MEDICATIONS
- Clopidogrel 75mg — stents
- Atorvastatin 20mg twice daily + Ezetimibe 10mg
- Bisoprolol, lercanidipine, allopurinol
- Stopped: apixaban, aspirin, clindamycin, colchicine
ONGOING CONCERNS
- Anaemia recovering — Hb 125 (12 Oct); colonoscopy Dec
- L knee osteitis — CRP normal (<0.5, 12 Oct), off antibiotics
- DVT — apixaban stopped Oct; follow-up doppler Dec
MEDICAL HISTORY
- 3-vessel CAD — 3 stents (RCA Jul 2026; left main + LAD Aug 2026)
- Hypertension, gout, hiatus hernia
- R hip replacement 2018
- L knee septic arthritis + osteitis (Jun 2026)
- DVT L calf (Jul 2026)
- Scalp psoriasis/eczema
- Family: father/brother cardiac; mother leukaemia; sister colon cancer
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 →
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
- Colonoscopy — December 2026
- DVT follow-up venous doppler — December 2026
- PSA — annual (next due ~Nov 2026)
- Lipid panel post-PCI — none on file
- DTP, pneumococcal, 2nd shingles dose
1. Outstanding Health Issues
Open items as of 19 October 2026| Issue | What's needed |
|---|---|
| DVT follow-up doppler — December 2026 | Isolated distal DVT, left fibular vein (7.5mm, provoked), found 10 Jul 2026. Apixaban was stopped at the 3-month mark in Oct 2026. The repeat doppler due ~10 Oct was cancelled and rebooked for December to confirm the clot has resolved. |
| Colonoscopy — December 2026 | Indications: iron-deficiency component to the anaemia while on antithrombotics, sister with colon cancer, polyp removed Dec 2022 (pathology not on file). Antithrombotic plan around the procedure to be agreed with cardiology. |
| Anaemia — recovering | Hb 103 (4 Sep) → 116 (22 Sep) → 125 g/L (12 Oct), reference 129–167. Aug workup showed a mixed picture: inflammation plus true iron deficiency. Repeat FBC and iron studies to confirm full recovery; colonoscopy outstanding. |
| Left knee osteitis — CRP normalised | MSSA septic arthritis (Jun 2026) with osteitis of the medial tibial plateau on CT (19 Aug 2026). CRP <0.5 on 12 Oct 2026 (23.1 on 19 Aug). Clindamycin stopped. Follow-up plan after treatment not yet recorded here. Separate pre-existing tricompartmental osteoarthritis. |
| Lipids — no post-PCI panel on file | On atorvastatin 20mg twice daily + ezetimibe 10mg. Target LDL-C <1.4 mmol/L (<55 mg/dL) and ≥50% reduction from baseline. Repeat fasting lipid panel. |
| ECG machine read "old infarct(s)" (6 Aug 2026) | The PDF was unreadable (scanned image) so this was never checked against a cardiologist's interpretation. Ask at the next cardiology review. |
| Immunisations behind | DTP not up to date, no pneumococcal vaccine ever, shingles 1 of 2 doses (2025) — see Medications, Allergies & Immunisations. |
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/eczema, rather than treating flares reactively.
3. Upcoming Appointments
As of 19 October 2026Dec
2026
Rebooked from ~10 Oct (cancelled) · Date to be confirmed
Confirms the clot has resolved (apixaban already stopped at 3 months, Oct 2026). Bring the result to GP Dr Paur. Original report (10 Jul 2026): isolated distal DVT, left fibular vein, 7.5mm, provoked.
Dec
2026
Colonoscopy
Lined up for December · Date and centre to be confirmed
Sister with colon cancer, polyp removed Dec 2022, iron-deficiency component to the anaemia. Agree the clopidogrel plan around the procedure with Dr Quillot and the endoscopist beforehand.
