10mg added, desloratadine/Aerius 5mg (antihistamine, dermatologist-prescribed) confirmed as ongoing, colchicine stopped, vitamin D switched to 2,500 IU daily. See Medications section for the full current list and reasoning on the statin/ezetimibe combination.
Knee — Antibiotic-free window, MDT 31 Aug
Fenêtre thérapeutique
MSSA Staphylococcus aureus. Two surgical washouts completed (26 Jun, 4 Jul). 19 Aug CT confirmed osteitis (bone infection) of the medial tibial plateau — two erosive geodes (12mm, 5mm). Same-day X-ray showed separate, unrelated tricompartmental osteoarthritis, unchanged from a prior film. CRP then rose despite corrected antibiotic dose — aspiration today (serosanguinous, 10ml) sent for culture/cytology. Clindamycin now deliberately paused ~2 weeks to get a clean culture off treatment, ahead of an orthopaedic MDT on 31 Aug. Interim monitoring: bloods today + Mon/Fri, self-monitoring, re-admit if worse.
Explain this to me
S. aureus is a common skin bacterium that entered Dad's bloodstream and settled in the knee joint, requiring two operations to wash it out. The CT scan on 19 August confirmed the infection had reached the bone itself — two areas of actual bone erosion in the shin bone. Since then, CRP has risen despite the antibiotics, which is why the team took fluid from the knee today and — this sounds like a step backward but is a deliberate, monitored decision — is deliberately pausing antibiotics for about 2 weeks. Antibiotics can suppress bacterial growth on a culture test even when infection is still present, so testing while on treatment risks a falsely reassuring "clean" result going into Monday's surgical planning meeting. A short, closely-watched break lets the lab get an honest answer about what's actually happening in the bone before deciding whether surgery is needed for the eroded areas. The safety net is real: blood tests twice this week, close self-monitoring for fever or worsening, and a clear plan to go straight back to hospital if things deteriorate rather than waiting it out. Dr Bayle also clarified two useful things: the raised ferritin on recent iron studies is very likely just inflammation rather than good iron stores, so true iron deficiency probably sits underneath it; and the joint fluid never showed gout crystals despite repeated testing, which is why stopping colchicine earlier was safe.
Heart — Both stages complete
Full revascularisation
SYNTAX score 24 — PCI guideline-appropriate, confirmed correct call. Stage 1 (29 Jul): RCA, TIMI 3 flow. Stage 2 (6 Aug): left main + mid-LAD, rotational atherectomy + 2 stents, discharged home 7 Aug. Antithrombotic: aspirin (Kardegic) stops 14 Aug (confirmed by Dr Quillot's 7 Aug letter); clopidogrel + apixaban continue as maintenance dual therapy.
Explain this to me
The SYNTAX score measures how complex the coronary narrowings are. Dad's score of 24 is "intermediate" — stenting and bypass give equally good results at this level. Stage 1 went well: the right coronary artery is now open and flowing normally. Stage 2 treated the more complex left main + LAD together, needing rotational atherectomy first — a small rotating burr that grinds down hardened calcium in the artery wall before the stent can be properly placed. This is a routine technique for calcified lesions but is a slightly more involved procedure than a plain stent.
DVT — Calf Blood Clot
Being Treated
Small clot in left fibular vein (calf), found 10 July. Treated with apixaban (blood thinners) for 3 months and class 3 compression stocking daily. Repeat scan 10 October.
Explain this to me
A DVT (deep vein thrombosis) is a blood clot in a deep vein — in Dad's case a small one in the calf, the least dangerous location. Blood thinners prevent it growing or travelling to the lung. The compression stocking helps blood flow back up the leg. The clot almost certainly formed because he was immobile in hospital for weeks. It will be rescanned in October to confirm it has dissolved.
Scalp Psoriasis
Being Treated
Derm review 27 Jul (CHIAP Aix) — minimal plaques found, scalp-knee infection link dismissed by interns. Actual prescription (confirmed from script): Clobex shampoo (clobetasol, potent steroid) — 1 application/day for 15 days, plus Aerius (desloratadine) 5mg at night as needed for itch. Biologic appropriate later — not now given active infection and upcoming cardiac intervention.
Explain this to me
Dad's itchy scalp is almost certainly psoriasis. The dermatology appointment on 27 July was seen by two junior doctors who found very little to examine and were not convinced by the scalp-to-knee infection link. They prescribed a steroid scalp application for two weeks and antihistamines for the itch. The longer-term treatment — a biologic injection like secukinumab, which Laurent's father now takes for the same condition — is not appropriate right now because of the active infection and upcoming heart procedure. Once both are resolved, a re-referral for stronger treatment can be arranged if the scalp doesn't settle.
Upcoming Appointments
31
Aug
🏥 Orthopaedic MDT — Decision point
CHD Avignon · Multidisciplinary team including orthopaedic surgeon
Reviewing the clean (off-antibiotic) culture/cytology from today's aspiration, plus the CT-confirmed osteitis. Will decide next steps — could include surgery for the bony erosions/geodes. Clindamycin resumes only on direction from this team, not automatically.
20
Aug
✓ Infectiology Outpatient Review — Dr Bayle — Done
CHD Avignon · Very fast turnaround: Guy emailed her directly yesterday, her secretary phoned within an hour to offer today's slot
Knee aspiration performed — serosanguinous fluid, only 10ml drawn, sent for culture and cytology. Plan changed to a 2-week antibiotic-free window ("fenêtre") to get a clean culture ahead of the 31 Aug MDT — see Status section for full reasoning. Interim: bloods today (incl. iron) + Mon/Fri (CRP), self-monitoring for fever/worsening, re-admit if things deteriorate. Also clarified: iron studies show raised ferritin (likely inflammatory, not true iron adequacy) with genuinely low iron; CT reassuring for GI/GU generally, PSA previously normal — bleeding colonic polyp on blood thinners is the leading theory for the anaemia, reinforcing the overdue colonoscopy.
19
Aug
✓ Knee CT + X-ray — Orange — Done, osteitis confirmed
Centres d'Imagerie Médicale, Orange · Ordered by Dr Bayle (Infectiology), 13 Aug
⚠ CT confirmed osteitis: diffuse bone demineralisation + erosive damage to the medial tibial plateau, with two geodes (12mm and 5mm). This is genuine bone infection (osteomyelitis), not just soft-tissue/joint infection — clearly justifies the ~6-week antibiotic extension. Same-day X-ray showed separate, unrelated tricompartmental osteoarthritis (worst patellofemoral), persistent effusion, no fracture, unchanged from a prior film.
24
Jul
✓ Suture Removal — Done
Visiting nurse (IDE à domicile) · At home · Day 21 post-op · Completed this morning
26
Jul
✓ Pre-angiogram Blood Tests — Done
Bionyval Valréas · Results 27 Jul · CRP 41.1 · Hb 102 · eGFR 72
27
Jul
Seen by two interns · 2:20pm · Centre Hospitalier du Pays d'Aix
Outcome: betamethasone scalp x2 weeks + antihistamines. Minimal plaques found. Scalp-knee infection link dismissed. Re-referral for biologic planned if no improvement once cardiac and infection resolved.
