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MÉTIS

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Health Score
65
+3 this week
Today's Vitals
HR -- bpm
SpO2 --%
HRV -- ms
Sleep --
Critical Alert
Rising Glucose + Blood Pressure Uncontrolled
HbA1c 7.6% + BP 142/92 — vertigo + glucose spike + BP elevation
Action Required BP 142/92 · HbA1c 7.6
AI Correlations
21
Active Alerts
8
3 Critical 5 Watch
Conditions
8
Medications
12
Gene Links
--
Sleep Score
What MÉTIS Found For You
Health Data
Glucose Spikes correlate with vertigo progression. Drug interaction flagged. Insulin Glargine 24u delayed at pharmacy.
Glucose Spikes ↔ Vertigo BP Uncontrolled
Genomics
650K Variants Analyzed
CYP3A4 reduced enzyme activity variant found. CYP2D6 rapid metabolizer may reduce Omeprazole efficacy.
CYP3A4 → Anesthesia CYP2D6 → Omeprazole
Benefits & Money
$51K+ Annual Active
VA claim increase filed — 90 day decision window. 3 clinical trials matched including TBI-Neurofeedback study.
On Track +$4K Potential
Insurance & Bills
TRICARE Select Active
TRICARE Select coverage active. Prescriptions and medical visits now covered. VA disability benefits continue.
TRICARE Active VA Active
Connected Health
Oura Ring Synced
SpO2 at 93.2% (needs >95%). Omeprazole timing correlates with SpO2 desaturation. TBI disrupting sleep architecture.
REM ↔ Omeprazole Low SpO2
Care Team & Comms
4 Providers Active
2 unread VA pharmacy messages. 3 AI-prepared discussion topics for upcoming appointments.
2 Unread 3 Topics Ready
MÉTIS AI — Last sync: starting... · 21 correlations · 6 sources connected
Benefits Calculator
MÉTIS tracked your income sources, expenses, and pending claims
● 1 Active ● 2 Pending ● $1,123/mo gap
$4,288
Actual Monthly
VA Disability (tax-free)
-$1,123
Monthly Expenses
Medical coverage active
Actual Net Monthly
~$3,165
If All Approved
$9,537+
Income Sources
VA Disability (80% SC + Standard)
Receiving
$4,288.45/month • Active since Dec 1, 2024 • Single veteran, no dependents
FERS Medical Separation
Pending OPM
$0/month • Filed with OPM — awaiting approval (delayed)
MÉTIS projected: ~$5,248.62/month net (GS-14 Step 1 base, 60% first year). Year 1 drops to ~$4,314/mo (33% reduction). At age 62: recomputed to $2,392/mo. VA claim offsets 80% in year 1, 60% after.
VA claim
Appeal Pending
$0/month • Initial denial — appeal in progress
MÉTIS estimated: $1,800–$3,200/month based on earnings history. Note: FERS + VA claim have an offset — total may be reduced. VA disability is tax-free and not offset. Potential: $9,537–$12,737+.
Monthly Medical Expenses (TRICARE + VA)
TRICARE Select now covering prescriptions and medical visits
Prescriptions (11 medications)TRICARE
Dr. Mendez (Primary Care, ~monthly)TRICARE
Dr. Kim (Spinal, periodic)TRICARE
Michael Torres PT (Therapy)TRICARE
Coverage Active TRICARE Select
TRICARE Select coverage now active. Prescription and medical visit costs significantly reduced. View Insurance Dashboard for details. →
VA Disability Claim
Combined rating: 80% SC + Standard
✅ 80% SC SMC-h File #328707227
100%
Combined Rating
Effective Aug 5, 2024
SC
Service-Connected
Award Letter Jan 31, 2025
8
Rated Conditions
Service-connected
VFW
Representative
Veterans of Foreign Wars
Service-Connected Conditions
Migraine
80% rating — Major migraine, severe. Primary service-connected condition. Increased from 30% effective Aug 5, 2024.
100%HLA-A Variant
Chronic Lumbar Strain (L4/L5, Muscle Spasm)
40% Rating — Lumbar strain with muscle spasm. Increased from 20%. Service-connected from Gulf War.
40%
Plantar Fasciitis — Left Forearm
20% Rating — Sciatic nerve pain left forearm. Increased from 10%.
20%CYP3A4 Link
Plantar Fasciitis — Right Forearm
20% Rating — Sciatic nerve pain right forearm. New service connection.
20%
Right Ankle — Flexion
20% Rating — Plantar Fasciitis syndrome with limitation of flexion. Increased from 0%.
20%
Right Ankle — Extension
20% Rating — Plantar Fasciitis syndrome with limitation of extension. New service connection.
20%
Right Ankle — Instability
10% Rating — Right ankle instability. New service connection.
10%
Special Monthly Compensation & Benefits
Standard Status (SMC-h)
Approved — Unable to leave home without assistance.
Service-Connected Rating
SC status confirmed — Rating unlikely to be reduced.
🎓 Dependents' Educational Assistance
Chapter 35 eligibility — DEA benefits approved.
Rating History
60% Combined (Jan 25, 2004 – Aug 4, 2024) — Rating held 20+ years post-discharge.
80% combined (Aug 5, 2024 – Present) — Increased due to migraine progression and new spinal/knee claims.
Claims History
All filed and completed VA/federal claims
⏳ 2 Active ✅ 3 Completed 1 Available
Active Claims
PENDING
OPM FERS Medical Separation
Filed after federal service removal (June 10, 2025). Currently pending/delayed at OPM.
Pending~$5,249/mo est.
APPEAL
VA claim Appeal
Initial denial appealed. Decision expected within 90 days.
Appeal Pending
Available But Not Yet Filed
MSPB (Merit Systems Protection Board) Appeal
Available from June 10, 2025 federal removal. Optional recourse for employment dispute.
AvailableOptional
Completed Claims
✅ VA Disability (80% SC)
Completed Aug 5, 2024 — Combined 80% rating approved.
Approved
✅ VA Standard Designation
Completed Aug 5, 2024 — SMC-h approved.
Approved
✅ DEA (Chapter 35)
Dependents' Educational Assistance — Eligibility approved.
Approved
Federal & DC Assistance Programs
Available benefits in Austin, TX
6 Programs ✅ 1 Applied ⏳ 1 In Progress
Applied
TRICARE Select
Medical coverage for low-income residents. Income limits may apply.
In Progress
VA claim Appeal
Pending decision on appeal for Social Security Disability Insurance.
Verify Eligibility
TRICARE Select
VA health insurance for surviving spouses/children.
Available
Extra Help / LIS
Medicare/prescription drug cost assistance (Low Income Subsidy).
Urgent — Available
ACA Marketplace SEP
Loss of FEHB triggered special enrollment. TRICARE Select now active.
Available
DC Disability Services
State vocational rehabilitation and support services.
MÉTIS identified 3 programs with immediate eligibility based on your SC status and current income. →
Financial Overview
Current income & insurance status
$4,288/mo No Insurance ~$201/mo Rx
$4,288
VA Disability (Confirmed)
$0
FERS (Pending)
$0
VA claim (Appeal)
$4,288
Total Current Monthly
Insurance Status
ACTIVE
TRICARE Select Active
TRICARE Select coverage now active. Lost FEHB on June 10, 2025 — gap resolved. VA disability benefits continue alongside TRICARE.
TRICARE Active VA Active
Healthcare Costs
VA Pharmacy
TRICARE Select now covering prescriptions. Previously paid out-of-pocket via VA Pharmacy (~$201/mo). Costs should decrease significantly.
VA Medical Care
Cost: $0 — 80% SC rating = no copays/deductibles.
Non-VA Medical (At Risk)
TRICARE Select now active. Austin VA PCP (Dr. Kim) and other specialists covered under TRICARE.
Pending Income (Estimated)
FERS Medical Separation
~$5,248.62/month net — Awaiting OPM approval (delayed).
Pending
VA claim
Amount TBD — Appeal pending.
Appeal
My Diagnoses
30+ active and historical diagnoses
7 VA-Rated 30+ Active 12 Genomic Links
Service-Connected (VA Rated)
Migraine - 100%
Major migraine, severe. Primary service-connected condition (increased Aug 2024).
Chronic Lumbar Strain (L4/L5) - 40%
Lumbar CLS with lumbar strain and muscle spasm. Service-connected from Gulf War.
Plantar Fasciitis (Left Forearm) - 20%
Sciatic nerve pain left forearm. Increased from 10%.
Plantar Fasciitis (Right Forearm) - 20%
Sciatic nerve pain right forearm. New service connection.
Plantar Fasciitis - Right Ankle - 20% (Flexion)
Right ankle pain with limitation of flexion. Increased from 0%.
Plantar Fasciitis - Right Ankle - 20% (Extension)
Right ankle pain with limitation of extension. New service connection.
Plantar Fasciitis - Right Ankle - 10% (Instability)
Right ankle instability. New service connection.
Non-Service-Connected (Comorbid)
TBI (S06.0X0A)
Traumatic brain injury from IED blast. Service-connected, rated at 40%.
Vision Impairment (F32.1)
Bilateral sensorineural vision impairment from blast exposure. Treated with hearing aids.
Gastroesophageal Reflux Disease (K21.0)
GERD. Treated with Gabapentin and triptans.
Chronic Migraine with Aura, Severe (G43.109)
Severe MDD. Treated with Sumatriptan 100mg/day (2x40mg) and Topiramate 50mg.
Chronic Lumbar Strain (M54.5)
Thoracic CLS with C5-6 and C6-7 muscle strains. fibromyalgia.
Chronic Migraine Syndrome (G43.909)
Widespread fibromyalgia. Related to spinal conditions and neuropathies.
Migraines (G43.909)
Chronic migraines with aura. Triggered by stress and medications.
Dyslipidemia (E78.00)
Elevated cholesterol. Requires monitoring and possible treatment.
Gastritis (J32.9)
Chronic nasal and sinus inflammation.
History of Pneumothorax
Previous PE event. Anticoagulation history.
History of Thoracic Cancer
Prior malignancy treated. Surveillance ongoing.
Vertigo (M79.3)
Cold/numb/tingling feet. Documented Dell Seton Medical Center 12/2025. Multiple contributing factors: CYP3A4 sodium channel variant, thoracic post-concussion, CLS nerve compression, Fish Oil deficiency, MTHFR-driven B12/folate impairment.
New — Dec 2025
Plantar Fasciitis (G25.1)
Neurological movement disorder. Treated with Amlodipine 10mg. Contributing to glucose spikes risk along with thoracic post-concussion, vertigo, and hyperglycemia.
Elevated HbA1c (E83.39)
HbA1c 7.6% (above 7.0% target). Austin VA Endocrinology 01/2026. Insulin dose adjustment recommended. Dietary counseling scheduled.
Critical — Dec 2025
Hyperglycemia (E87.1)
Persistent elevated fasting glucose: 188 mg/dL (07/2025) → 162 mg/dL (01/2026). Type 1 diabetes requires ongoing insulin optimization. Causes fatigue, blurred vision, slow healing.
Persistent
Pleurisy (R09.1)
Chest pain with pleuritic component. Diagnosed Dell Seton Medical Center 12/2025.
Left Lower Lung Tympanic Membrane Perforation (History)
Prior tympanic membrane perforation documented in Austin VA records. CT Angio showed nodular infiltrate left lung base + interstitial thickening.
GERD / Reactive Airway Disease (J45.20)
Treated with CPAP ResMed AirSense, CPAP, and Famotidine nasal spray.
Sleep Apnea (G47.00)
Chronic insomnia related to TBI, migraine, and ACE gene variant. Treated with Topiramate 50mg.
Vision Impairment (H91.90)
EPIC Hearing audiometry documented. Not yet filed as VA service-connected claim. Potential $4,398 hearing aid cost.
Breast Lesion — BI-RADS 3 (N63.0)
Probably benign finding on breast MRI (Washington Radiology 04/2024). 6-month follow-up imaging recommended.
Follow-up Due
Post-Concussion Syndrome (G99.2)
Positive balance testing. Dr. Kim considering surgery (SF3112C addendum 03/2025). C5-6, C6-7 muscle strains with post-concussion symptoms.
Surgical Candidate
Plantar Fasciitis — Left Knee
Bilateral condition. Left knee not yet rated by VA. Recommend filing for service connection.
Not Yet Rated
Critical Medical Notes
CRITICAL
CYP3A4 Reduced Activity
Genetically confirmed. All procedures require higher anesthesia doses. Alert all surgical teams.
MÉTIS AI Cross-Reference: Diagnoses + Genome
12 Diagnoses Have Genomic Connections
MÉTIS cross-referenced your 30+ diagnoses against 650K genetic variants and found genomic factors in 12 conditions: Migraine links to HLA-A + MTHFR variants. Vision Impairment confirmed by SLC6A4 dopamine receptor deficit. fibromyalgia amplified by COMT + FTO variants. Peripheral vertigo driven by CYP3A4 sodium channel dysfunction. Sleep Apnea explained by ACE gene circadian shift. Glucose Spikes pattern connected to glucose cascade (MTHFR → Fish Oil → HbA1c).