Prevention
Targets and tracking — "TBC" means no data on file yetCARDIOVASCULAR HEALTH
| Measure | Where he is now | Target |
|---|---|---|
| Cholesterol (LDL-C) On atorvastatin 20mg twice daily + ezetimibe 10mg |
Controlled? TBC. No lipid panel on file since the PCIs and the dose increase. | LDL-C <1.4 mmol/L (<55 mg/dL) and ≥50% reduction from baseline (ESC/EAS very-high-risk). Repeat fasting panel; if above target on this regimen, discuss adding a further agent. |
| Blood pressure On lercanidipine 10mg + bisoprolol 2.5mg |
Controlled? TBC. No home readings on file. Last recorded: 160/80 at cardiology, 18 Jun 2026 (in pain, acutely unwell, so not representative). | Below 140/90 at minimum; systolic 120–129 if tolerated (ESC 2024). Home BP for 7 days (two readings morning and evening) to check control. |
| BMI / body fat Withings |
TBC from Withings. Hospital records: 80 kg, BMI 26.4 (23 Jun 2026); 77.6 kg, BMI 25.3 (15 Jul 2026). | BMI 22–26, stable weight; body-fat % and waist to be set once Withings data is in. |
| VO2max Fitbit cardio fitness score |
TBC from Fitbit. | Steady rise from baseline through cardiac rehab and regular cycling. |
CANCER SCREENING
| 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. | Lined up for December 2026. Reasons: sister with colon cancer, previous polyp, and an iron-deficiency component to the anaemia while on antithrombotics. |
| Prostate | PSA Nov 2025 — 1.39 µg/L (normal, <4) | Feb 2026 ultrasound referral for dysuria/nocturia — outcome not found in folder. CT Aug 2026 reassuring for the pelvis. | Annual PSA — next due ~Nov 2026. At 75 this is an individual decision rather than organised screening; keep the LUTS follow-up in view. |
No other organised screening is documented beyond the dermatology visits covered under Past Medical History.
MUSCULOSKELETAL HEALTH — FIVE MOBILITY TESTS
| Ability | Now | Target | Why it matters |
|---|---|---|---|
| 1. Dead hang (both hands, overhead bar) | TBC — time in seconds | 30 s; longer-term 60 s | Grip, shoulder health and thoracic extension (kyphosis). Breathe normally, no breath-holding, stop for chest symptoms. |
| 2. Squat — depth and knee range of motion | TBC. Left knee flexion was painful at 90° on admission (23 Jun 2026); no measurement since. | Pain-free bodyweight squat to parallel; left knee flexion ≥120°, full extension (0°), matching the right | Getting up from low seats and the floor; tracks recovery of the left knee after infection and OA. |
| 3. 30-second sit-to-stand | TBC — repetitions | ≥15 reps (age-norm cut-off for men 75–79 is about 11) | Lower-limb power and independence. |
| 4. Single-leg balance (eyes open) | TBC — seconds each leg | ≥30 s each leg; under 5 s means high fall risk | Falls and bleeding risk while on blood thinners; matters for outdoor cycling. |
| 5. Thoracic extension / posture (back-to-wall) | TBC — head-to-wall distance with heels and back against the wall (cm) | 0 cm | Kyphosis noted through the illness; track with rows, prone extensions and wall angels. |
MENTAL HEALTH
| Domain | Where he is now | Target |
|---|---|---|
| Sleep quality Fitbit |
TBC from Fitbit (duration, efficiency, awakenings). Using Quviviq 50mg at night since Jul 2026. | 7+ hours most nights and a stable pattern; review the need for Quviviq with Dr Paur once sleep settles. |
| Mood and stress | Cardiac diagnosis, three stents and a serious knee infection, all within about two months. | Regular check-in on mood and on processing these events; GP review if low mood or anxiety persists. |
| Alcohol | Baseline about 2 beers + 2 glasses of wine a day (roughly 28 standard drinks a week); sharply lower since hospitalisation. | Within the French guideline of no more than 10 standard drinks a week, with alcohol-free days. |
| Fun and normal life | Cycling in the countryside, squash and gardening are the usual outlets; currently limited. | Rebuild these gradually, starting with cycling once cleared. |
Immunisations have their own tab — see Medications, Allergies & Immunisations.