29
Jul
Cardiology Unit, CHD Avignon · Dr Quillot + Dr Durieu Alix · Right radial approach
Outcome: ORSIRO stent 3.5×30mm placed in mid-RCA, tight 70–90% stenosis pre-dilated then stented. Final flow TIMI 3 (normal). Same-day home. Aspirin (Kardegic) added, continuing to 14 Aug.
3
Aug
✓ Pre-op bloods for Stage 2 — Sample submitted
NFS/plaquettes, K, Na, creatinine, CRP, TP/TCA · Results to be brought to admission or sent to cardiology secretariat
6
Aug
Cardiology Unit, CHD Avignon · Dr Quillot · Right radial 7F · Entry 10:07, ~1.5hrs prep-to-finish
Outcome: rotational atherectomy (1.5mm burr) of distal left main, then XIENCE Skypoint 3.5×33mm stent to left main + XIENCE Skypoint 3×38mm stent to mid-LAD (new 50-70% stenosis found and treated same session), kissing balloon to protect circumflex. Full revascularisation achieved, no complications. Discharged home 7 Aug.
What happened at this procedure?
The left main lesion had hardened calcium deposits, so a tiny diamond-coated burr ground a channel through the calcium at high speed before the stent was placed. The team also found a second significant narrowing in the middle of the LAD that hadn't been the main focus going in — this was treated with a second stent in the same session, using a technique called kissing-balloon to protect the origin of a nearby branch artery (the circumflex). Overall this means Dad now has full revascularisation — all three affected vessels have been opened and stented across the two procedures.
11
Aug
Consultations Externes Zone E, 1st Floor · CHD Avignon
⚠ Knee not fully settled — mechanical-type pain + significant effusion persist, CRP improving (14.6 by 12 Aug) but not normalised. Clindamycin 900mg×3/day now extended a further ~6 weeks per the infectiologue (verbal, written confirmation pending). CT + X-ray of the knee still booked for 19 Aug in Orange (checking for osteitis). Bloods now fortnightly.
What did this appointment find?
The knee still has fluid and mechanical-feeling pain, and while the inflammatory blood markers (CRP) are trending down, they haven't normalised. Rather than stop the antibiotic on schedule, Dr Bayle ordered a CT scan of the knee to check specifically for osteitis — a deeper bone infection — before deciding when to actually stop the antibiotics. She also raised two useful points: first, the joint fluid was tested repeatedly during the hospital stay and never showed gout crystals, which is why the colchicine was safely stopped — it wasn't really treating anything. Second, she thinks the scalp psoriasis may actually have been the entry point for the original infection, especially since Dad had been on a course of steroid cream for it just before the knee got infected, which would have suppressed his immune defences a bit at exactly the wrong time.
10
Oct
3 months from 10 July · Local radiology · Confirm clot has resolved
Bring result to GP Dr Paur · Original DVT report linked above
Cardiac Plan — Complete
Updated 7 August 2026
✓ SYNTAX Score 24 — PCI confirmed, guideline-appropriate
SYNTAX score formally calculated at 24 (intermediate range). ESC 2023 guidelines show PCI and CABG have comparable outcomes at this score. Agreed by Dr Quillot, Dr Unal, and Guy himself. Bypass surgery remains an option in future if needed.
✓ Stage 1 — 29 July — Successful
Right coronary artery: tight 70–90% mid-RCA stenosis, pre-dilated with balloon then treated with an ORSIRO drug-eluting stent (3.5 × 30mm) via right radial approach. Final angiographic control: artery free of significant residual lesion, normal (TIMI 3) flow. No complications. Home same day.
✓ Stage 2 — 6 August — Successful, full revascularisation achieved
Distal left main: severe (70-90%) calcified stenosis treated with rotational atherectomy (1.5mm Rotablator burr) then pre-dilated and stented with XIENCE Skypoint 3.5×33mm. During the same procedure, a significant new mid-LAD stenosis (50-70%) was identified and treated with a second stent, XIENCE Skypoint 3×38mm — a kissing-balloon technique protected the circumflex origin throughout. Right radial access, ~1.5hrs prep-to-finish. No complications, discharged home 7 Aug. Discharge diagnosis: "revascularisation myocardique complète."
Antithrombotic strategy going forward — confirm the aspirin stop date
Aspirin (Kardegic) stops 14 August — confirmed on Dr Quillot's 7 Aug outpatient ordonnance, where she handwrote the correction from 13th to 14th. That's just over two weeks of triple therapy (aspirin + clopidogrel + apixaban) bridging both stages, then dropping to dual therapy (clopidogrel + apixaban) as the maintenance regimen.
Why PCI rather than bypass surgery?
The key factor is the SYNTAX score of 24. This measures how complex the coronary narrowings are on a scale where higher = more complex. Below 22 favours stenting, above 32 favours bypass, and 23–32 is the zone where both give equivalent results. At 24, the landmark SYNTAX trial showed stenting and bypass give equivalent survival.
Dr Quillot also noted that in Dad's specific situation, stenting makes more sense right now: his knee is still healing from the septic arthritis (bypass carries slightly higher infection risk in this context), he needs to regain mobility quickly (bypass recovery is 6–8 weeks vs days for stenting), and his other features — no diabetes, good heart pumping function, normal kidneys — all favour stenting outcomes.
Dr Quillot also noted that in Dad's specific situation, stenting makes more sense right now: his knee is still healing from the septic arthritis (bypass carries slightly higher infection risk in this context), he needs to regain mobility quickly (bypass recovery is 6–8 weeks vs days for stenting), and his other features — no diabetes, good heart pumping function, normal kidneys — all favour stenting outcomes.
What about the bleeding risk from multiple blood thinners?
After stenting, Dad will need three blood-thinning medications for one week: aspirin, clopidogrel (antiplatelet for the stent), and apixaban (for the DVT). After one week, aspirin is stopped and he continues on just clopidogrel and apixaban. This approach — confirmed by Dr Quillot as per ESC 2023 guidelines — keeps the triple therapy period as short as possible while protecting both the new stent and the DVT.