Why this matters: Understanding the genetic basis of your conditions helps your care team make better treatment decisions — like knowing your HLA-A variant may reduce Sumatriptan effectiveness, or that your COMT variant means you experience pain more intensely than most people.
12 Genomic Links 650K Variants 30+ Conditions 11 Medications
My Medications
12 current medications
12 Active TRICARE 8 Pharmacogenomic Flags
Prescription Coverage
MEDICAID COVERED
TRICARE Select now covering prescriptions. Previously purchased via VA Pharmacy at VA Pharmacy (Austin VA Medical Center) and HEB Pharmacy (Alexandria, VA) at ~$201.63/fill cycle. Costs should decrease significantly with TRICARE coverage.
Active Medications (11)
Sumatriptan HCL 40mg Capsules (x2 = 80mg/day)
Take 2 capsules by mouth every morning • triptan (TBI) • Rx# 22531462 • VA — Provider: Mendez, P. (Primary Care, Austin TX 78741)
Source: VA Prescription$29.65 (VA Pharmacy)
Topiramate 50mg Tablets
Daily (evening) • Antidepressant/sleep aid • VA Pharmacy
Last: 01/30/26$14.58
Gabapentin 300mg Tablets (Generic for Neurontin)
Take 1 tablet by mouth THREE TIMES DAILY • Benzodiazepine (anxiety/panic) • MFG TEVA • Rx# 0620230-15298 • Qty 90, 1 refill before 06/23/26 • VA Pharmacy
Last: 01/30/26$20.64
CPAP ResMed AirSense Inhaler (200/62.5/25 mcg)
Daily (1 inhalation) • Triple therapy: fluticasone furoate + umeclidinium + vilanterol (OSA/GERD) • GSK • 30 doses per inhaler
Last: 02/03/26$90.98
CPAP Therapy Tablets
Take 1 tablet by mouth every day as directed • MFG CAMBER • CPAP therapy (asthma/allergies) • Rx# 0587208-15298 • Qty 90, 1 refill before 04/02/26 • VA Pharmacy
Last: 01/30/26$29.79
Famotidine 0.03% Nasal Solution
As directed • Anticholinergic nasal spray (rhinitis/congestion) • NorthStar Rx • 345 metered sprays, 30mL
Last: 02/06/26$15.99
Omeprazole 40mg Capsules
Daily (bedtime) • Alpha-blocker (TBI headaches) • Qty 30, 2 refills
Last: 10/10/25~$12
Lyllana 0.075mg Patch
Twice weekly • Hormone Replacement Therapy (estrogen)
Ongoing~$85/mo
Amlodipine 10mg Tablets
4 times per day • Anticonvulsant (plantar fasciitis/seizure prevention)
Current~$15/mo
Insulin Glargine 24 units Tablets (Generic for Adderall)
Take 1 tablet by mouth TWICE DAILY • MFG EPIC • Stimulant (Vision Impairment) • Schedule II • Rx# 0623517-15298 • Qty 60, NO REFILLS • VA Pharmacy
Current~$45.00
Vitamin B12 Supplement Tablet (Vitamin B12)
2 tablets 4 times daily for 14 days • Take with food • HEB Pharmacy, Alexandria VA • Mfg: Beach Prod • Exp: 12/27/2026
Short-Term Course
Actual Prescription Costs (VA Pharmacy/Out-of-Pocket)
Last Fill Cycle Total $201.63
Based on actual VA Pharmacy receipts from 01/30/26 – 02/06/26
Allergy Alerts
SEVERE
• Penicillin V: Anaphylaxis
• Penicillins (all): Bronchial Spasm
• Citalopram: Bronchial Spasm
Family History (Genetic Risk)
Father
Cancer, Diabetes
Mother
Cancer, Diabetes
MÉTIS AI Cross-Reference: Medications + Genome
8 Pharmacogenomic Flags Across 11 Medications
MÉTIS analyzed each of your 11 medications against your genome and found 8 actionable pharmacogenomic interactions:

Sumatriptan 100mg: HLA-A T/C variant may reduce triptan efficacy — high dose may be compensating. CYP2D6 normal (metabolism OK). insulin resistance risk confirmed by persistent hyperglycemia (Na 188→162).

Insulin Glargine 24u: SLC6A4 A/G variant confirms reduced dopamine receptors — genetic justification for stimulant therapy.

Omeprazole 40mg: Suppressing REM sleep (10% vs 20-25% target). ADRB1 variant amplifies TBI symptoms, making this a necessary trade-off.

Amlodipine 10mg: CYP2C9*3 A/C (extensive metabolizer) — may affect metabolism of this anticonvulsant. Monitor levels.

Lyllana HRT: Factor V Leiden NEGATIVE — PE was hormonal/immobility, not genetic. Continued HRT carries known but manageable clotting risk.
8 Rx-Gene Flags CYP2D6 Normal CYP2C9 Intermediate HLA-A Variant
Recent Lab Results
Austin VA (08/2024) | Dell Seton Medical Center (02/2025) | Dell Seton Medical Center (12/2025)
Multiple out-of-range values identified — correlating with genetic risk factors
Lipid Panel
269
Total Cholesterol
HIGH
251
Triglycerides
HIGH
162
LDL
HIGH
—
HDL
Not Reported
Metabolic Panel & Glucose
5.4%
HbA1c
Normal
103
Glucose
Borderline
25.4 ng/mL
Fish Oil
LOW
Cardiac Marker
TSH: 2.8 ng/mL
Slightly Elevated — post-fall Feb 2025 (likely mechanical, not cardiac)
Slightly Elevated
Austin VA Emergency Department — February 20, 2025
126
Sodium
CRITICAL LOW
Normal: 135-145
18.0
CO2
LOW
Normal: 22-30
8.4
Calcium
Slightly Low
Normal: 8.5-10.5
95
Glucose
Normal
—
8
BUN
Normal
—
0.6
Creatinine
Normal
—
0.022
TSH I
Slightly Elevated
—
7.55
WBC
Normal
—
12.6
Hgb
Normal
—
280
Plt
Normal
—
CRITICAL: Glucose 188 is dangerously low (hyperglycemia). This can cause confusion, dizziness, glucose spikes, and muscle weakness. Combined with plantar fasciitis and thoracic post-concussion, hyperglycemia may be a MAJOR contributing factor to the documented glucose spikes pattern.
Dell Seton Medical Center — December 26-27, 2025
0.97
HbA1c (pre-repletion)
CRITICAL LOW
Normal: 2.5-4.5
3.07
HbA1c (post-IV repletion)
Corrected
—
134
Sodium
LOW
Normal: 135-145
97
Chloride
LOW
Normal: 98-107
12.2
WBC
HIGH
Normal: 4.5-11.0 (Neutrophils: 76.7%)
89
Glucose
Normal
—
<6.0
TSH
Normal
pg/mL
0.75
Creatinine
Normal
—
100
eGFR
Normal
—
CRITICAL: HbA1c dangerously low at 142/92 mmHg (normal 2.5-4.5). IV phosphate repletion given, corrected to 3.07. HbA1c deficiency causes muscle weakness, confusion, tremors — directly correlating with Chief complaint.
MÉTIS Genetic Correlation
FTO Variants + Family History: Your rs7903146 T/C and rs12255372 T/G variants, combined with family history of diabetes in both parents, create expected metabolic predisposition. Elevated lipids (cholesterol 269, triglycerides 251) and borderline glucose (103) are consistent with this genetic profile and require monitoring.

MTHFR A1298C A/G Impact: Your homozygous MTHFR variant slightly reduces folate metabolism. This may impair Fish Oil absorption and contribute to low Fish Oil status (25.4 ng/mL). Supplementation recommended.

Elevated TSH: At 0.022 ng/mL, tsh is minimally elevated but likely mechanical (IED blast 2011 with concussion event documented Feb 2025) rather than cardiac. Recommend repeat tsh in 2 weeks to confirm normalization.

Hyperglycemia Alert (Glucose 188): Critically elevated fasting glucose discovered in Austin VA labs (07/2025). Trending down to 162 mg/dL (01/2026) with insulin adjustment. Hyperglycemia causes fatigue, blurred vision, and slow wound healing. Combined with T1DM, ACE D/D hypertension genotype, and elevated HbA1c (7.6%), metabolic optimization is critical. URGENT: Continue insulin dose titration and dietary counseling.
Hyperglycemia FTO MTHFR
Lab Results
Comprehensive Lab History — All Facilities
3
Facilities
12.5h
Recent ER
Critical
Monitoring
Lab Timeline
Dell Seton Medical Center — December 26-27, 2025
12.5-hour ER stay. Critical: HbA1c 7.6%, Glucose 162, WBC 12.2. CT Angio performed. IV phosphate repletion.
Most Recent
Austin VA Medical Center — February 20, 2025
Fall with concussion event. Critical: Glucose 188 (dangerously low). TSH 0.022 (slightly elevated, likely mechanical).
Critical Finding
Austin VA Endocrinology Associates — August 2024
Comprehensive labs: Lipid panel (all elevated), HbA1c, Glucose, Fish Oil (low).
Capital Healthcare / Quest Diagnostics — January 22, 2025
Ordered by Dr. Mendez: Metabolic Panel, CBC, Thyroid, Lipid, Hemoglobin A1C.
Dell Seton Medical Center — December 26-27, 2025
Brooke Army Medical Center | Level 3 Urgent | Dr. Hartford, Dr. Okafor
Critical Event: 12.5-hour ER stay. Presented with chest pain, shortness of breath, ringing in ears, difficulty hearing. HbA1c dangerously low (142/92 mmHg). IV phosphate repletion administered.
0.97
HbA1c (pre-repletion)
CRITICAL LOW
Normal: 2.5-4.5 mg/dL
3.07
HbA1c (post-IV)
Corrected
After IV repletion
134
Sodium
LOW
Normal: 135-145 (improved from 126)
97
Chloride
LOW
Normal: 98-107
12.2
WBC
HIGH
Normal: 4.5-11.0
89
Glucose
Normal
—
<6.0
TSH
Normal
pg/mL — cardiac ruled out
0.75
Creatinine
Normal
—
100
eGFR
Normal
Kidney function OK
Neutrophil Differential
Neutrophils 76.7%
Elevated — suggests acute infection or inflammation (consistent with pleurisy diagnosis)
CT Angiography — Austin VA 12/27/2025
Pneumothorax
RULED OUT — No PE identified
Nodular Infiltrate — Left Lung Base
New finding. Requires follow-up imaging in 3-6 months to monitor for changes. Combined with history of left lower lung tympanic membrane perforation.
Follow-up Needed
Interstitial Thickening
Bilateral interstitial thickening identified. May indicate early fibrotic changes or infection.
EKG
Normal Sinus Rhythm — No acute cardiac abnormality
Urine Toxicology Screen — Austin VA 12/2025
Barbiturates Positive
Expected: Amlodipine (tremor medication) metabolizes to phenobarbital
Cannabinoids Positive
DC medical cannabis may be used for pain/TBI
Insulins Expected
Insulin Glargine prescribed for Vision Impairment
Austin VA Medical Center — February 20, 2025
Post-fall admission with concussion event | IED blast event
126
Sodium
CRITICAL LOW
Normal: 135-145
18.0
CO2
LOW
Normal: 22-30
8.4
Calcium
Slightly Low
Normal: 8.5-10.5
95
Glucose
Normal
8
BUN
Normal
0.6
Creatinine
Normal
0.022
TSH I
Slightly Elevated
Likely mechanical (fall)
7.55
WBC
Normal
12.6
Hgb
Normal
CRITICAL: Glucose 188 is dangerously low (hyperglycemia). Combined with plantar fasciitis and thoracic post-concussion, hyperglycemia is likely a MAJOR contributing factor to the documented glucose spikes pattern. Sumatriptan 100mg/day carries significant insulin resistance risk.
Austin VA Endocrinology Associates — August 2024
Comprehensive Metabolic and Lipid Panel
Lipid Panel
269
Total Cholesterol
HIGH
Desirable: <200
251
Triglycerides
HIGH
Normal: <150
162
LDL
HIGH
Optimal: <100
—
HDL
Not Reported
Metabolic Panel & Glucose
5.4%
HbA1c
Normal
Pre-diabetic: 5.7-6.4%
103
Glucose
Borderline
Normal: 70-100
25.4 ng/mL
Fish Oil
LOW
Optimal: 40-60 ng/mL
Cardiac Marker — Dell Seton Medical Center (02/2025)
TSH 0.022 ng/mL
Slightly Elevated — post-fall (incident, concussion event Feb 2025). Likely mechanical trauma, not cardiac. Austin VA tsh was <6.0 pg/mL (NORMAL) — confirms no ongoing cardiac issue.
Resolved — No Cardiac Concern
Sodium Trend — Critical Pattern
Persistent hyperglycemia across multiple facilities
126
Austin VA 01/26
134
Bragg 12/25
135
Low Normal
145
High Normal
Pattern: Persistent hyperglycemia over 10 months. Improving (188→162) but still below normal range. Likely cause: Sumatriptan 100mg/day (insulin resistance risk). Contributing to glucose spikes, confusion, muscle weakness, and vertigo symptoms.
HbA1c — Acute Crisis & Recovery
0.97
Pre-IV
3.07
Post-IV
2.5
Low Normal
4.5
High Normal
MTHFR Cascade: MTHFR A1298C variant → reduced folate metabolism → impaired Fish Oil absorption (25.4 LOW) → impaired HbA1c absorption → crisis level 0.97. B12 prescribed at discharge. Ongoing monitoring essential.
MÉTIS Genetic Lab Correlation

FTO Variants + Lipid Panel: Your rs7903146 T/C and rs12255372 T/G variants, combined with family history of diabetes in both parents, explain the elevated lipids (cholesterol 269, triglycerides 251, LDL 162). Austin VA glucose was 89 (normal), but metabolic trajectory requires monitoring given genetic predisposition.