Past Medical History
Compiled from hospital records & referral letters| Condition | When / Detail |
|---|---|
| Coronary artery disease (3-vessel) — 3 stents | Angiography 7 Jul 2026 (left main ~80%, mid-LAD 60%, mid-RCA 80%; SYNTAX 24). PCI in two sessions: 29 Jul 2026 — mid-RCA, Orsiro 3.5×30mm drug-eluting stent; 6 Aug 2026 — rotational atherectomy of the distal left main, then Xience Skypoint 3.5×33mm (left main) and 3×38mm (mid-LAD), kissing balloon to the circumflex. Complete revascularisation. LVEF 80% (echo 18 Jun 2026). |
| Septic arthritis, left knee (MSSA) + osteitis | Pain from 12 Jun 2026; admitted 23 Jun 2026. Washouts 26 Jun and 3 Jul 2026. CT 19 Aug 2026 confirmed osteitis of the medial tibial plateau (two erosive geodes, 12mm and 5mm). Clindamycin, then stopped; CRP <0.5 on 12 Oct 2026. |
| DVT, left calf (fibular vein), provoked | Found 10 Jul 2026 — apixaban Jul–Oct 2026 (stopped at 3 months); follow-up doppler December 2026 |
| Anaemia (inflammation + iron deficiency) | From Jun–Jul 2026, Hb nadir 88–89 g/L (Jul–Aug 2026); 125 g/L on 12 Oct 2026 |
| Osteoarthritis, left knee (tricompartmental) | Found on X-ray 19 Aug 2026 (unchanged from an older film) — pre-existing and separate from the infection |
| Hypertension | 20+ years (month not recorded) — lercanidipine + bisoprolol |
| Gout | 30+ years (month not recorded) — allopurinol long term. Colchicine trialled Jun–Aug 2026 during the knee episode and stopped Aug 2026; no crystals were ever found. |
| Scalp psoriasis/eczema | Longstanding; multiple topical courses with limited success. Dermatology review 27 Jul 2026 (Aix). Current: desloratadine daily and emollients; biologic considered later |
| Lower urinary tract symptoms | Dysuria/nocturia — prostate ultrasound referral Feb 2026 (Dr Maclet); outcome not found in folder. PSA Nov 2025 normal |
| Popliteal cyst, ruptured | Jun 2026 — suspected by Dr Unal on 18 Jun 2026, before septic arthritis was found |
| Right total hip replacement | 2018 (month not recorded), for osteoarthritis |
| Diverticulosis + colonic polyp (removed) | Colonoscopy Dec 2022, Clinique d'Orange (Dr Rabbia). Repeat colonoscopy December 2026 |
| Hiatus hernia | Endoscopy 2022 (month not recorded) |
| Right inguinal hernia repair ×2 | Two separate procedures, dates not recorded |
| Tonsillectomy | Age 5 |
FAMILY HISTORY
| Relative | Condition |
|---|---|
| Father and brother | Cardiac disease |
| Mother | Leukaemia (deceased) |
| Sister | Colon cancer — under treatment (per the Jul 2026 discharge letter) |
Compiled from discharge summaries and referral letters in the Drive folder — not a substitute for the full GP record. Flag anything missing or inaccurate.