Cardiovascular Overview
Risk factors, anatomy, function| Domain | Detail |
|---|---|
| Risk factors | Hypertension (20+ years) · Age 75 · Male sex · Gout · Family history: father and brother both had cardiac disease · Now on high-intensity statin + ezetimibe. No diabetes. No smoking history. Alcohol: previously ~2 beers + 2 glasses wine/day baseline (per 15 Jul discharge letter), apparent aversion since hospitalisation — see Medications note. |
| LV function | LVEF 80% on echo 18 Jun 2026 (Dr Unal) — hyperkinetic, no valvulopathy, minimal mitral regurgitation, minimal carotid atheroma. Heart muscle function well preserved throughout both PCI stages. |
| Coronary anatomy | Three-vessel disease (tritronculaire). Distal left main 70-90% (type C, >20mm, calcified) — treated. Mid-LAD 50-70% (type C, >20mm) — found and treated at Stage 2. Mid-RCA 70-90% — stented Stage 1. SYNTAX score 24 (intermediate) — PCI guideline-appropriate (ESC 2023 IIa) vs CABG. |
| Revascularisation | Complete. Stage 1 (29 Jul): RCA — ORSIRO DES 3.5×30mm, TIMI 3 flow restored. Stage 2 (6 Aug): rotational atherectomy of left main, then XIENCE Skypoint 3.5×33mm (left main) + XIENCE Skypoint 3×38mm (mid-LAD), kissing balloon to protect circumflex. |
| Rhythm/ECG | 18 Jun baseline (pre-admission): sinus rhythm ~70-76bpm, narrow QRS, no repolarisation disturbance, normal QTc — reassuring. 23 Jun admission ECG: sinus 70bpm, narrow QRS, no repolarisation disturbance, normal QTc. 6 Aug ECG (post-Stage-2): machine-interpreted "old infarct(s)" — couldn't extract readable text from this specific PDF (appears to be a scanned image, Drive tools returned no content). Automated ECG software flags old-infarct patterns fairly often on Q-wave or R-wave-progression criteria that turn out to be non-specific, especially after LV strain from a long procedure — but this needs the actual printed interpretation or a photo of the strip to say anything definitive rather than guess. Worth asking the team directly whether they endorsed that read or dismissed it as a software artefact, since two clean baseline ECGs make a genuine prior infarct less likely but don't rule one out. |
| Statin dose target | Post-PCI with confirmed multivessel ASCVD puts him in the "very high risk" category under ESC/EAS 2019 (reaffirmed 2025) dyslipidaemia guidelines — target LDL-C <1.4 mmol/L (<55 mg/dL) and ≥50% reduction from baseline. The hospital's discharge dose of atorvastatin 20mg is a fairly conservative starting point and often insufficient alone to hit that target in patients with this degree of disease. Adding a second 20mg (→ 40mg total) plus ezetimibe 10mg is exactly the guideline-directed next step when a statin alone doesn't get there — ezetimibe is specifically recommended to be added first if target isn't met 4-6 weeks post-event on maximally tolerated statin, before escalating to a PCSK9 inhibitor. The 20mg on the discharge paperwork is plausibly just standard-issue post-PCI dosing that the interventional cardiologist wasn't focused on optimising mid-procedure — worth a lipid panel in 4-6 weeks and flagging the addition to Dr Unal, who as his regular cardiologist is well placed to formalise the target and confirm whether 40mg + ezetimibe gets there or whether 80mg should be considered. |
| Current cardioprotective meds | Bisoprolol 2.5mg, lercanidipine 10mg, atorvastatin 40mg (20+20), ezetimibe 10mg, aspirin/clopidogrel/apixaban (triple to 14 Aug, then dual). |
Past Medical History
Compiled from hospital records & referral letters
✓ Family history now on record — from the full 15 Jul discharge letter (uploaded 7 Aug)
Father and brother both had cardiac disease; mother died of leukaemia; a sister has colon cancer, currently under treatment. Relevant to both the Cardiovascular and Cancer Screening panels below.
| Condition | Since / Detail |
|---|---|
| Coronary artery disease (3-vessel) | Diagnosed Jul 2026, revascularisation complete — see Cardiovascular panel |
| Hypertension | 20+ years — on lercanidipine ± bisoprolol |
| Gout | 30+ years — on allopurinol; colchicine used during acute knee episode, now stopped |
| Hiatal hernia | Found on 2022 endoscopy, on pantoprazole |
| Right total hip replacement | 2018, for osteoarthritis |
| Bilateral inguinal hernia repair | Two separate procedures, dates not specified in records |
| Tonsillectomy | Age 5 |
| Septic arthritis, left knee (S. aureus) + confirmed osteitis | Jun–Jul 2026 — two surgical washouts (26 Jun, 4 Jul). 19 Aug CT confirmed osteitis of the medial tibial plateau — two erosive geodes (12mm, 5mm). CRP rose despite treatment; clindamycin deliberately paused 20 Aug pending clean culture from today's aspiration, ahead of orthopaedic MDT 31 Aug. Same-day X-ray found separate, unrelated tricompartmental osteoarthritis. |
| Osteoarthritis, left knee (tricompartmental) | Found on 19 Aug X-ray, compared against an older film (unchanged) — pre-existing, separate from the infection, worst in the patellofemoral compartment. Contributes to some of the "mechanical-type pain" noted on 11 Aug. |
| DVT, left calf (fibular vein) | Found 10 Jul 2026 — on apixaban, follow-up doppler due ~10 Oct |
| Scalp psoriasis | Longstanding, multiple prior topical courses (Betneval, Diprosone, Clarelux) with limited success — current: Clobex + Aerius; biologic being considered once infection/cardiac issues resolve |
| Diverticulosis + colonic polyp (removed) | Colonoscopy Dec 2022, Clinique d'Orange (Dr Rabbia) — see Cancer Screening for follow-up interval, now with family history factored in |
| Lower urinary tract symptoms | Dysuria/nocturia — prostate ultrasound referral Feb 2026 (Dr Maclet); outcome not found in folder |
| Popliteal cyst, ruptured | ~Jun 2026, initially thought to explain knee symptoms before septic arthritis was found |
Compiled from discharge summaries and referral letters in the Drive folder — not a substitute for the full GP record. Flag anything missing or inaccurate.
Blood Test Results
Fortnightly monitoring ongoing (per 12 Aug order)
⚠ CRP down to 14.6, but Hb continues to slide — 89 g/L (12 Aug)
CRP is now clearly trending the right way (27.3 → 14.6), consistent with the infection settling. But haemoglobin has dropped again — 89 g/L, down from 93 on 3 Aug and the lowest reading of the whole admission — worth actively investigating rather than just monitoring at this point, especially with him still on aspirin/clopidogrel/apixaban together until 14 Aug. * INR 1.40–1.42 and APTT ratio elevated throughout are expected effects of apixaban — not a clotting disorder.