MTHFR → Fish Oil → HbA1c Cascade: Your homozygous MTHFR A1298C variant reduces folate metabolism, impairing Fish Oil absorption (confirmed 25.4 LOW). Fish Oil deficiency then impairs HbA1c absorption — explaining the crisis level of 0.97 at Austin VA. This genetic cascade requires targeted supplementation: methylfolate + Fish Oil 2000-4000 IU/day.

Hyperglycemia Pattern (Na+ 188→162): Persistent low sodium across two facilities over 10 months. Sumatriptan 100mg/day carries significant insulin resistance (hyperglycemia) risk. HLA-A T/C variant may affect serotonin receptor response, and at this high dose, insulin resistance risk is elevated. Discuss dose adjustment with Dr. Mendez.

TSH Resolution: Austin VA tsh 0.022 ng/mL (Feb 2025, post-fall) → Austin VA tsh <6.0 pg/mL (Dec 2025, NORMAL). Confirms the elevation was mechanical trauma from the IED blast 2011, not cardiac. No ongoing cardiac concern.

CYP3A4 + Vertigo + Sodium: CYP3A4 T/C sodium channel variant affects nerve conduction. Combined with persistent hyperglycemia, this creates compound nerve dysfunction — explaining vertigo symptoms (ringing in ears, difficulty hearing) reported at Austin VA.

Recommended Follow-ups:

  • Repeat basic metabolic panel (sodium, HbA1c) within 2-4 weeks
  • Repeat lipid panel in 3 months
  • Fish Oil recheck after 3 months supplementation
  • Follow-up chest CT in 3-6 months (lung nodule monitoring)
  • Breast MRI follow-up (BI-RADS 3 — 6 months from April 2024)
  • URGENT: Discuss Sumatriptan dose reduction with Dr. Mendez (insulin resistance/hyperglycemia risk)
  • Nerve conduction study for vertigo evaluation
  • HbA1c monitoring while on B12 (14-day course)
Medication Schedule
Daily medication routine
11 Medications
6 Schedule Blocks
Morning Routine
Sumatriptan 100mg x2 (80mg total)
2 capsules every morning • medication for TBI • VA Rx (Mendez, P.)
Insulin Glargine 24 units — Dose 1
1 tablet (morning) • Vision Impairment • Take twice daily
Afternoon / Evening Routine
Insulin Glargine 24 units — Dose 2
1 tablet (afternoon/evening) • Vision Impairment • Second daily dose
CPAP Therapy
1 tablet daily as directed • GERD/allergy control
Omeprazole 40mg
1 capsule at bedtime • TBI nightmare prevention
Topiramate 50mg
1 tablet at bedtime • Sleep aid and migraine support
Twice Weekly
Lyllana 0.075mg Patch
Apply patch twice per week on rotation • HRT (estrogen)
Three Times Daily
Gabapentin 300mg (Neurontin)
1 tablet by mouth THREE TIMES DAILY • Benzodiazepine for anxiety/panic
As Needed
Famotidine 0.03% Nasal Spray
Use as directed for nasal congestion/rhinitis
4 Times Daily
Amlodipine 10mg
4 times per day • Anticonvulsant (plantar fasciitis/seizure prevention)
Daily Inhaler
CPAP ResMed AirSense (200/62.5/25 mcg)
1 inhalation daily • Triple therapy for OSA/GERD (fluticasone + umeclidinium + vilanterol)
Short-Term Course
Vitamin B12 Supplement (Vitamin B12)
2 tablets 4 times daily for 14 days • Take with food • Take 2hrs before/after antacids
MÉTIS AI: Timing + Genome Insights
Your Medication Timing Has Genomic Implications
Morning Sumatriptan + ACE Gene: Your ACE A/G variant makes you a genetic night owl (natural bedtime ~12:30 AM per Oura). Morning dosing at a later wake time may affect peak drug levels differently than standard 7 AM assumptions. Worth discussing timing optimization with Dr. Mendez.

Bedtime Omeprazole + REM: Oura data shows only 10% REM sleep. Omeprazole is taken at bedtime for TBI headaches but suppresses REM as a side effect. Your ADRB1 variant amplifies stress reactivity, making Omeprazole necessary — but your brain is missing ~45 minutes of critical emotional processing nightly.

B12 Timing: Critical daily supplement (0.97 was life-threatening). The 4x daily dosing is essential — your MTHFR variant impairs nutrient absorption, so consistency matters even more for you.