Current Medications
As of 19 October 2026| Drug | Indication | What it does | When | Until |
|---|---|---|---|---|
| Clopidogrel 75mg | Antiplatelet — protects the 3 coronary stents | Stops platelets clumping on the stents | 8am | Per cardiology (Dr Quillot) |
| Allopurinol — TWO 100mg tablets together, once daily | Gout prophylaxis | Gout prevention (long-standing) | 6pm — 2 tablets together (200mg) | Long term |
| Atorvastatin 20mg — one tablet twice daily | Hyperlipidaemia — secondary prevention post-PCI | Statin — lowers cholesterol and stabilises artery narrowings. 40mg/day in total. | 8am · 6pm | Long term |
| Ezetimibe 10mg | Hyperlipidaemia — secondary prevention post-PCI | Blocks cholesterol absorption — added to the statin for extra LDL lowering | Evening | Long term |
| Bisoprolol 2.5mg | Cardioprotection / rate control | Beta-blocker — reduces heart rate and workload | 8am | Long term |
| Colécalciférol (Vitamin D) 2,500 IU | Vitamin D deficiency | Vitamin D — levels were low on admission | Daily | Ongoing |
| Desloratadine (Aerius) 5mg | Pruritus (dermatologist-prescribed) | Antihistamine — daily and non-negotiable per rehab goals | Evening, daily | Ongoing |
| Emollient (unspecified) | Skin barrier / general skin care | Skin barrier support | 3 times daily + after every shower | Ongoing, non-negotiable |
| Fer (Iron) | Iron deficiency (anaemia) | Iron supplement — dose and frequency to be confirmed | To confirm | To confirm |
| Lercanidipine 10mg | Hypertension | Blood pressure (long-standing) | 8am | Long term |
| Pantoprazole 40mg | Gastroprotection | Stomach protector — prevents ulcers | 6pm | Originally 30 days — review with Dr Paur |
| Paracetamol (Doliprane) — TWO 500mg tablets together | Analgesia / antipyretic, as needed | Pain relief / fever — as needed | Every 8 hours if needed — 2 tablets together (1g) | As needed |
| Quviviq (daridorexant) 50mg | Insomnia | Sleep aid — started ~16-17 Jul 2026 for stress-related insomnia and oxazepam withdrawal | 30 min before bed | Ongoing — review with Dr Paur |
| Vitamine B12 | Anaemia work-up / supplementation | Vitamin B12 supplement — dose and frequency to be confirmed | To confirm | To confirm |
Stopped: apixaban (Oct 2026, at the 3-month mark), aspirin (14 Aug 2026), clindamycin, colchicine (Aug 2026). Stock counts have been removed because the last count (15 Aug) is out of date — send a fresh count to add them back.
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.
Immunisations
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.
Documents & Lab Results
Labs first, then documents · Tap to open · Google DriveBlood Test Results
Latest: 12 Oct 2026
✓ 12 Oct 2026 — CRP normalised (<0.5 mg/L), Hb 125 g/L
CRP has fallen from 23.1 (19 Aug) to <0.5, and Hb has recovered from 89–103 to 125 (still just below range 129–167). WBC 5.22 and platelets 202 normal. *4 Sep and 22 Sep values are taken from the "previous results" columns of the 12 Oct report only (CRP, Hb, platelets); other tests for those dates not available.
| 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 | 4 Sep* | 22 Sep* | 12 Oct ↑ |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 ▲ | 0.6 | 6.4 ▲ | <0.5 ▼ ✓ |
| Haemoglobin (g/L) Anaemia |
129–167 | 121 | 119 | 118 | 107 | 100 | 104 | 99 | 94 ▼ | 89 ▼ | 93 ▲ | 88 ▼ | 100 ▲ | 102 | 93 ▼ | 89 ▼ | 89 → | 103 | 116 ▲ | 125 ▲ |
| 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 ▲ | — | — | 5.22 |
| Platelets (G/L) Clotting |
140–385 | 384 | 479 | 520 | 548 | 536 | 589 | 574 | 547 | 543 | 520 ▼ | 458 ▼ | 417 ▼ | 401 ▼ | 363 ▼ | 349 ▼ | 375 ▲ | 281 | 164 | 202 |
| 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 ✓ | — | — | — |
| INR Clotting |
0.8–1.2 | — | — | — | — | — | — | — | — | — | — | — | — | 1.40* | 1.42* | — | — | — | — | — |
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.
✓ 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 cardiologist review
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/Immunisations 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
Blood Test Results — normalised CRP
12 Oct 2026 · CRP <0.5 (6.4 on 22 Sep) · Hb 125 (116 on 22 Sep) · WBC 5.22 · Platelets 202
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/eczema 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.
Full Timeline
Most recent firstOctober 2026
Apixaban stopped at the 3-month mark
Course for the left calf DVT completed. The follow-up doppler due ~10 Oct was cancelled and rebooked for December to confirm the clot has resolved.
12 October 2026
Bloods — CRP normalised, Hb recovering
CRP <0.5 mg/L (6.4 on 22 Sep), Hb 125 g/L (116 on 22 Sep, 103 on 4 Sep), WBC 5.22, platelets 202.
6 August 2026
Stage 2 PCI — Rotational atherectomy + Left Main/LAD stents
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
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
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.
3 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