⚠ CRP has ticked back up — 23.1 (19 Aug), from 14.6 (12 Aug)
Worth flagging rather than ignoring: the trend had been clearly favourable, and this is a reversal, even if a modest one. Haemoglobin has at least stabilised (89, unchanged from 12 Aug) rather than continuing to fall. Renal function and liver enzymes remain normal and stable — reassuring given his prior hepatotoxic drug reaction. * INR 1.40–1.42 and APTT ratio elevated throughout are expected effects of apixaban — not a clotting disorder.
| Test | Normal | 24 Jun | 26 Jun | 28 Jun | 30 Jun | 1 Jul | 3 Jul | 5 Jul | 7 Jul | 9 Jul | 13 Jul | 15 Jul | 22 Jul | 27 Jul | 3 Aug | 12 Aug | 19 Aug ↑ |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CRP (mg/L) Infection marker |
<5 | 149 | 192 | 235 ▲ | 206 | 207 | 200 | 120 ▼ | 44.8 ▼ | 43.1 | 39.4 ▼ | 36.2 ▼ | 28.3 ▼ | 41.1 ▲ | 27.3 ▼ | 14.6 ▼ | 23.1 ▲ |
| Haemoglobin (g/L) Anaemia |
129–167 | 121 | 119 | 118 | 107 | 100 | 104 | 99 | 94 ▼ | 89 ▼ | 93 ▲ | 88 ▼ | 100 ▲ | 102 | 93 ▼ | 89 ▼ | 89 → |
| WBC (G/L) White cells |
3.84–9.80 | 10.1 | 9.34 | 10.5 | 11.1 | 9.71 | 9.11 | 7.63 | 6.41 ▼ | 7.95 | 6.65 ▼ | 6.04 ▼ | 7.26 | 7.81 | 6.27 ▼ | 5.98 ▼ | 6.40 ▲ |
| Platelets (G/L) Clotting |
140–385 | 384 | 479 | 520 | 548 | 536 | 589 | 574 | 547 | 543 | 520 ▼ | 458 ▼ | 417 ▼ | 401 ▼ | 363 ▼ | 349 ▼ | 375 ▲ |
| eGFR (mL/min) Kidney function |
>90 | 76 | 58 | 61 | 65 | 66 | 71 | 70 | 62 | 60 | 73 | 74 | 67 ▼ | 72 ▲ | — | 73 ▲ | 67 ▼ |
| Creatinine (µmol/L) Kidney marker |
64–104 | 86 | 107 | 103 | 98 | 97 | 91 | 92 | 102 | 105 | 89 ▼ | 88 ✓ | 96.3 | 90.2 ✓ | — | 88.4 ✓ | 96.2 ✓ |
| GGT (U/L) Liver enzyme |
10–71 | 131 | 139 | 635 ▲▲ | 341 | 258 | 632 ▲▲ | 581 | 332 ▼ | 239 ▼ | 146 ▼ | 114 ▼ | 79 ▼ | — | — | — | 61 ✓ |
| AST (U/L) Liver enzyme |
10–50 | 47 | 40 | 314 ▲▲ | 41 | 41 | 63 | 37 | 29 ✓ | 22 ✓ | 21 ✓ | 17 ✓ | 14 ✓ | — | — | — | 15 ✓ |
| ALT (U/L) Liver enzyme |
10–50 | 97 | 76 | 173 | 80 | 66 | 78 | 65 | 42 ✓ | 33 ✓ | 19 ✓ | 16 ✓ | 17 ✓ | — | — | — | — ✓ (normal, exact value cut off in source) |
| INR Clotting (apixaban effect) |
0.8–1.2 | — | — | — | — | — | — | — | — | — | — | — | — | 1.40* | 1.42* | — | — |
⚠ Haemoglobin dropped again — 93 g/L (3 Aug), down from 102 (27 Jul)
Worth flagging to the team before Stage 2, given he'll be on triple antithrombotic therapy (aspirin + clopidogrel + apixaban) through a more complex atherectomy procedure. CRP continuing to improve (27.3, lowest since admission) is reassuring on the infection side.
Why are the liver enzymes elevated?
GGT and ALP (liver enzymes) have been elevated throughout — with two large spikes on 28 June and 3 July. The most likely explanation is a reaction to the antibiotic piperacillin/tazobactam (pip/tazo), which was stopped on 9 July. These enzymes are now falling. The AST and ALT (other liver enzymes) have largely normalised, which is reassuring. They will be monitored in weekly blood tests.
Current Medications
As of 22 August 2026
🚨 22 Aug — Apixaban dosing error caught, notation now fixed everywhere
The old format ("5mg ×2") was genuinely ambiguous and led to Guy's meds box being prepared with two 5mg tablets per dose instead of one — effectively double-dosed this morning. Caught same-day, PM dose skipped to compensate. Every drug on this page that used the same "×2" shorthand (apixaban, allopurinol, paracetamol, colchicine) has been rewritten to spell out tablet count and total dose explicitly, with the wording "ONE tablet" or "TWO tablets together" instead of ambiguous multiplication notation. This was a genuine formatting flaw, not a misreading on anyone's part.
✓ Aspirin stop date corrected — 14 August, not 13th
Confirmed from Dr Quillot's 7 Aug outpatient ordonnance — she handwrote a correction on the letter changing the stop date from 13th to 14th.
✓ Statin optimised — 40mg + ezetimibe added
Atorvastatin increased to 40mg/day total (20mg discharge dose + 20mg added) and ezetimibe 10mg added. This is the guideline-correct next step for a "very high risk" post-PCI patient not yet confirmed at LDL target — see Cardiovascular panel for the full reasoning. Recheck lipids in 4-6 weeks.
✓ Why colchicine was actually stopped — now confirmed
Per the 11 Aug infectiology letter: colchicine was trialled on the working hypothesis of an associated gout flare, but no crystals were ever found on any of the joint fluid samples taken throughout the hospitalisation — so it was stopped because it wasn't treating anything, not for any other reason. Doesn't change the alcohol question below, but good to have the actual clinical reasoning confirmed rather than assumed.
Colchicine stopped — does it explain the alcohol aversion?
Short answer: probably not directly. There's no well-established pharmacological interaction where colchicine causes an aversion to alcohol, either while taking it or after stopping — it doesn't have a disulfiram-like effect. A more likely explanation is conditioned taste aversion: colchicine's main side effects are GI (nausea, cramping, loose stools), and he was taking it during weeks when he was also generally unwell from the infection, antibiotics, and hospitalisation — that overlap of feeling ill and reduced appetite is a classic setup for alcohol (or any food/drink) to become associated with feeling bad, independent of any specific drug interaction. Worth knowing his baseline was actually fairly regular (~2 beers + 2 glasses wine/day, per the 15 Jul discharge letter) — so this is a genuine behaviour change, not nothing. Your read (not fighting it, since less alcohol is a net positive for his health) seems reasonable either way — see the Longevity panel for the one thing worth watching: that it stays a comfortable change rather than something anxiety-driven.
⚠ Possible portal of entry identified — scalp psoriasis + pre-hospitalisation steroid cream
Dr Bayle's letter raises this directly: the pre-hospitalisation corticosteroid treatment for the scalp psoriasis likely caused some local immunosuppression right around the time the knee infection took hold, making the psoriatic scalp a plausible entry point for the S. aureus. This is a different read than the earlier dermatology visit, where junior doctors dismissed a scalp-knee connection — worth keeping in mind for how the psoriasis gets managed going forward (topical steroids aren't risk-free, especially around other active infection risk).