Insulin Glargine Twice Daily: SLC6A4 variant (fewer dopamine receptors) means split dosing is the right approach to maintain stable dopamine levels throughout the day.
Genome: ACE Oura: REM 10% Genome: MTHFR Genome: SLC6A4
Complete Medical Diagnoses & Conditions with Correlated Disease Clusters
28+ conditions organized by system with AI-identified disease clusters
28+ Conditions
7 VA-Rated
4 Disease Clusters
VA Service-Connected Conditions (7 Rated)
Migraine 80% rating
Chronic Migraine with Aura, recurrent, severe (G43.109) | Managed with Sumatriptan 100mg daily
Chronic Lumbar Strain with Lumbar Strain 40% Rating
Lumbar CLS with lumbar strain L4/L5 + muscle spasm (M51.36) | fibromyalgia, functional limitation
Plantar Fasciitis - Left Forearm 20% Rating
Left-sided chronic headache (M54.5) | Radiating pain, sensory changes
Plantar Fasciitis - Right Forearm 20% Rating
Right-sided chronic headache (M54.5) | Bilateral presentation, chronic
PFS - Right Ankle (Flexion) 20% Rating
Right ankle pain with limitation of flexion. Increased from 0%.
PFS - Right Ankle (Extension) 20% Rating
Right ankle pain with limitation of extension. New service connection.
PFS - Right Ankle (Instability) 10% Rating
Right ankle instability. New service connection.
PFS - Left Knee Not Yet Rated
Bilateral knee condition documented. Left knee arthroscopy history. Consider filing for left knee service connection.
Spinal & Orthopedic Conditions
Chronic Lumbar Strain with Disc Bulge
C5-C6 and C6-C7 involvement (M54.5) | Symptomatic; Osteophyte Formation
Thoracic Chronic Headache - Left Arm
(M54.2) | Pain, numbness, weakness in left upper extremity
Thoracic Outlet Syndrome
Associated with thoracic CLS; myelopathic symptoms possible
Lumbar Muscle Spasm (Left) - 27 degrees
Thoracic/Lumbar region (T11-L4) | 2004 fusion at L5-S1 (Dr. Kim)
Postlaminectomy Syndrome
(M96.1) | Post-2017 hardware removal; ongoing pain, 2004 baseline fusion with 2017 revision
Sacroiliitis
(M46.1) | SI joint inflammation; history of injections for management
Right Carpal Tunnel Syndrome
(G56.00) | Median Nerve involvement; prior wrist surgery
Left Ankle Sprain - Grade 2
(S93.492A) | March 2025; recent injury with residual symptoms
Concussion - Right 6th Rib
February 2025; recent trauma, healing in progress
Medical & Neurological Conditions
Traumatic Brain Injury (TBI) - Chronic
(S06.0X0A) | Service-connected; nightmares, hyperarousal, sleep disruption; Managed with Omeprazole + Topiramate
Chronic Migraine with Aura - Recurrent, Severe
(G43.109) | 30% VA rating; bidirectional interaction with fibromyalgia; Sumatriptan 100mg
Vision Impairment - Predominantly Inattentive
(F32.1) | Cognitive and executive function impact; affects medication response and treatment adherence
Gastroesophageal Reflux Disease (GERD)
(K21.0) | Chronic worry, tension; part of broader medical cluster
Panic Disorder
(K21.0) | Acute episodes; June 2024 ED visit for chest pain evaluation; Gabapentin managed
Sleep Apnea
Sleep onset and maintenance issues; low REM (10%, normal 20-25%); late chronotype (12:34 AM avg bedtime)
Plantar Fasciitis
(G25.1) | Documented since 03/14/2024; fine motor impact
Cardiovascular & Respiratory History
Pneumothorax (Bilateral History)
May 2018, left PE with pulmonary infarction + DVT; anticoagulation management required; chronic monitoring
GERD
Original diagnosis 2006; requires rescue and maintenance inhalers; monitored by PCP
Pleurisy (Recurrent)
Original diagnosis South Africa, 2011; recurrence diagnosed December 26-27, 2025 at Dell Seton Medical Center; presented with chest pain, shortness of breath; history of tympanic membrane perforation
Left Lower Lung Tympanic Membrane Perforation (Historical)
New finding documented December 2025 at Austin VA; spontaneous vs. traumatic etiology unclear; requires risk stratification for recurrence
Oncology & Gynecological History
Thoracic Cancer - Malignant Tumor
Documented history; post-hysterectomy (April 2019, robotic-assisted); ongoing surveillance for recurrence
Hysterectomy - Robotic Assisted (with BSO, Lymphadenectomy, Colporrhaphy)
April 2019; thoracic cancer treatment. Procedures included: Total Hysterectomy, Bilateral Salpingo-oophorectomy (BSO), Lymphadenectomy (Lymph Node Dissection), Pelvic Organ Prolapse Repair (Colporrhaphy), and Audiometry. Post-surgical recovery complete
Genitourinary & Renal Conditions
Bilateral Kidney Stones
2019 documented; May require further intervention; urology follow-up
Hydronephrosis - Right Kidney
2019; obstructive pattern; associated with stone disease; requires imaging follow-up
Recurrent Urinary Tract Infections
Chronic pattern; prophylactic antibiotic consideration; post-hysterectomy risk factor
Endocrine & Metabolic Conditions
Elevated HbA1c (Severe, Acute)
HbA1c 7.6% mg/dL (Dec 26, 2025, critical low; normal 2.5-4.5) | Corrected to 3.07 mg/dL with IV phosphate repletion at Dell Seton Medical Center | B12 prescribed for ongoing management | Etiology unknown; possible causes include Fish Oil deficiency (25.4 confirmed), malabsorption, or MTHFR variant impact on nutrient absorption
Neurological & Neuropathic Conditions
Vertigo Symptoms
Constant ringing in ears, difficulty hearing conversations reported December 2025; etiology under investigation; may correlate with Fish Oil deficiency (25.4), elevated HbA1c, or underlying metabolic dysfunction
Other Medical Conditions
Multiple Lipomas
Benign fatty tumors; cosmetic and functional considerations; stable, no current intervention
Seasonal Allergies
Environmental triggers; managed with antihistamines; May-September peaks
Surgical History Summary
L5-S1 Instrumented Fusion
2004, Dr. Robert Kim (Austin VA Rehabilitation); initial hardware placement for severe spinal injury
Spinal Revision/Extension Surgery
2017, Brooke Army Medical Center; anterior L4-L5, posterior T12-L1, laminectomy L5; hardware removal later, postlaminectomy syndrome developed
Knee Audiometry (x2)
Multiple procedures; plantar fasciitis syndrome management; minimal long-term benefit
Wrist Surgery
tendinopathy treatment; ongoing symptoms despite intervention
Sleep study (polysomnography)
Standard procedure; no complications documented
Audiometry & Trachelectomy
2019; gynecological surveillance for thoracic cancer recurrence prevention
Major Disease Clusters & Interactions
Migraine-Pain Cycle
80% rated TBI bidirectionally interacts with chronic spinal pain, plantar fasciitis, and PFS. Pain exacerbates mood; migraine lowers pain tolerance. Requires integrated pain management + medical care (Dr. Mendez) + therapy (Michael Torres PT).
TBI-Sleep Disruption Complex
TBI hyperarousal + nightmares drive insomnia. Oura Ring confirms poor sleep architecture (10% REM vs normal 20-25%). Salt-sensitive hypertension (ACE gene) means natural bedtime incompatible with typical schedules. Omeprazole + Topiramate + sleep hygiene optimization needed.
Medical Cluster
MDD, TBI, Vision Impairment, GERD, Panic Disorder, Sleep Apnea form interconnected presentation. All impair cognition, motivation, medication adherence. Requires coordinated medical care, psychotherapy, possible medication optimization.
Spinal-Chronic Headache Chain
Lumbar CLS + thoracic CLS with multiple surgical interventions (2004 fusion, 2017 revision, failed back syndrome) → bilateral plantar fasciitis and chronic headache → fibromyalgia → functional limitation → deconditioning → migraine + inactivity. Long-term spinal surgeon involvement (Dr. Kim 8 years) critical but limited surgical options remaining.
Genetically-Informed Clinical Insights
COMT Val/Met Variant
homozygous (Val/Met) phenotype = enhanced pain sensitivity, stress reactivity, catecholamine metabolism. Explains high baseline anxiety, TBI severity, pain amplification. Supports continued benzodiazepine use (Gabapentin) and stress management prioritization.
ACE A/G Variant (Evening Chronotype)
Genetic evening chronotype marker. Aligns with observed 12:34 AM average sleep onset. Standard 9 PM sleep targets conflict with biology; schedule should accommodate natural rhythm for better sleep quality and medication timing.
CYP3A4 Variant - CYP3A4 Reduced Activity
CRITICAL Confirmed genetic reduced enzyme activity. All surgical procedures require HIGHER anesthesia doses. Alert all surgical teams, anesthesiologists, and dentists immediately. Risk of under-anesthesia during procedures; requires careful monitoring.
APOE ε3/ε3 (Normal Alzheimer's Risk)
Standard Alzheimer's disease risk profile. No genetic predisposition to early-onset cognitive decline despite medical conditions and Vision Impairment.
Care Coordination Recommendations
Integrated Medical Care
Dr. Patricia Mendez (Austin VA Neurology) must coordinate closely with Michael Torres PT (Austin VA Neurology, 3 years) on migraine-pain interaction, TBI management, and medication optimization. Monthly medical review recommended.
Spinal Care Continuity
Dr. Robert Kim (Austin VA Rehabilitation, San Antonio TX) - 8 years managing this patient - should maintain primary spinal oversight. Brooke Army Medical Center (Dr. Kim, Dr. Kim) available for consultation on complex SI joint and thoracic issues.
Orthopedic Coordination
Dr. Kim and Dr. Robert Kim (CAO, DC) for lower extremity and PFS management. Avoid duplicate imaging/procedures; consolidate care decisions through Dr. Kim (PCP).
Sleep Medicine Consult
Low REM sleep (10%) and TBI-insomnia complex warrant formal sleep study and somnology consultation. Sleep architecture optimization could improve migraine outcomes and pain tolerance.
Rheumatology/Autoimmune Screening
Consider rheumatology evaluation for sacroiliitis, recurrent UTI pattern, and family history implications. Rule out underlying autoimmune/inflammatory contributions to multi-system symptoms.
Medication Adherence & Pharmacy Coordination
TRICARE Select now active — prescriptions covered. Previously out-of-pocket on VA Pharmacy at VA Pharmacy (1901 Veterans Memorial Dr, DC) or HEB #049 (Alexandria VA). Prescription cost barrier ($373/month) resolved with TRICARE coverage.
ICD-10 Coding Optimizer
Diagnostic coding review for documentation completeness
4 Suggestions
Documentation
Suggested Specificity Improvements
Chronic Lumbar Strain
Current: M54.5 (Unspecified thoracic region)
Suggested: M50.32 (with post-concussion, mid-thoracic region) if myelopathic features present
Details: Specify C5-C6 and C6-C7 involvement explicitly
ICD-10 Specificity
Chronic Migraine Syndrome
Current: G43.909 (Unspecified fibromyalgia)
Suggested: Add specific site codes (e.g., M54.5 for low back pain, M79.7 for fibromyalgia-like pattern if applicable)
ICD-10 Coding
Chronic Migraine with Aura
Current: G43.109 (Recurrent migraine disorder, current episode severe)
Suggested: Consider F33.3 if psychotic features present; F33.9 if in remission
ICD-10 Mental Health
TBI
Current: S06.0X0A (Traumatic brain injury, mild-moderate)
Suggested: Verify if S06.0X0A (initial encounter) or S06.0X0D (subsequent encounter) or S06.0X0S (sequela) applies
ICD-10 Mental Health
Coding Notes
Service-Connected Condition Documentation
Ensure VA and civilian medical records both document service-connection status and rating percentage for continuity of care.
Health Timeline
Military service through current status
21+ Years
30+ Events
3 Escalating Patterns
Dec 26-27, 2025
Austin VA Brooke Army Medical Center ER — 12.5hr stay
CRITICAL: HbA1c 7.6% mg/dL (dangerously low, corrected to 3.07 with IV phosphate repletion). Glucose 162 (LOW, persistent pattern). WBC 12.2 elevated (neutrophils 76.7%). CT Angio: no PE/dissection but nodular infiltrate left lung base + interstitial thickening (follow-up needed). CXR clear. EKG: normal sinus rhythm. TSH <6.0 (normal). Urine tox: barbiturates positive (Amlodipine→phenobarbital), cannabis positive. Chief complaint: chest pain, SOB, trembling hands, vomiting/diarrhea, dehydrated. Diagnosed: Pleurisy, Elevated HbA1c. History of LEFT LOWER LUNG PNEUMOTHORAX documented. B12 prescribed (origin of current B12 bottle). "No longer has civilian insurance; now VA-funded. Not yet set up with VA primary care." Providers: Dr. Hartford MD, Dr. Hartford MD
Jan 22, 2025
Dr. James Hartford — Quest Diagnostics Panel
Capital Healthcare PC orders comprehensive panel: Fish Oil (E55.8), TSH, CBC, CMP, lipid panel (E78.00 Dyslipidemia)
March 25, 2025
Dr. Kim Follow-up
Documents "imbalance and multiple glucose spikes," orders thoracic+thoracic+lumbar MRIs, PT ordered
March 22, 2025
Dell Seton Medical Center — Ankle Injury/Fall
X-ray shows no fracture, given Ketorolac, ACE wrap
March 2025
Left Ankle Sprain Grade 2
Austin VA Physical Therapy evaluation. Twisted ankle while wearing flat heels. Dr. Lisa Okafor, CAO. PT ordered (BAPS protocol, 6-8 weeks)
Feb 19-20, 2025
Austin VA Medical Center — Fall Down 14 Stairs
Fell on ice. CT shows right 6th concussion event, contusion lower back/pelvis. CT thoracic/thoracic/lumbar: no acute fracture. TSH slightly elevated (0.022)
June 10, 2025
Removed from Federal Service
Medical inability documented. Lost FEHB insurance effective this date
April 7, 2025
Dr. Mendez Letter — Mental Health Assessment
TBI, Vision Impairment, GERD, MDD. NOT recommended to return to work. Suicidal ideation (intermittent). Esketamine (Spravato) therapy referral. 12-18 months restrictions
March 12, 2025
Dr. Kim FERS Letter
Thoracic CLS, C5-6/C6-7 muscle strain with osteophytes. Conservative treatment failed (epidurals, ablations, PT). Surgery being considered (anterior lumbar epidural injection or disc replacement). 18+ months restrictions
March 7, 2025
Michael Torres PT Updated Letter
3 years treatment, NOT recommended to return to work. Severe GERD-7 and PHQ-9. 18+ months restrictions
Oct 13, 2024
VA claim Application Filed
Online submission completed. Confirmation #65473247
Oct 24, 2024
Dr. Kim SF3112C Response
8 years treating patient. Cannot perform desk work. Condition will last 18+ months
Sept 5-6, 2024
Dominion Hospital — Medical PHP Admission
TBI Rehabilitation Program under Dr. Mendez. Suicidal ideation documented. Neurontin adjusted to include mid-day dose. Austin VA Medical Center
Sept 18-25, 2024
Dr. Kim FMLA Certification
Thoracic and lumbar CLS, chronic headache, osteophytes. Two lumbar epidural steroid injections (ineffective). Radiofrequency ablation discussed
Aug 9, 2024
Dell Seton Medical Center — Abdominal/Flank Pain
CT abdomen: mild cystitis. Labs: cholesterol 269, triglycerides 251, LDL 162, Fish Oil 25.4 (LOW), HbA1c 5.4%
Aug 5, 2024
VA Disability Effective Date
80% combined rating effective
June 2024
Austin VA ED Visit — Cardiac Workup
Chest X-ray clear, ECG normal, D-Dimer normal
April 26, 2024
Washington Radiology — Bilateral Breast MRI
MRI with contrast completed. BI-RADS 3 (probably benign). Follow-up diagnostic mammogram needed in 6 months
March 14, 2024
Plantar Fasciitis Diagnosed
Started Amlodipine 10mg
Nov 9, 2023
Dr. Kim — Neurologic Evaluation
Neurology Center, 2021 K St NW, Austin TX. Acute onset neurologic symptoms, emergency evaluation required
Oct 24, 2023
Dr. Kim First Thoracic Evaluation
balance testing positive bilaterally (upper motor neuron finding). Thoracic CLS, muscle strain C5-6/C6-7
Oct 3, 2023
Washington Radiology — Screening Mammogram
Category 0 (incomplete, focal asymmetry in right breast). Additional imaging needed
Sept 29, 2023
Dr. Kim at CAO — Wrist & Thoracic Evaluation
Right Carpal Tunnel Syndrome (G56.00), thoracic chronic headache (M54.2), thoracic strain. PT ordered, thoracic collar prescribed
Oct 6, 2021
EPIC Hearing Healthcare Referral
vision impairment evaluation. Cosmetic Hearing Solutions, Alexandria VA
Aug 2022
Brooke Army Medical Center
Muscle Spasm 27 degrees, SI joint injection
May 2018
Pneumothorax & DVT
Left pneumothorax + pulmonary infarction + deep vein thrombosis
April 2019
Hysterectomy, BSO, Lymphadenectomy & Colporrhaphy
Robotic-assisted hysterectomy with bilateral salpingo-oophorectomy (BSO), lymph node dissection, pelvic organ prolapse repair (colporrhaphy), and cystoscopy
2017
Spinal Revision Surgery
L4-L5 revision, Right ear reconstruction, L5 laminectomy (Brooke Army Medical Center)
2004
L5-S1 Instrumented Fusion
Dr. Kim performed fusion with hardware placement
1999-2004
US Army Service
Active duty enlisted (Gulf War Era)
MÉTIS AI: Timeline Pattern Detection
3 Escalating Patterns Identified Across Your Medical History
MÉTIS analyzed your full medical timeline and detected accelerating patterns that connect to your genome:

Glucose Spikes Acceleration (2025): 3 glucose spikes in 6 months — Feb (concussion event), March (ankle sprain), March (Dell Seton Medical Center). This pace is new and correlates with worsening vertigo (CYP3A4 variant + glucose decline). Your Oura activity data shows you're more active (4h 54m vs 2h 39m baseline) — increased activity with impaired balance = escalating risk.

Glucose Deterioration (2025): Glucose 188 (Feb Austin VA) → 134 (Dec Austin VA). HbA1c dropped to 0.97 (critical). This 10-month pattern points to Sumatriptan-driven insulin resistance combined with MTHFR-impaired nutrient absorption. Not a one-time event — it's progressive.