🚨 Clindamycin deliberately paused 20 Aug — do not resume without direction
Following a CRP rise despite treatment, the plan changed to a 2-week antibiotic-free window ("fenêtre") to get a clean culture off treatment ahead of the 31 Aug orthopaedic MDT — see Status section. Stock being at zero is no longer the issue; the antibiotic is paused on purpose. Colécalciférol (vitamin D) is still genuinely out and worth a pharmacy top-up. Quviviq is down to 2 and still has no prescription on file.
⚠ Aspirin — 36 left despite the 14 Aug stop date having passed
Worth double-checking he's actually stopped it as planned. 36 tablets remaining after a stop date that's now passed suggests either leftover stock from a larger original dispensing (most likely, and not a problem) or that it's still being taken past when it should have stopped — worth a quick confirm either way, since ongoing aspirin on top of clopidogrel + apixaban is more bleeding risk than intended long-term.
⚠ New additions not yet on this list — Fe (iron) and Vitamin B12
These weren't previously documented here. Given they line up with the anaemia that's been trending the wrong way (Hb down to 89), it looks like this is being actively investigated/treated rather than just watched — good. Can you confirm the iron dose/frequency so I can add it properly (currently just listed as "4 remaining, dose unclear")? B12 stock is ample so no urgency there.
| Drug | Indication | What it does | When | Until | Stock (15 Aug) |
|---|---|---|---|---|---|
| Apixaban (Eliquis) — ONE 5mg tablet per dose | DVT treatment | ⚠ Take ONE tablet (5mg) each time — NOT two tablets. Total 5mg + 5mg = 10mg per day, split across two doses, 12 hours apart. Blood thinner — treats the calf DVT. | 8am: 1 tablet (5mg) 8pm: 1 tablet (5mg) |
~10 Oct 2026 | 49 tablets (~25 days at 1/dose, runs out ~9 Sep) |
| Acétylsalicylique acide (Kardegic/Aspirin) 100mg | Post-PCI antiplatelet, short course | Antiplatelet — added after stenting, short course | 8am | STOP 14 Aug 2026 — confirm actually stopped | 36 (see note above) |
| Clopidogrel 75mg | Post-PCI antiplatelet, stent protection | Antiplatelet — stent protection | 8am | Longer term maintenance | 22 (~22 days, runs out ~6 Sep) |
| Allopurinol — TWO 100mg tablets together, once daily | Gout prophylaxis | Gout prevention (long-standing) | 6pm — 2 tablets together (200mg) | Long term | 16 (~8 days, runs out ~23 Aug) |
| Atorvastatin 20mg — actually bd, not once daily | Hyperlipidaemia — secondary prevention post-PCI | Statin — lowers cholesterol, stabilises artery narrowings. Confirmed via pill count as 20mg tablets taken twice daily (8am + 6pm) = 40mg/day total — corrected from how this was previously described (40mg once at 6pm). | 8am · 6pm (bd) | Long term — recheck lipids 4-6 wks | 15 (~7-8 days, runs out ~22-23 Aug) |
| Ezetimibe 10mg | Hyperlipidaemia — secondary prevention post-PCI | Cholesterol absorption blocker — added to statin for extra LDL lowering | Evening | Long term — recheck lipids 4-6 wks | 30 (~30 days, runs out ~14 Sep) |
| Bisoprolol 2.5mg | Cardioprotection / rate control | Beta-blocker — reduces heart rate and workload | 8am | Long term | 83 (~83 days, runs out ~Nov) |
| Clindamycin (Dalacine) 900mg ×3 — PAUSED 20 Aug | Septic arthritis + osteitis, left knee (S. aureus) | Antibiotic — was clearing the knee infection at the corrected 900mg×3/day dose. Deliberately paused for ~2 weeks from 20 Aug ("fenêtre thérapeutique") to get a clean, reliable culture off treatment — CRP had risen despite the corrected dose, and antibiotics can mask true infection status on culture. Do not resume without direction from Dr Bayle/the MDT team. | — | PAUSED ~2 weeks (to ~early Sept) — resume decision at orthopaedic MDT, 31 Aug | 0 — not needed while paused; confirm before any resumption |
| Colécalciférol (Vitamin D) 2,500 IU — dose updated | Vitamin D deficiency | Vitamin D — levels were low on admission | Daily | Ongoing | 0 — out, refill when convenient |
| Desloratadine (Aerius) 5mg | Pruritus (dermatologist-prescribed) | Antihistamine — as prescribed by the dermatologist (CHIAP Aix, 27 Jul), daily and non-negotiable per rehab goals (see above) | Evening, daily | Ongoing | 14 (~14 days, runs out ~29 Aug) |
| Lercanidipine 10mg | Hypertension | Blood pressure (long-standing) | 8am | Long term | 82 (~82 days, runs out ~Nov) |
| Pantoprazole 40mg | Gastroprotection | Stomach protector — prevents ulcers | 6pm | 30 days | 14 (~14 days, runs out ~29 Aug) |
| Paracetamol (Doliprane) — TWO 500mg tablets together | Analgesia / antipyretic, PRN | Pain relief / fever — as needed | Every 8 hours if needed — 2 tablets together (1g) | As needed | Not tracked (PRN) |
| Quviviq (daridorexant) 50mg | Insomnia (self-initiated) | Sleep aid — self-initiated by Philip for insomnia (stress/anxiety related) and to help with withdrawal from the oxazepam started in hospital. Dose confirmed as 50mg. Still no prescription document on file — purchased from the pharmacy rather than formally prescribed for Guy specifically (matches the standard dose on Elisabeth's script, found in her folder, not his). Worth getting a proper script if he's continuing it, given daridorexant isn't something to source informally long-term. | 30 min before bed | Started ~16-17 Jul 2026 (1-2 days post first discharge) — ongoing, review | 2 — nearly out, and still no script |
| Fer (Iron) — NEW, dose/frequency to confirm | Likely anaemia treatment (Hb 89, trending down) | Iron supplement — not previously on this list. Given the timing, this looks like it's addressing the anaemia flagged as needing active investigation rather than just monitoring — good if so, but worth confirming the dose/frequency and whether iron studies (ferritin, transferrin saturation) were actually checked before starting, since replacing iron without knowing the cause can mask an underlying source of blood loss. | To confirm | To confirm | 4 — very low, confirm dose urgently |
| Vitamine B12 — NEW | Likely anaemia treatment (Hb 89, trending down) | Vitamin B12 supplement — not previously on this list, presumably part of the same anaemia workup as the iron. | To confirm | To confirm | Ample supply |
| Colchicine — TWO 0.5mg tablets/day (1 each, 8am+8pm) — STOPPED | Was: gout/joint anti-inflammatory | Was: anti-inflammatory joint protection | — | Stopped 7 Aug 2026, confirmed on 7 Aug letter | — |
| Emollient (unspecified) | Skin barrier / general skin care | Skin barrier support — general skin care | 3× daily + after every shower | Ongoing, non-negotiable | Not tracked |
Clobex shampoo (clobetasol) has been removed from this list — its 15-day course from 27 Jul has run its course and it's not part of the ongoing regime. Stock counts and "runs out" estimates are based on your 15 Aug pill count and current dosing frequency — not shown in the printable export list, which is for clinical review rather than pharmacy logistics.