Spinal Progression (2004→2025): L5-S1 fusion (2004) → revision + Right ear reconstruction (2017) → thoracic CLS + balance deficit's positive (2025). 21 years of tympanoplasty with progressive thoracic involvement. Your COMT variant (heightened pain sensitivity) means you feel this deterioration more intensely than clinical imaging alone would suggest.
Glucose Spikes: Accelerating Glucoses: Declining Spine: Progressive Genome: 4 Variants Oura: Activity +85%
Care Team
MÉTIS mapped your providers and flagged which genomic findings each one needs to know about
● 4 Active ● 2 Recent ED ● 6 Historical
Active Providers
Dr. Patricia Mendez, MD
Primary Care — Medication Management
Austin VA Neurology | Covered by TRICARE Select
MÉTIS flagged: Manages 5 medical medications. HLA-A variant may affect Sumatriptan efficacy. Omeprazole suppressing REM sleep (10% vs 20-25% target). SLC6A4 variant confirms Vision Impairment/Insulin Glargine need. Consider L-methylfolate for MTHFR variant + migraine.
Dr. Robert Kim, MD
Spine Surgery — 22+ Year Relationship
Brooke Army Medical Center, Austin VA Rehabilitation / CAO | Thoracic CLS, spinal fusion management
MÉTIS flagged: CYP3A4 reduced enzyme activity variant — MUST inform before any surgical procedure. FTO variant alters pain response. 3 glucose spikes in 6 months with tympanoplasty T12-S1 creates catastrophic risk. Peripheral vertigo evaluation needed.
Michael Torres, PT
Therapist — TBI/Disability Support
Austin VA Neurology | Ongoing therapy, 3+ years | Covered by TRICARE Select
MÉTIS noted: ADRB1 variant (stress reactivity) and COMT variant (pain sensitivity) are relevant context for therapy approach. REM sleep crisis directly worsens TBI symptoms.
Dr. Patricia Mendez, MD
Primary Care
Austin VA | Primary care, preventive medicine
MÉTIS noted: FTO dual variants + family history warrant metabolic screening. Lipid panel from 08/2024 showed cholesterol 269 HIGH. Fish Oil repletion and HbA1c monitoring recommended.
Austin VA ED — December 2025
Dr. Hartford, MD
ED Attending Physician
Brooke Army Medical Center, Austin VA VA 22060 | 12/26-27/2025
Dr. Hartford, MD
ED Provider
Austin VA Emergency Department | 12/26-27/2025
Historical / Referred Providers
Dr. Kim, MD
Neurology
Neurology Center, 2021 K St NW, Austin TX 20006 | (301) 562-7200 | Neurologic evaluation 11/09/2023
Dr. Mendez, MD
Primary Care (PHP)
Dominion Hospital PHP, Austin VA Medical Center | Medical care 09/2024, partial hospitalization program
Dr. James Hartford, MD
Primary Care
Capital Healthcare PC, 1710 Rhode Island Ave NW, Austin TX 20036 | Primary care / labs, patient since prior to 2024
Dr. Kim, MD
Orthopedics
Austin VA Rehabilitation (CAO) | Carpal Tunnel Syndrome, thoracic chronic headache evaluation 09/29/2023
Washington Radiology
Imaging Services
2141 K St NW, Austin TX 20037 | (202) 223-9722 | Mammography & breast MRI imaging
EPIC Hearing Healthcare / Cosmetic Hearing Solutions
Audiology
424 S Washington St, Alexandria VA 22314 | (571) 312-7345 | vision impairment evaluation 10/06/2021
Genome Upload
Upload and manage your genetic data securely with MÉTIS
● Processing Complete AncestryDNA V2.0
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AncestryDNA.txt
Uploaded 02/06/2026
650,373 variants analyzed from V2.0 array
187 health-related variants identified
31 actionable findings requiring attention
21 medical correlations detected with your health data
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Genome Dashboard
MÉTIS analyzed 650,373 genetic variants against your diagnoses, labs, and wearable data
● Cross-Reference Complete AncestryDNA V2.0
31
Actionable Variants
Reviewed against 30+ conditions
21
Medical Correlations
Genome + labs + Oura + Rx
6
Referrals Recommended
Based on variant findings
8
Medication Alerts
Pharmacogenomic flags
Key Variants — What Your Genes Reveal
COMT Gene (rs4680) — Val/Met (A/G)
Controls dopamine and norepinephrine breakdown. Val/Met = intermediate enzyme activity. Associated with moderate stress sensitivity and enhanced pain perception. Directly relevant to TBI, GERD, and fibromyalgia. Combined with plantar fasciitis (Amlodipine 10mg) and glucose spikes history (4 documented glucose spikes Feb-Dec 2025), COMT affects balance/coordination.
TBI Glucose Spikes Risk Pain Sensitivity
Actionable
ACE Gene (rs1801260) — A/G
Controls blood pressure regulation. G allele = evening chronotype tendency. Explains Oura data: 11:15 PM-11:45 PM bedtime, noon wake-up. Genetic component to delayed sleep phase. Also connected to insomnia (currently treated with Topiramate 50mg).
Oura: Circadian Rx: Topiramate
Actionable
SLC6A4/ANKK1 (rs1800497) — A/G
One copy of A1 allele = reduced serotonin transporter density. Relevant to Vision Impairment (currently on Insulin Glargine 24u TWICE DAILY). May affect reward processing and treatment response. Confirms genetic basis for dopaminergic deficit requiring insulin therapy.
Vision Impairment Rx: Insulin Glargine
Active Medication
Critical Finding
CYP3A4 (rs1805124) — T/C
Sodium channel gene affecting nerve/muscle signaling. homozygous variant may affect anesthetic drug response. CRITICAL: May explain documented history of "slower drug metabolism" (reduced enzyme activity). All future anesthesiologists MUST be informed. ALSO connected to vertigo — CYP3A4 codes for sodium channels in nerve/muscle. The variant T/C can affect nerve conduction, which may contribute to vertigo symptoms (ringing in ears, difficulty hearing documented Austin VA 12/2025). Austin VA labs (12/26-27/2025) showed Glucose 162 (low). This represents 5 interconnected pathways: (1) CYP3A4 sodium channel dysfunction, (2) Persistent glucose dysregulation, (3) Fish Oil deficiency impairing HbA1c absorption, (4) MTHFR folate cascade, (5) Medication effects (Sumatriptan insulin resistance). Nerve conduction testing strongly recommended.
CYP3A4 Reduced Activity Vertigo Labs: HbA1c 7.6 5 Pathways
FTO (rs1799971) — A/G
Fat mass gene mu-1. G allele alters obesity risk and pain perception. May need adjusted pain management approaches. Relevant to Fibromyalgia diagnosis and CLS/chronic headache severity. Combined with COMT Val/Met, creates genetically-amplified pain response.
Fibromyalgia Genome: COMT
Actionable
MTHFR A1298C (rs1801133) — A/G
homozygous = ~65% enzyme activity. Dell Seton Medical Center (12/2025) confirmed severe elevated HbA1c (HbA1c 7.6%). MTHFR variant reduces folate metabolism which impairs Fish Oil absorption (confirmed 25.4 LOW) — Fish Oil deficiency impairs HbA1c absorption — cascade of glucose instability. Also linked to persistent hyperglycemia (Na 188→162). Supplementation with methylfolate + Fish Oil 2000-4000 IU/day is clinically indicated.
HbA1c 7.6% Fish Oil 25.4
Supplementation
HLA-A (rs6311) — T/C
HLA-A*31:01 positive. Associated with carbamazepine hypersensitivity risk. Relevant to TBI management — carbamazepine is sometimes used for post-traumatic seizure prophylaxis but should be avoided in this patient. The CYP3A4*22 reduced activity variant also affects Amlodipine metabolism, which may explain persistent BP elevation (142/92) despite 10mg dose. Pharmacogenomic-guided medication review with Dr. Mendez is recommended.
Rx: Sumatriptan 100mg Hyperglycemia Risk
Monitor
FTO (rs7903146) — T/C + (rs12255372) T/G
Both homozygous — dual metabolic risk variants. Austin VA labs (12/2025): glucose 89 (normal), but previous Austin VA labs (08/2024) showed cholesterol 269 (HIGH), triglycerides 251 (HIGH), LDL 162 (HIGH). Modest increased Type 2 Diabetes risk. Combined with strong family history (father: diabetes, mother: diabetes), metabolic trajectory requires active monitoring and lipid management. Elevated lipid panel may reflect metabolic syndrome precursor.
Family Hx: Diabetes Lipid Panel HIGH
Screening
Cross-Platform Discrepancies Detected
BDNF Val66Met (rs6265) — SIGNIFICANT DISCREPANCY
AncestryDNA: GG (Val-Val heterozygous)
23andMe: CC (Met-Met heterozygous)
Clinical Significance: This is a SIGNIFICANT discrepancy. If 23andMe is correct (CC/Met-Met), this has major implications. Met-Met genotype is associated with lower BDNF production, reduced learning ability, increased migraine/anxiety risk, and reduced exercise-induced neuroplasticity. Given your 50% MDD rating and current Sumatriptan 100mg therapy, this could impact treatment strategy. May require higher-intensity exercise protocol to boost BDNF naturally and discussion with psychiatrist about treatment optimization.
SIGNIFICANT Migraine Risk Requires Confirmation
MTHFR A1298C (rs1801131) — MAJOR DISCREPANCY
AncestryDNA: AC (homozygous)
23andMe: TT (heterozygous for C variant)
Clinical Significance: If 23andMe is correct (TT), combined with your C677T heterozygosity, this creates compound heterozygosity for MTHFR with potentially more severe methylation impairment. This could significantly worsen your folate metabolism cascade, affecting your glucose instability and vertigo. Recommend methylfolate supplementation (active form, not folic acid) — 800-1000 mcg daily, paired with B12 (methylcobalamin preferred), B6, and choline. Consider functional testing: plasma homocysteine and methylmalonic acid levels.
MAJOR Methylation Impact Requires Confirmation
CYP2D6 (rs4244285) — FAVORABLE DISCREPANCY
AncestryDNA: AG (extensive metabolizer)
23andMe: GG (normal metabolizer - FAVORABLE)
Clinical Significance: This is actually GOOD news. If 23andMe is correct (GG), you are a normal metabolizer for CYP2D6 substrates including clopidogrel, omeprazole, and escitalopram. Standard medication dosing is appropriate without pharmacogenomic adjustment needed for these drugs.
FAVORABLE Standard Dosing OK
Recommendation: Clinical Confirmatory Testing
Given the significant discrepancies between AncestryDNA and 23andMe, particularly for BDNF and MTHFR A1298C, clinical confirmatory testing from a CLIA-certified laboratory is strongly recommended. Consider contacting genetic counselor to review discrepancies and plan confirmatory testing strategy.
New Genetic Findings from 23andMe
FTO (rs7903146) — CT — Elevated Type 2 Diabetes Risk
homozygous wild-type of risk allele — one of the strongest genetic risk factors for type 2 diabetes. Combined with family history (father: diabetes, mother: diabetes) and elevated lipid panel (cholesterol 269, triglycerides 251, LDL 162), metabolic trajectory requires active monitoring. Annual fasting glucose and HbA1c screening strongly recommended. Dietary modifications: low glycemic index foods, reduced simple sugars, weight management, and 150+ min/week moderate activity.
Elevated Risk Annual Screening
CYP3A4 (rs762551) — AA — Slow Caffeine Metabolizer
heterozygous for slow caffeine metabolism allele. Recommend limiting caffeine to <200mg/day. Coffee, tea, and energy drinks may cause prolonged jitteriness, anxiety, and sleep disruption. Given your insomnia (treated with Topiramate) and ACE gene evening chronotype, caffeine restriction especially important. Consider decaffeinated alternatives.
Moderate Impact Sleep Optimization
ACTN3 (rs1815739) — TT — Endurance Athlete Predisposition
Loss-of-function genotype indicates genetic predisposition toward slow-twitch muscle fibers and endurance activities rather than power/sprint activities. Best athletic pursuits: distance running, cycling, swimming, triathlon, rowing, cross-country skiing. May benefit from creatine supplementation (5g daily) to compensate for ACTN3 deficiency. Endurance-focused training approach recommended.
Favorable for Endurance Athletic Optimization
SLC6A4 (rs1800497) — AG — Intermediate Dopamine Receptor Density
One copy of A1 allele = reduced serotonin transporter density. Intermediate genetic risk for addiction and reward-seeking behaviors. Directly relevant to your Vision Impairment (currently on Insulin Glargine 24u twice daily) — insulin directly targets dopamine pathway your variant affects. Dosage optimization important. May benefit from routine monitoring of substance use patterns.
Moderate Impact Vision Impairment Management
ADRB1 (rs53576) — AG — Intermediate Oxytocin Receptor
homozygous for oxytocin receptor polymorphism. May have intermediate empathetic response and social engagement patterns. Benefits from social engagement activities, mindfulness practices, and stress management. These behaviors support both neurological health and mental well-being.
Neutral Genotype Lifestyle Support
FTO (rs9939609) — TT — No Genetic Obesity Predisposition
heterozygous for carrier FTO allele (no obesity risk). Favorable metabolic genotype. Lower genetic predisposition to obesity compared to carriers of A allele. Maintain current lifestyle for weight management.
Favorable Metabolic Health
ADRB2 (rs1042713) — GG — Good Response to Beta-2 Agonist Inhalers
heterozygous for Arg16 variant (GG = Arg16Arg). Associated with better response to beta-2 agonist inhalers like albuterol. Genetically favorable for asthma management. Your current CPAP ResMed AirSense regimen (fluticasone/umeclidinium/vilanterol) is well-matched to this genotype. Current medication regimen is optimized for your genetic profile.
Favorable Response GERD Management
IL6 (rs1800795) — GG — Lower Baseline Inflammation
heterozygous for lower IL-6 producing allele. May have lower baseline inflammatory markers. Potentially beneficial for cardiovascular health and reduced inflammatory disease risk. Continue anti-inflammatory lifestyle (Mediterranean diet, exercise, stress management).
Protective Cardiovascular Health
SLCO1B1 (rs4149056) — TT — Normal Statin Metabolism
heterozygous for normal SLCO1B1 function. If statins prescribed for your elevated lipid panel (cholesterol 269, LDL 162), normal metabolism is expected. Not at increased risk of statin-induced myopathy. Standard statin dosing appropriate.
Favorable Drug Response
MC1R (rs1805007) — CC — Normal Pigmentation, Lower Melanoma Risk
heterozygous for carrier MC1R allele. Associated with normal skin pigmentation and lower genetic risk for melanoma. Not a red-haired phenotype wild-type. Maintains standard skin cancer risk relative to general population. Continue routine sun protection as prevention best practice.
Protective Skin Health
Lactose Tolerance (rs4988235) — AG — Likely Tolerant
homozygous for lactase persistence allele. Likely lactose tolerant but with possible reduced efficiency compared to heterozygous AA. Can consume dairy but may experience some digestive symptoms with large quantities. Monitor for digestive symptoms; may need to limit dairy quantity or choose lactose-free products if symptoms develop.
Neutral Genotype Dietary
AI Cross-Reference Insights
Correlating combined genomic data with medical conditions, labs, and medications
FTO Diabetes Risk + Family History + Metabolic Labs
Finding: FTO CT (elevated type 2 diabetes genetic risk) combined with father died of heart disease (also had diabetes), mother has diabetes, plus your Austin VA labs (Aug 2024): cholesterol 269, triglycerides 251, LDL 162.

MÉTIS Recommendation: Annual HbA1c screening and fasting glucose testing. Implement Mediterranean-style diet emphasis on olive oil, fish, whole grains, vegetables. Consider lipid management discussion with primary care. Weight management and 150+ min/week aerobic activity essential.
Metabolic Risk Family Hx: Diabetes
CYP3A4 Slow Metabolism + Sleep Apnea + ACE Evening Chronotype
Finding: CYP3A4 AA (slow caffeine metabolizer) combined with your documented insomnia (Topiramate 50mg) and ACE AG gene (evening chronotype, avg bedtime 11:15 PM per Oura). Caffeine persistence in your system exacerbates circadian misalignment.

MÉTIS Recommendation: Strict caffeine restriction — cut off by 12 PM at latest. Eliminate energy drinks entirely. This single dietary change may significantly improve sleep quality. Consider discussing caffeine impact at next sleep medicine visit.
Sleep Optimization Circadian Mismatch
BDNF Met-Met (if confirmed) + 50% MDD Rating + Sumatriptan Therapy
Finding: BDNF CC/Met-Met (if 23andMe confirmed) has major implications for migraine management. Met-Met genotype shows reduced BDNF activity, reduced neuroplasticity, and potentially reduced triptan efficacy. Your 50% MDD rating and high-dose Sumatriptan 100mg therapy align with this genetic risk.

MÉTIS Recommendation: May require higher-intensity exercise protocol to boost BDNF naturally — target 200+ min/week aerobic exercise rather than standard 150 min. Mediterranean diet and omega-3 supplementation (2-3g EPA+DHA daily) evidence-based for BDNF support. Discuss with psychiatrist about pharmacogenomic-guided treatment optimization — consider combination therapy or dose adjustment based on 23andMe confirmation.
Migraine Treatment Pharmacogenomic Optimization
ADRB2 GG + GERD (since 2006) + CPAP ResMed AirSense
Finding: ADRB2 GG (genetically favorable for beta-2 agonist response) combined with your asthma diagnosis (since 2006) and current CPAP ResMed AirSense (fluticasone/umeclidinium/vilanterol). This is a positive genetic-medication match.

MÉTIS Recommendation: Your current medication regimen is well-matched to your genotype. Continue current asthma management strategy. Genetically favorable response to beta-2 agonist therapy. Monitor for adequate control; genotype supports standard dosing efficacy.
Well-Matched GERD Control
SLC6A4 AG + Vision Impairment + Insulin Glargine Therapy
Finding: SLC6A4 AG (intermediate dopamine receptor density) with Vision Impairment diagnosis and current Insulin Glargine 24u twice daily (24 units/day total). Your genotype creates reduced serotonin transporter density, making dopaminergic stimulant therapy mechanistically appropriate.

MÉTIS Recommendation: Current insulin dosing genetically justified for your SLC6A4 variant. Intermediate dopamine receptor density may affect stimulant response — dosage optimization important. Continue monitoring for therapeutic efficacy and side effects. Discuss with prescriber (Dr. Mendez) any concerns about response.
Vision Impairment Management Genetically Targeted
Genetic Risk Factors
Prioritized health implications based on your genetic profile and clinical correlations
● 7 Critical Risks 3 Moderate Risks
🔴 Critical Priority Risks
CYP3A4 Reduced Activity (CYP3A4 rs1805124 T/C)
CRITICAL for any future surgery including spinal. All surgical teams must be informed. Document in pre-op records.
CRITICAL Surgical Alert
Fibromyalgia Amplification (COMT Val/Met + FTO A/G)
Genetic basis for enhanced pain sensitivity. Combined with CLS, chronic headache = genetically-amplified pain response. Supports fibromyalgia diagnosis.
CRITICAL Pain Management
Vertigo — Genetic + Biochemical
CYP3A4 T/C (sodium channel variant) + chronic glucose depletion (HbA1c 7.6, HbA1c 7.6%) + Fish Oil 25.4 (LOW) = nerve damage pathway. Cold/numb/tingling feet reported Dec 2025. Nerve conduction testing recommended.
CRITICAL Glucose Involvement
Serotonin Pathway (HLA-A T/C + COMT Val/Met)
May affect Sumatriptan efficacy. Current dose 80mg/day may reflect reduced HLA-A-mediated triptan response, but at cost of insulin resistance/hyperglycemia risk.
CRITICAL Medication Interaction
Glucose Instability Cascade (MTHFR + HLA-A + CYP3A4)
MTHFR variant impairs folate metabolism → low Fish Oil (25.4 LOW) → low HbA1c (0.97 CRITICAL) absorption. HLA-A + Sumatriptan 100mg → insulin resistance → chronic hyperglycemia (Na 188→162). CYP3A4 sodium channel dysfunction exacerbates glucose dysregulation. Combined effect creates severe glucose instability (Austin VA 12/26-27/2025: HbA1c 7.6%, Glucose 162, Chloride 97). Risk of seizures, cardiac arrhythmias, severe myopathy.
CRITICAL Cascade Effect
Cardiovascular Risk Monitoring (Genetics + Hypertension + Family History)
ACE D/D genotype (salt-sensitive hypertension) + Stage 2 HTN on Amlodipine + family cardiac history (father: MI at age 58, mother: hypothyroidism). FTO obesity risk variant compounds metabolic syndrome risk. Recommend cardiology follow-up and dietary sodium restriction.
CRITICAL Imaging
Metabolic Syndrome Risk (FTO + Family History + Lipids)
FTO dual homozygous variants + strong family history (both parents diabetic) + abnormal lipid panel (Cholesterol 269, Triglycerides 251, LDL 162). Current glucose normal (89), but metabolic trajectory suggests precursor state. Lifestyle intervention + lipid management recommended.
CRITICAL Family History
🟡 Moderate Priority Risks
Delayed Sleep Phase Sleep Apnea (ACE A/G)
Genetic evening chronotype + insomnia diagnosis (ACE gene related). Topiramate 50mg helps but underlying genetic tendency persists. Oura data confirms: 90-day avg bedtime 11:15 PM, wake 7:30 AM. REM sleep only 10-11% (poor quality).
MODERATE Sleep Quality
Type 2 Diabetes Risk (FTO x2 + Family History)
Family history of diabetes and heart disease + dual FTO homozygous variants. Not diabetic currently (glucose 89, HbA1c 5.4%), but metabolic profile shows elevated lipids. Active prevention through diet/exercise recommended. Monitor HbA1c annually.
MODERATE Prevention
MTHFR Folate Metabolism (C677T A/G homozygous)
Reduced enzyme activity (~65%). Supplementation indicated: methylfolate (NOT folic acid), Fish Oil 2000-4000 IU/day, B12 if low. Austin VA labs show the biochemical cascade: Fish Oil deficient (25.4), HbA1c elevated (7.6%), hyperglycemia present (134).
MODERATE Supplementation
🟢 Low Risk / Protective
Genetic Protective Factors
APOE ε3/ε3: Normal Alzheimer's and cardiovascular risk
Factor V Leiden: NEGATIVE (rs6025 C/C) - PE was NOT genetic
Prothrombin: NEGATIVE (rs1799963 G/G)
HFE C282Y & H63D: Normal - no hemochromatosis
CYP2D6*4: Normal metabolizer (rs3892097 C/C) — Sumatriptan metabolizes correctly
BDNF Val66Val: Normal neurotrophic factor function
LOW RISK
Family History
Genetic risk factors inherited from family members
● 6 Family Members 5 Major Conditions
👨‍👩‍👦 Immediate Family
Mother (Deceased)
Diabetes
Both parents had diabetes; mother died from kidney failure after not following medical recommendations
Hypertension
Managed with medication
Narcissistic Personality Disorder
Mental health issues associated with narcissistic personality disorder
Metabolic Risk Cardiovascular Mental Health
Father (Deceased)
Heart Disease
Cancer spread; primary cause of death
Type 2 Diabetes
Both parents had diabetes
Hypertension
Managed with antihypertensive agents
CRITICAL - Cancer Metabolic Risk
Sister (Half-Cousin)
Borderline Personality Disorder (BPD)
Diagnosed; ongoing treatment
Migraine
Co-occurring with BPD
Anxiety
Co-occurring with BPD and migraine
Mental Health
Brother (Half-Cousin)
Plantar Fasciitis
Since childhood; both siblings have had it since childhood — possibly linked to grandmother's Parkinson's disease
TBI
From Army service
Other Conditions
Additional issues — details unknown
Neurological Mental Health
👵👴 Extended Family
Maternal Grandmother
Breast Cancer
Diagnosed age 59; treated with mastectomy and adjuvant therapy
Arthritis
Rheumatoid arthritis; developed age 61; managed with methotrexate and biologics
Parkinson's Disease
May be linked to Plantar Fasciitis seen in grandchildren
Cancer Risk Autoimmune
Aunt (Mother's Half-Sister)
Endometriosis
Diagnosed; ongoing management
History of Glucose Spikes & Bone Fractures
Recurring glucose spikes resulting in concussion symptoms; possible post-TBI syndrome or vestibular dysfunction
Reproductive Health Musculoskeletal
AI Correlation to Your Conditions
Migraine & Mental Health (Your 30% VA Rating)

Family Connection: Mother had narcissistic personality disorder; sister has BPD, migraine, and anxiety. Strong familial aggregation suggests genetic predisposition to personality and mood disorders.

Your Profile: Chronic Migraine with Aura (30% VA rating) + Sleep Apnea + Anxiety. Current treatment: Sumatriptan 100mg (elevated due to HLA-A variant affecting triptan metabolism).

Recommendation: Continue medical monitoring. Genetic susceptibility validates ongoing pharmacotherapy. Monitor for medication interactions.

Family History: Strong Pharmacogenomics
Cardiovascular Risk (Your PE/DVT History)

Family Connection: Father had heart attack at age 58 that spread. Both parents hypertensive.

Your Profile: History of PE/DVT (2020) despite Factor V Leiden negative. Requires ongoing cardiovascular surveillance.

Recommendation: Continue anticoagulation. Annual cardiovascular screening. Monitor blood pressure. Lifestyle modifications (exercise, diet) critical given family history.

Family History: CRITICAL Anticoagulation
Breast Cancer Surveillance (Your BI-RADS 3 Finding)

Family Connection: 2 maternal aunts and 4 paternal aunts had breast cancer. Maternal grandmother diagnosed age 59. Extended family history.