⚠ Quviviq — undocumented, self-sourced
No script exists for Guy for this. Philip connected the dots after a rough first night home and bought it from the pharmacy himself — reasonable in the moment, but worth getting a proper prescription if he's staying on it, both so the dose is confirmed and so it's visible to Dr Paur and the cardiology team alongside everything else he's on. It also belongs in the broader picture from the Longevity panel — insomnia, stress, and processing what's been a genuinely hard stretch.
Why is he on three blood-thinning medications right now?
Since the stents went in, Dad is temporarily on three: aspirin and clopidogrel (both protect the stents) plus apixaban (protects against the calf DVT growing). Triple therapy carries a higher bleeding risk, which is why the aspirin has a stop date rather than running indefinitely — after that he drops to dual therapy (clopidogrel + apixaban), which is safer for longer-term use.
Allergies & Adverse Drug Reactions
✓ No formal drug allergy documented
Confirmed in two independent places: the 15 Jul discharge letter states "Pas d'allergie connue" and the 29 Jul discharge fiche records "Allergies au cours du séjour: non." No allergy flagged anywhere else in the records reviewed.
⚠ Adverse drug reaction — piperacillin/tazobactam (pip/tazo)
Not a classic allergy, but a significant hepatotoxic-pattern reaction: liver enzymes spiked sharply (AST 314, ALT 173, GGT 635 peak) in late June 2026 while on IV pip/tazo. Drug stopped 9 July, enzymes fell steadily afterward and are now near-normal. Worth documenting as an ADR to avoid pip/tazo in future rather than a true allergy.
Immunizations
Now documented — from full 15 Jul discharge letter| Vaccine | Status |
|---|---|
| Influenza | Up to date |
| COVID-19 | Up to date |
| Shingles (VZV) | 1 of 2 doses given, 2025 — likely overdue for the second dose if this was a 2-dose series (e.g. Shingrix, usually 2-6 months apart) |
| DTP (diphtheria/tetanus/polio) | Not up to date — booster needed |
| Pneumococcal | Never vaccinated — worth prioritising given age 75 and recent hospitalisations |
⚠ Three catch-up items
DTP booster, pneumococcal vaccine (first dose), and the second VZV/shingles dose are all reasonable to raise with Dr Paur once he's clear of the current antibiotic course and stable post-PCI — none are urgent this week, but worth booking in for the coming weeks.
Cancer Screening
Colorectal & prostate
🚨 Now actively relevant, not just overdue — probable bleeding source for the anaemia
20 Aug: Dr Bayle noted iron studies show low true iron under an inflammation-raised ferritin, and the CT plus previously-normal PSA are reassuring against a mass — leading theory is a small bleeding colonic polyp, invisible to CT, oozing under the aspirin/clopidogrel/apixaban combination. Combined with the family history below, this pushes the colonoscopy from "worth scheduling" to genuinely worth prioritising once he's through the current knee decision-making.
⚠ Family history now on record — sister has colon cancer, currently under treatment
This changes the picture for colorectal surveillance. A first-degree relative with colorectal cancer generally moves someone into an earlier/more frequent screening category regardless of what his own 2022 polyp turns out to have been — worth flagging this family history explicitly when re-referring for colonoscopy, since it may shift the recommended interval shorter than the polyp findings alone would suggest.
| Screen | Last done | Result | Status |
|---|---|---|---|
| Colorectal (colonoscopy) | Dec 2022 — Clinique d'Orange, Dr Rabbia | Diverticulosis + polyp removed | Polyp pathology/size not in the records reviewed. Combined with the family history (sister, colon cancer) and now a plausible bleeding-polyp theory for the current anaemia, this is worth actively scheduling rather than treating as a "someday" item — timing to coordinate around the knee situation resolving. |
| Prostate | PSA Nov 2025 (1.39 µg/L, normal) · CT Aug 2026 reassuring | PSA comfortably normal (<4 threshold). Feb 2026 ultrasound referral for dysuria/nocturia — outcome not found in folder, though the recent hospital CT was reassuring for the pelvis generally. | No active concern currently. At 75, most guidance (NHS, USPSTF) favours an individualised discussion rather than routine organised screening — worth a formal LUTS follow-up once the knee situation has settled, but nothing urgent here. |
No other organised screening programme (e.g. skin, other) is documented beyond the dermatology visits already covered under Past Medical History.
Documents
Tap to open · Google Drive
✓ Linked directly from Google Drive
All documents below open the individual file. Tap any card to view. Last synced: 4 August 2026.
CARDIAC
Stage 2 Angioplasty Report — LM + LAD Stents
6 Aug 2026 · Dr Quillot · Rotational atherectomy · 2× XIENCE Skypoint
Stage 2 Discharge Summary (Fiche réglementaire)
6-7 Aug 2026 · Confirms complete revascularisation
ECG — Admission for Stage 2
6 Aug 2026 · Machine read "old infarct(s)" — needs review, see Cardiovascular panel
Dr Quillot Ordonnance — Outpatient Follow-up
7 Aug 2026
Full Admission Discharge Letter (Compte-Rendu)
Dictated 15 Jul, uploaded 7 Aug · Family history, social history, immunisation status — source for PMH/Social/Immunizations panels
Stage 1 Angioplasty Report — RCA Stent
29 Jul 2026 · Dr Quillot · ORSIRO 3.5×30mm · TIMI 3
Stage 1 Discharge Summary (Fiche réglementaire)
29 Jul 2026 · Confirms Stage 2 = 6 Aug, atherectomy noted
Stage 2 Convocation — Coronarographie
6 Aug 2026 · Prep instructions + consent forms
Dr Quillot Ordonnance — Full Cardiac Regime
29 Jul 2026 · 9 medications, 3-month supply
Pre-Stage-2 Bloods Order
3 Aug 2026 · NFS, K, Na, creat, CRP, TP/TCA
Pre-Stage-2 Bloods — Results
3 Aug 2026 · CRP 27.3 ▼ · Hb 93 ▼ · INR 1.42
Bloods — Fortnightly Monitoring Result
19 Aug 2026 · CRP 23.1 ▲ (up from 14.6) · Hb 89 → (stable) · Renal/liver normal
Bloods — Fortnightly Monitoring Result
12 Aug 2026 · CRP 14.6 ▼ (best yet) · Hb 89 ▼ (lowest yet)
Dr Unal — Cardiology Referral Letter
18 Jun 2026 · Echo: LVEF 80%, original workup trigger
Dr Unal — Nefopam Prescription
18 Jun 2026 · Pain management pre-admission
Note: the original 7 July coronary angiogram report PDF itself hasn't turned up as a standalone file in the Drive folder — the anatomy (left main 70-90%, proximal LAD critical, mid-RCA 70-90%, SYNTAX 24) is documented in Dr Quillot's discharge summaries and referenced in Philip's 28 July letter. Worth uploading the standalone report if you have it.