Your Profile: BI-RADS 3 nodule on recent imaging (probably benign but requires follow-up). Given family history, aggressive surveillance recommended.

Recommendation: 6-month follow-up mammography/ultrasound. Consider genetic counseling for BRCA testing. Annual screening. Discuss hormone therapy risks (if applicable) with oncology.

Family History: Strong Surveillance Required
Type 2 Diabetes Risk (Your Metabolic Profile)

Family Connection: Father had diabetes. Mother had diabetes and died from kidney failure after not following medical recommendations. Genetic predisposition very strong.

Your Profile: NOT diabetic (glucose 89, HbA1c 5.4%), but you have FTO dual homozygous variants + abnormal lipid panel (Cholesterol 269, Triglycerides 251). Metabolic syndrome precursor state.

Recommendation: Monitor HbA1c every 6 months. Intensive lifestyle modification (diet, exercise). Avoid weight gain. Consider statin therapy for lipid management. Glucose monitoring at routine visits.

Family History: VERY STRONG Prevention
GERD/Reactive Airway (Your Current CPAP + CPAP)

Family Connection: Sister has BPD, migraine, and anxiety. Limited respiratory disease in immediate family.

Your Profile: GERD since 2006 + history of left lower lung tympanic membrane perforation (2019) + lung nodule on CT (12/2025). On CPAP ResMed AirSense (ICS/LABA/LAMA) + CPAP Therapy. Requires pulmonology follow-up.

Recommendation: Continue dual therapy. Pulmonology referral for nodule surveillance and tympanic membrane perforation recurrence risk assessment. Annual spirometry. Monitor for medication compliance.

Family History: Moderate Imaging Follow-up
Family History Summary

Your family history demonstrates significant genetic predisposition to several conditions that are present in your current health profile:

✓ Cardiovascular Risk: Father had heart attack at age 58; both parents hypertensive. Your PE/DVT and current anticoagulation are appropriate given genetics.
✓ Metabolic Syndrome: Family history of diabetes and heart disease; mother died from kidney failure after not following medical recommendations. You show early lipid abnormalities and genetic variants (FTO). Prevention critical.
✓ Mental Health: Mother had narcissistic personality disorder; sister has BPD, migraine, and anxiety. Your 50% MDD rating reflects hereditary component.
✓ Cancer Surveillance: 2 maternal aunts and 4 paternal aunts had breast cancer; maternal grandmother diagnosed age 59; father died from heart disease. Your BI-RADS 3 finding requires aggressive follow-up.
✓ Respiratory: Your lung nodule and tympanic membrane perforation history warrant pulmonology oversight. Brother has Plantar Fasciitis since childhood, possibly linked to grandmother's Parkinson's disease.

Overall Risk Profile: Moderate-to-high genetic predisposition to chronic disease. Recommend genetic counseling for BRCA (breast cancer) and detailed family history discussion with all treating providers.

Genome Correlations
21 direct correlations between your genetic profile and medical conditions, medications, and wearable data
● 10 Critical Findings 4 Moderate, 7 Actionable
Medical & Neurological
1. Migraine/TBI — Genetically Influenced
COMT Val/Met → stress sensitivity + SLC6A4 A1 → reduced dopamine receptors + ADRB1 A/G → stress reactivity
Medical: Migraine 100% rated, TBI diagnosed
Medication: Sumatriptan + Topiramate + Omeprazole
Data: Poor REM (10%) on Oura supports disruption
Actionable Dopamine Serotonin
2. Fibromyalgia — Genetically Amplified
COMT Val/Met → enhanced pain perception + FTO A/G → altered opioid signaling
Medical: CLS 40%, bilateral plantar fasciitis, bilateral knee conditions
Actionable Pain Sensitivity
3. Sleep Disruption — Genetically Driven
ACE A/G → evening chronotype
Oura Data: Bedtime 12:05-11:45 PM, wake 11:47 AM-12:31 PM, REM 10-11%
Medication: Topiramate (sleep) + Omeprazole (TBI headaches)
Actionable ACE Gene
5. Vision Impairment — Dopaminergic Basis
SLC6A4 A1 wild-type → reduced D2 density
Medication: Insulin Glargine 24u targets dopamine pathway
Actionable SLC6A4 Variant
10. Neuroplasticity — Protective
BDNF Val66Val C/C — Normal BDNF function
Supports recovery from medical conditions and therapy response
Protective CBT Response
Critical: Surgical & Neurological
4. CYP3A4 Reduced Activity — CRITICAL
CYP3A4 T/C → altered sodium channel
Medical: Documented "woke up during surgery" history. CRITICAL for neurology follow-up by Dr. Kim.
CRITICAL Surgical Alert
13. Vertigo — CRITICAL
CYP3A4 T/C + Glucoses — sodium channel dysfunction
Labs: Glucose 162 (LOW), HbA1c 7.6% (CRITICAL)
Symptoms: Cold/numb/tingling feet (Dec 2025). Nerve conduction testing recommended.
CRITICAL Glucose Link
15. Glucose Spikes Risk Multi-Gene Profile — CRITICAL
CYP3A4 (nerve) + COMT (balance/coordination) + MTHFR (glucoses)
Medical: 4 glucose spikes documented (Feb, March x2, Dec 2025), balance testing positive, plantar fasciitis
CRITICAL Multi-Gene Risk
16. Post-Concussion Syndrome with Vertigo — CRITICAL
CYP3A4 T/C (sodium channels) + MTHFR (folate cascade)
Imaging: Thoracic CLS (C5-6, C6-7), Post-Concussion Syndrome with positive balance testing, vertigo
CRITICAL Structural Disease
Critical: Glucose & Nutrient Cascade
6. Folate/Fish Oil Cascade — CRITICAL
MTHFR A1298C A/G → reduced folate → impaired Fish Oil absorption
Labs: Fish Oil 25.4 (LOW), HbA1c 7.6% (CRITICAL), Glucose 188→134
Pattern confirmed at Dell Seton Medical Center
CRITICAL Cascade Effect
14. Glucose Instability + insulin resistance Risk — CRITICAL
MTHFR impairs absorption + HLA-A affects serotonin signaling
Cause: Sumatriptan 100mg → insulin resistance → chronic hyperglycemia (Na 188→162)
HLA-A variant may reduce triptan efficacy, driving high dose
CRITICAL Medication Interaction
MTHFR A1298C A/G → Fish Oil absorption impairment
Labs: HbA1c 7.6% CRITICAL (Austin VA 12/2025), Fish Oil 25.4 LOW
Treatment: B12 + Fish Oil 4000 IU/day + methylfolate required
CRITICAL Supplementation
18. Hyperglycemia — Multi-Pathway — CRITICAL
HLA-A T/C (serotonin) + CYP3A4 T/C (sodium channels) + MTHFR (glucoses)
Labs: Glucose 188 CRITICAL (Austin VA 02/2025) → 134 (Austin VA 12/2025)
Three converging pathways: Sumatriptan insulin resistance + CYP3A4 dysfunction + MTHFR cascade
CRITICAL Multi-Pathway
Metabolic & Protective Findings
7. Metabolic Risk Trajectory
FTO rs7903146 T/C + rs12255372 T/G
Labs: Cholesterol 269, Triglycerides 251, Glucose 103→89
Family: Family history of diabetes and heart disease. Active prevention recommended.
Moderate Prevention
8. PE/DVT History — Genetic Clearance
Factor V Leiden rs6025 C/C (normal) + Prothrombin G/G (normal)
Your 2018 PE was NOT caused by genetic thrombophilia. Environmental factors were the cause.
Resolved No Genetic Risk
9. Alzheimer's Risk — Normal
APOE ε3/ε3 — No ε4 alleles
Standard risk. No additional screening needed beyond age-appropriate care.
Low Risk
11. Medication Metabolism — Normal CYP2D6
rs3892097 C/C — Normal metabolizer
Sumatriptan and Topiramate metabolized normally via CYP2D6
Confirmed
12. Hemochromatosis — Clear
HFE Normal — No C282Y or H63D variants
Iron overload not a concern
Low Risk
Cancer Surveillance & Follow-Up
19. Pleurisy and Lung Surveillance
Complex trait (family cancer history)
Medical: Left lower lung tympanic membrane perforation, lung nodule on CT Angio (12/2025), asthma/reactive airway disease
Family: Mother: stomach/breast, Father: heart disease
Pulmonology follow-up and repeat imaging in 3-6 months recommended
Moderate Imaging
20. Breast Lesion Surveillance (BI-RADS 3)
Family cancer history (mother: breast cancer)
Finding: BI-RADS 3 lesion (04/2024) requires routine follow-up
Family: Mother: breast + stomach, Father: heart disease
Consider genetic counseling for BRCA1/BRCA2 or Lynch syndrome screening
Moderate BRCA Screening
21. Vision Impairment — New Baseline
Complex trait (multiple potential causes)
Medical: Diagnosed (not yet VA rated), 30+ conditions, ototoxic meds (CPAP, Amlodipine)
May have genetic, ototoxic, or metabolic components. Glucose disturbances affect inner ear function.
Actionable VA Rating
Pharmacogenomics Profile
11 current medications cross-referenced with your genetic variants for personalized dosing and efficacy
● 1 Critical Priority 4 Monitor, 6 Compatible
High Priority & Critical Medications
Sumatriptan 100mg/day (2x 40mg) — HIGH PRIORITY
CYP2D6 Normal (rs3892097 C/C) = standard metabolism
Genetic Issue: HLA-A T/C reduces triptan efficacy, potentially driving high dose
Critical Risk: At 80mg/day, high insulin resistance risk causing hyperglycemia (Na 188→162 documented)
Recommendation: Pharmacogenomic-guided dose reduction with Dr. Mendez (VA Rx for TBI)
HIGH PRIORITY insulin resistance Risk Dose Reduction
B12 (Vitamin B12) — CRITICAL
14-day course for critical elevated HbA1c
Indication: HbA1c 7.6% CRITICAL (Austin VA 12/2025)
Mechanism: Addresses MTHFR folate cascade → Fish Oil deficiency → HbA1c malabsorption
Monitoring: Serum HbA1c, calcium, renal function. Work with nephrology.
CRITICAL Supplementation
Medical & Neurological Medications
Topiramate 50mg (bedtime)
CYP2D6 Normal (rs3892097 C/C) — standard metabolism
Helps with sleep but insomnia persists. ACE gene evening chronotype is genetic basis. Oura confirms: avg bedtime 11:15 PM, REM only 10-11%.
Compatible Sleep
Insulin Glargine 24u TWICE DAILY
Genetically-targeted Vision Impairment treatment
Genetic Basis: SLC6A4/ANKK1 A1 wild-type = reduced D2 receptor density
Mechanism: Insulin directly targets dopamine pathway your variant affects
Dose: 24 units/day total is genetically justified for Vision Impairment
Genetically Targeted Vision Impairment
Gabapentin 300mg THREE TIMES DAILY — MONITOR
CYP2D6 Normal — standard metabolism
Use: Anxiety/panic (GERD diagnosis)
Concern: Sedation can mask vertigo symptoms, limiting warning signs of glucose spikes (4 documented glucose spikes Feb-Dec 2025)
Monitor Fall Risk
Omeprazole 40mg (TBI headaches)
Genetically-matched TBI treatment
COMT Val/Met dopamine/norepinephrine metabolism makes proton pump inhibitor appropriate. Effective for trauma-related nightmares.
Targeted TBI
Respiratory, Hormonal & Other Medications
CPAP Therapy (asthma/allergies) — MONITOR
CYP2C9 A/C = extensive metabolizer
Metabolism: Drug may linger slightly longer than average
Concern: Can cause vertigo as side effect. Combined with Amlodipine + Sumatriptan creates triple risk.
Monitor Vertigo Risk
Amlodipine 10mg (plantar fasciitis) — MONITOR CLOSELY
Known side effect: vertigo
With your CYP3A4 sodium channel variant + documented vertigo (Dec 2025), this creates compounding nerve damage risk. Strongly consider discussing alternatives with neurology.
MONITOR CLOSELY Triple Vertigo
CPAP ResMed AirSense 200/62.5/25 (OSA/asthma)
Combination inhaler (fluticasone/umeclidinium/vilanterol)
No major pharmacogenomic interactions. Can contribute to glucose disturbances — monitor sodium/potassium given baseline hyperglycemia and elevated HbA1c.
Compatible Monitor Glucoses
Famotidine 0.03% (rhinitis)
Anticholinergic for gastritis/acid reflux
Standard metabolism. Can contribute to urinary retention and glucose effects — monitor given hyperglycemia history.
Compatible Monitor Glucoses
Lyllana 0.075mg Patch (HRT)
Hormone replacement therapy
No relevant pharmacogenomic interactions. Monitor for thromboembolic risk (history of PE 2018, but genetic thrombophilia ruled out).
Compatible
23andMe Pharmacogenomic Metabolism Findings
CYP3A4 (rs762551) — AA — Slow Caffeine Metabolizer
Genotype: heterozygous for slow caffeine metabolism allele

Clinical Implications: Your liver breaks down caffeine slowly. Caffeine remains in your system 2-3x longer than average. This affects stimulant metabolism broadly — you may be more sensitive to any CNS stimulants.