KNEE INFECTION — MICROBIOLOGY
Infectiology Consultation Letter — Dr S. Bayle
20 Aug 2026 · Joint aspiration performed · Antibiotic fenêtre (2wks) proposed · MDT 31 Aug · Serum clindamycin level + anaemia workup sent
Comprehensive Anaemia Workup + Electrophoresis
20 Aug 2026 · Hb 91 stable · Mixed inflammatory + iron-deficiency picture · IgG/IgA/IgM normal (resolves Nov 2025 flag)
Infectiology Follow-up Letter — Dr S. Bayle
11 Aug 2026 · Clindamycin dose corrected (900mg×3) · CT scan ordered · Antibiotic stop date now provisional
Knee CT + X-ray — Results (Osteitis Confirmed)
19 Aug 2026, Orange · CT: osteitis, medial tibial plateau, 2 geodes (12mm, 5mm) · XR: separate tricompartmental OA
Knee CT + X-ray Referral/Order
Ordered 13 Aug 2026 · Appointment 19 Aug, Orange · Checking for osteitis
Bloods Order — Fortnightly Monitoring
12 Aug 2026 · NFS, CRP, liver enzymes, bilirubin · 5 weeks
Second Washout — Bacteriology + Antibiogram
3 Jul 2026 · MSSA S. aureus · Full sensitivity panel
Original Joint Aspirate Culture
24 Jun 2026 · S. aureus confirmed · Antibiogram
Stool Culture — C. diff
10 Jul 2026 · Negative — no C. diff detected
COVID / Flu / RSV PCR
10 Jul 2026 · All negative
BLOOD CULTURES
Blood Culture — 23 Jun (Set 1)
Aerobic + Anaerobic · Negative
Blood Culture — 23 Jun (Set 2)
Aerobic + Anaerobic · Negative
Blood Culture — 24 Jun · Serology
HIV neg · Hep B neg · Syphilis neg
Blood Culture — 24 Jun (Set 2)
Aerobic + Anaerobic · Negative
Blood Culture — 30 Jun (Set 1)
Aerobic + Anaerobic · Negative
Blood Culture — 30 Jun (Set 2)
Aerobic + Anaerobic · Negative
Blood Culture — 11 Jul (Set 1)
Aerobic + Anaerobic · Negative
Blood Culture — 11 Jul (Set 2)
Aerobic + Anaerobic · Negative
BLOOD TEST RESULTS
Blood Results — 24 Jun 2026
Urinalysis + urine culture · Admission day
Blood Results — 5 Jul 2026
Hb 9.9 · CRP 120 · GGT 581
Blood Results — 7 Jul 2026
Hb 9.4 · CRP 44.8 · GGT 332
Blood Results — 9 Jul 2026
Hb 8.9 · CRP 43.1 · GGT 239
Blood Results — 13 Jul 2026
Hb 9.3 · CRP 39.4 · GGT 146
Blood Results — 15 Jul 2026 (Discharge)
Hb 8.8 · CRP 36.2 · GGT 114
Blood Results — 22 Jul 2026 ✦ Latest
Hb 100 ▲ · CRP 28.3 ▼ · GGT 79 · eGFR 67
DERMATOLOGY
Prescription — Clobex + Aerius (current)
27 Jul 2026 · CHIAP Aix · Actual post-visit script
GP Referral to Dermatology — Dr Paur
3 Jun 2026 · Scalp psoriasis query · To Aix-en-Provence
Prescription — Clarelux + Solupred + Ebastine
Nov 2025 · Clobetasol scalp mousse (failed treatment)
Prescription — Betneval Lotion (Betamethasone)
Oct 2025 · Topical steroid scalp (failed treatment)
Prescription — Diprosone + Lercanidipine
Feb 2026 · Betamethasone dipropionate scalp
DVT
PRE-ADMISSION HISTORY
Prescription — Naproxen (Apranax)
15 Jun 2026 · NSAIDs for knee pain pre-admission
Prescription — Solupred 80mg + Flector + Lamaline
19 Jun 2026 · High-dose steroids — masked infection
Prescription — Lercanidipine + Nerisone + Allopurinol
3 Jun 2026 · Routine long-term medications
Prescription — Clamoxyl + Ultralevure
Feb 2026 · Amoxicillin course
Colonoscopy — Clinique d'Orange
Dec 2022 · Dr Rabbia · Diverticulosis + polyp removed
Prostate Echo Referral — Dr Maclet
Feb 2026 · Dysuria + nocturia
Prescription — Cerulyse + Allopurinol + Nerisone
Sep 2024 · Ear wax + gout + skin
APPOINTMENTS
Hospital Admission Form — Stage 2
27 Jul 2026 · Cardiologie hébergement · Scan 6 Aug 07:00
Full Medication List (current)
2 Aug 2026 · GP-issued consolidated ordonnance
Infectiology Appointment (11 Aug)
Dr S. Bayle · 4:30pm · (upload individually for direct link)
Folder last synced 4 August 2026. Drop new files into the Drive folder and ask Claude to re-sync to add them here.
All Documents — Date Order
Most recent firstCompiled from the shared Drive folder as of 4 August 2026. Some exact duplicate uploads have been collapsed to one entry.
Emergency — Chest Pain
🚨 If Dad has chest pain
- One spray of GTN (Natispray) under the tongue immediately
- Sit or lie down — complete rest
- If pain not gone in 5 minutes: second spray
- If pain persists: call 15 (SAMU) immediately — do not drive
15 SAMU — French emergency medical services
Also call 15 immediately if:
Breathlessness at rest · Palpitations · Sudden leg pain or swelling · Dizziness or collapse · Any new cardiac-feeling symptom
Nearest cardiac hospital
Centre Hospitalier Henri Duffaut · 305 rue Raoul Follereau, Avignon · ~40 minutes from Le Fournas · Tel: 04 32 75 33 33
Full Timeline
Most recent first6 August 2026 — Upcoming
Stage 2 PCI scheduled — Rotational atherectomy + Left Main/LAD stent
Confirmed for 12:00 noon. More involved than originally expected — hospital note specifies rotational atherectomy needed first due to calcification. Apixaban timing confirmed verbally by Dr Quillot: omit evening-before (5 Aug) and morning-of (6 Aug).
29 July 2026
Stage 1 PCI successful — RCA stented
ORSIRO drug-eluting stent (3.5×30mm) placed in mid-RCA via right radial approach. Tight 70-90% stenosis pre-dilated then stented. Final flow normal (TIMI 3), no residual lesion. No complications. Home same day. Aspirin added to regime (Kardegic, until 14 Aug).
27 July 2026
Dermatology — Aix-en-Provence · Disappointing
Seen by two junior interns at CHIAP. Minimal scalp plaques visible on examination — the connection between scalp psoriasis and the S. aureus knee infection was dismissed. Actual prescription: Clobex shampoo (clobetasol) daily for 15 days + Aerius (desloratadine) as needed for itch. Philip frustrated but acknowledges: biologic therapy not appropriate now regardless (active infection, pre-cardiac surgery). Re-referral planned if needed once infection and cardiac surgery resolved.
28 July 2026 — Today
Dr Quillot responds — PCI confirmed ✓ · SYNTAX Score 24
Philip wrote to Dr Quillot with pre-procedure questions. Full response received. SYNTAX score 24 — PCI guideline-appropriate. Two-stage plan: RCA stent tomorrow, left main + LAD ~1 week later. Triple therapy one week only post-stent then dual. Apixaban: omit tonight AND tomorrow morning. Procedure ~11am, arrive 9am. Discharge Thursday 30 Jul ~9am.
24 July 2026 — This morning
Sutures removed ✓ · Compression regime established
Sutures out at Day 21 post second washout — on schedule. IDE nurse visiting each morning for compression bandage (Class 3) application for DVT management. Family taught to apply independently — important given week away in Carpentras. Knee wound healing well.
22 July 2026
Blood results — best since admission 🎉
Haemoglobin 100 g/L — up from 88 at discharge and 120 pre-admission. First time back in three figures. Anaemia recovering well.
CRP 28.3 mg/L — lowest since admission (was 235 at peak). Still elevated but continuing a consistent downward trend — the infection is resolving.
Liver enzymes almost normal — GGT 79 (nearly there), AST 14 ✓, ALT 17 ✓. The pip/tazo drug reaction has fully resolved.
Lymphocytes 1.42 — back in normal range. Immune system recovering.
eGFR 67 — slight dip from 74 last week. Ensure good hydration in the heat. Worth monitoring next week.
Monocytes 0.81 — still mildly elevated. Persistent but not worsening. Keep an eye on this over coming weeks.
Eosinophils 0.33 — unchanged. Drug reaction signal persisting but within normal range.
CRP 28.3 mg/L — lowest since admission (was 235 at peak). Still elevated but continuing a consistent downward trend — the infection is resolving.
Liver enzymes almost normal — GGT 79 (nearly there), AST 14 ✓, ALT 17 ✓. The pip/tazo drug reaction has fully resolved.
Lymphocytes 1.42 — back in normal range. Immune system recovering.
eGFR 67 — slight dip from 74 last week. Ensure good hydration in the heat. Worth monitoring next week.
Monocytes 0.81 — still mildly elevated. Persistent but not worsening. Keep an eye on this over coming weeks.
Eosinophils 0.33 — unchanged. Drug reaction signal persisting but within normal range.
15 July 2026
Discharged home to Le Fournas
Oral clindamycin until 14 Aug. Weekly blood tests. Nurse for wound dressing. All follow-up appointments arranged.
10 July
DVT confirmed · PCI deferred
Small clot in left calf fibular vein. Apixaban started. Planned stent on 10 July cancelled due to ongoing fever and elevated CRP — the right call.
7 July
Coronary angiogram — three narrowed arteries
Left main 70-90%, mid LAD 50-70%, mid RCA 70-90%. All TIMI 3. LVEF 55% on echo — heart muscle intact. Stent vs bypass decision pending.
5 July
First afebrile day — CRP drops to ~120
First day without fever. First meaningful CRP fall. Weight-bearing without focal knee pain for the first time.
4 July
Second surgical washout — open surgery
Open capsulotomy, frank pus found, 6L saline washout, Redon drain placed. General anaesthetic. IV pip/tazo started post-op. Philip arrived from Canada same day.
1 July
IV antibiotics stopped — cannula site infection
Phlebitis at cannula site. Cannula removed, switched to oral clindamycin. CRP still ~200 — concern that switch was too early.
26 June
First surgical washout (arthroscopic)
Keyhole surgery under spinal anaesthetic. 6L saline washout of knee joint. Post-op exhausted and in significant pain.
25 June
S. aureus confirmed — IV antibiotics started
Culture result: MSSA Staphylococcus aureus — the treatable type. IV cloxacillin started.
24 June
Joint aspiration — 325ml cloudy fluid removed
Sent for culture. Antibiotics held pending results — debated decision in retrospect.
23 June
Admitted to hospital
Presented to A&E, CHD Avignon. Admitted overnight.
22 June
Complete relapse
All knee pain and swelling returned despite steroids — warning sign that infection had not been controlled.
18–20 June
GP diagnosis: psoriatic arthritis — brief improvement
CRP 77. High-dose prednisolone 80mg — near-complete but brief relief. Steroids masked the infection temporarily.
~10 June 2026
Left knee pain begins
After squash and ladder work. Initially thought to be a sprain.
Diet Guidance
Cardiovascular optimisation
Current diet is a good baseline
Low processed food, lean protein, vegetables. The tweaks below are targeted refinements — not a wholesale change.
| Current | Suggested swap / addition | Why |
|---|---|---|
| Granola | Plain porridge oats + fruit | Oat beta-glucan reduces LDL by ~5-10%. Commercial granola often high in sugar and palm oil. |
| Yellow fruit pot (syrup) | Berries or fruit in juice | Blueberries and raspberries have the best cardiovascular evidence — polyphenols, low sugar. |
| Taramasalata | Hummus or mashed avocado | Chickpeas = soluble fibre (lowers LDL). Avocado = monounsaturated fats + potassium. |
| White fish mainly | Oily fish 2–3x/week | Sardines, mackerel, salmon. Omega-3 lowers triglycerides. Tinned sardines = cheap and easy. |
| Milk chocolate | Dark chocolate 70%+ | Flavonoids in dark chocolate have genuine cardiovascular evidence. A few squares daily is fine. |
| — | Add: small handful of walnuts daily | Best nut for cardiovascular evidence. ALA omega-3. On porridge or as a snack. |
| — | Add: olive oil as main cooking fat | Monounsaturated, anti-inflammatory, Mediterranean diet evidence base (PREDIMED trial). |
| — | Add: lentils or beans 2x/week | Soluble fibre, plant protein, LDL lowering. Lentil soup is easy and cheap. |
How much difference does diet actually make?
Dietary modification for established coronary artery disease is worthwhile but the effect size is modest compared to medications. The atorvastatin alone will do more for Dad's cholesterol than any dietary change. The Mediterranean diet evidence (PREDIMED trial) shows roughly 30% reduction in cardiovascular events — real, but his situation requires surgical intervention beyond diet alone. Think of dietary tuning as protecting the investment of whatever cardiac surgery achieves, not as a substitute for it. The porridge swap and the oily fish are the two highest-yield changes.
Social History
Now documented — from full 15 Jul discharge letter