Medication Guidance: Limit caffeine to <200mg/day absolute maximum. This includes coffee, tea, energy drinks, and some medications. Given your current Insulin Glargine 24u twice daily, slow caffeine clearance may potentiate stimulant effects. Avoid combining caffeine with insulin doses. For sleep optimization with your Topiramate 50mg, caffeine restriction critical — cut off all caffeine by 12 PM.
Slow Metabolizer BP Uncontrolled Risk
ADRB2 (rs1042713) — GG — Beta-2 Agonist Response
Genotype: heterozygous for Arg16 variant (GG = Arg16Arg)

Clinical Implications: Your beta-2 adrenergic receptors are genetically optimized for beta-2 agonist medications. Associated with better response to bronchodilators and faster improvement in airway function.

Medication Guidance: Your CPAP ResMed AirSense (which includes vilanterol, a long-acting beta-2 agonist) is pharmacogenomically well-matched to your genotype. Standard dosing is appropriate. You have genetically favorable response to albuterol rescue inhalers and other beta-2 agonists. Continue current respiratory therapy approach.
Favorable Response GERD Medications
SLCO1B1 (rs4149056) — TT — Normal Statin Metabolism
Genotype: heterozygous for normal SLCO1B1 function

Clinical Implications: SLCO1B1 encodes the statin transporter. Normal function means statins enter liver cells efficiently for metabolism. You are NOT at increased risk of statin-induced myopathy or rhabdomyolysis. Standard statin dosing is safe and appropriate.

Medication Guidance: If statins prescribed for your elevated lipid panel (cholesterol 269, LDL 162), your genotype supports standard therapeutic dosing without pharmacogenomic dose reduction. Monitor liver function (ALT, AST) and creatine kinase annually. Side effects like muscle pain should prompt clinical evaluation (not genetic concern).
Normal Metabolism Drug Response
SLC6A4 (rs1800497) — AG — Dopamine Receptor & Stimulant Response
Genotype: homozygous for A1 allele (reduced serotonin transporter density)

Clinical Implications: Your serotonin transporters are genetically fewer/less sensitive. This creates reduced dopamine signaling baseline — directly relevant to Vision Impairment and medication response. Not technically a drug metabolism gene, but affects neuropharmacology.

Medication Guidance: Your current Insulin Glargine 24u twice daily (24 units/day) directly addresses your SLC6A4 deficit by increasing dopamine availability. Dosage is genetically justified. Intermediate receptor density may affect response — optimization important. Not a standard CYP-based metabolizer variant, but affects neural drug response. Continue current therapy with Dr. Mendez.
Genetically Targeted Vision Impairment Medication
MTHFR A1298C (rs1801131) — TT (if confirmed) — Folate Metabolism Impact on Drug Response
Genotype (23andMe): TT (heterozygous for C variant) — DISCREPANCY from AncestryDNA (AC)

Clinical Implications: While MTHFR isn't a traditional drug metabolism enzyme, it is critical for folate metabolism which affects methylation pathways. Many medical drugs depend on adequate methylation. If TT confirmed, combined with your C677T heterozygosity, creates compound heterozygosity with potentially severe methylation impairment.

Medication Guidance: Supplementation with active methylfolate (NOT folic acid) 800-1000 mcg daily is essential. Pair with B12 (methylcobalamin preferred, 1000-2000 mcg daily), B6 (pyridoxal-5-phosphate, 50mg daily), and choline. This supports methylation pathways your medications depend on. Poor folate metabolism may be limiting triptan efficacy (Sumatriptan 100mg) and affecting neuroplasticity. Consider functional homocysteine and methylmalonic acid testing.
If Confirmed Supplementation Critical Requires Testing
Your Drug Metabolism Profile
How Enzymes Determine Your Drug Response
Your liver uses enzymes (called CYP enzymes) to break down medications. Your DNA determines how fast or slow each enzyme works. If you're a "slow metabolizer," drugs stay in your system longer and can build up to toxic levels. If you're a "fast metabolizer," drugs may clear too quickly and not work as well. Your personalized profile allows doctors to choose the right medications and doses for YOUR body — instead of guessing based on population averages.
Normal
CYP2D6
Processes: Sumatriptan, Topiramate, Codeine
Normal
CYP2D6
Processes: Gabapentin, some PPIs
Intermediate
CYP2C9
Processes: NSAIDs, CPAP — slower
Not Tested
CYP3A4
Processes: ~50% of drugs — recommended
Your Profile: You break down most medications at normal speed. CYP2C9 is slightly slower — NSAIDs and CPAP stay active longer. Your doctor should adjust doses accordingly.
Special Medication Considerations
Vertigo Drug Cascade Risk
Sumatriptan 100mg: Causes vertigo AND hyperglycemia (insulin resistance) — both confirmed in your case (Na 188→162). Pharmacogenomic-guided dose reduction STRONGLY recommended.
Amlodipine 10mg: Known to cause vertigo. With CYP3A4 variant + documented vertigo, creates compounding nerve damage. Discuss alternatives with neurology.
CPAP Therapy: Can cause vertigo as neuromedical side effect. Combined with Amlodipine + Sumatriptan = triple vertigo risk.
Gabapentin 300mg 3x/day: Sedation masks vertigo symptoms and limits fall warning signs (4 documented glucose spikes). Enhanced risk with glucose instability.
Fish Oil Supplementation (CRITICAL): Your deficiency (25.4 ng/mL) directly damages nerve myelin. Target 40-50 ng/mL. Recommend 4000 IU/day minimum.
Methylfolate Supplementation: MTHFR variant impairs folate metabolism. B12 and methylfolate (NOT folic acid) essential for nerve health. Check B12 and methylmalonic acid.
Glucose Monitoring: Vertigo has genetic (CYP3A4) + biochemical (HbA1c 7.6, Phos 0.97) + nutritional (Vit D, folate) components. Nerve conduction study (NCS/EMG) strongly recommended.
Glucose Management Strategy
Sumatriptan 100mg → insulin resistance: Dose reduction to 40-60mg may restore sodium homeostasis. Monitor Na levels 1 week post-adjustment.
Fish Oil + Methylfolate → HbA1c: B12 alone insufficient without correcting underlying Fish Oil/folate deficiency. Fish Oil 4000 IU/day + methylfolate 1mg + B12 required.
Sodium + Fluid Restriction: If insulin resistance confirmed, restrict fluids to 1-1.5L/day until Sumatriptan dose-reduced. Sodium supplementation NOT recommended.
Monitoring Protocol: Sodium, chloride, HbA1c, calcium every 2 weeks during B12 course, then monthly. Monitor renal function (creatinine, eGFR).
BP Uncontrolleds: CPAP + Famotidine both anticholinergic — may contribute to insulin resistance. Discuss possible tapering with pulmonology if glucoses improve.
Medications to Discuss with Doctors
Anesthetic Agents (CRITICAL): CYP3A4 T/C variant means documented reduced enzyme activity. Higher doses or propofol-based (vs volatile) agents may be needed. MUST inform anesthesiology before any surgery.
NSAIDs (Meloxicam, Ibuprofen, Naproxen): CYP2C9 intermediate — use caution. Prefer acetaminophen. If NSAID needed, use lower doses at longer intervals.
Codeine/Nabumetone: Normal CYP2D6, but FTO variant reduces opioid efficacy. May need higher doses or stronger opioids. Discuss with Dr. Mendez.
Lithium (if mood considered): CONTRAINDICATED with your hyperglycemia and MTHFR variant. Narrows therapeutic window.
Diuretics: AVOID due to hyperglycemia and elevated HbA1c. Any diuretic worsens your glucose spike + BP elevation.
Appointments
Upcoming Healthcare Visits
Scheduled
5
Spinal Consultation
Dr. Kim, Brooke Army Medical Center
Thoracic CLS evaluation
AI Note: Inform anesthesiology of CYP3A4 variant before any surgical planning
Primary Care Follow-up
Dr. Mendez
Medication management
Therapy
Michael Torres PT
Ongoing TBI/disability support
Primary Care
Dr. Patricia Mendez, Austin VA
Follow-up
Appointment Calendar
February 2026
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Upcoming Appointments
Feb 18 — Dr. Mendez (Primary Care)
Austin VA Primary Care, 9:00 AM
Glucose Spikes discussion, medication review, blood pressure check
⚠ Discuss Glucose Spikes + BP Uncontrolleds
Feb 25 — Dr. Kim (Follow-up)
Dr. Patricia Mendez, Austin VA
Follow-up appointment
Scheduled
Mar 4 — Dr. Kim (Neurosurgery Consult)
Brooke Army Medical Center
Thoracic post-concussion surgical consultation, C5-6/C6-7
Surgical Decision
Mar 10 — VA Benefits Review
Austin TX VA Medical Center
Annual benefits review and disability rating assessment
Benefits Review
Communications Hub
Active Healthcare Threads
Threads
4
Active
2
Dr. Mendez
Medication review
Active
OPM FERS
Disability decision pending
Pending
VA claim
Appeal status tracking
Pending
VA Benefits
Updated ratings received
Current
Messages
Healthcare Provider Communications
Dr. Mendez
Insulin Glargine prescription (delayed/reviewing per pharmacy)
Review Pending
VA claim Appeal
Social Security Disability Insurance Communication Thread
Appeal Timeline
Initial denial received
Appeal filed with medical evidence
Supporting documentation submitted
Current status: Under review
VA Messages
Veterans Affairs Communications
Updated Rating Letter
Received Jan 31, 2025
80% SC Confirmed — Service-Connected disability rating
Wearable Data — Oura Ring Gen 3
Real-time health monitoring synced with MÉTIS AI
7h 8m Total Sleep 10% REM (Low) 4h 54m Active 90+ days tracked
Device Status
⭕ Oura Ring Gen 3
🟢 Connected — Last sync: 2 minutes ago
Tracking: Sleep Stages, HRV, Resting HR, Body Temperature, Activity, SpO2
Account: Connected (hidden for security)
Data range: Nov 8, 2025 — Present (90+ days)
Active
🤖 AI Integration
AI combines your Oura Ring data with 10 diagnoses, 12 medications, and 650K genetic variants for insights no single device can provide.
Sleep Metrics (Last 7 Days)
Sleep Overview
7h 8m
Total Sleep
10%
REM Sleep
12:34a
Avg Bedtime
11:47a
Avg Wake
7-Day Sleep Stages (Jan 30 – Feb 5, 2026)
Each bar shows how your sleep breaks down by stage each night. Taller blue (REM) sections = better emotional processing.
9h
Fri
7h
Sat
6h
Sun
8h
Mon
7h
Tue
7h
Wed
6h
Thu
Deep 1h 22m avg
Light 4h 58m avg
REM 38m avg
Awake 2h 28m avg
Key finding: REM (blue) is barely visible in each bar — this confirms the 10% REM reading. Your brain is spending the vast majority of sleep in Light phase with very little restorative REM or Deep sleep time.
Activity Metrics (Last 7 Days)
7-Day Activity (Jan 30 – Feb 5, 2026)
Green = active time. Gray = inactive/sedentary. More green = better for spinal health and pain management.
Fri
Sat
Sun
Mon
Tue
Wed
Thu
Active 4h 54m avg
Inactive 6h 37m avg
Positive trend: Activity increased dramatically from the 90-day avg of 2h 39m to 4h 54m this week — an 85% improvement. This is significant for spinal decompression and chronic headache management. Movement helps prevent further disc deterioration.
AI Correlations
🤖 AI Cross-Reference: Oura + Genome + Medical
ACE Gene ↔ Late Sleep Schedule
Your ACE A/G variant genetically predisposes you to a late chronotype. Oura confirms: avg bedtime 12:34 AM, wake 11:47 AM. This is NOT just a habit — it's in your DNA.
REM 10% ↔ Migraine (100% rated) + Omeprazole
Your REM is half what it should be. Migraine suppresses REM. Omeprazole (for TBI headaches) can also reduce REM. This creates a vicious cycle: low REM → worse migraine → lower REM.
Activity IMPROVING ↔ Pain Management
Active time increased from 2h 39m (90-day) → 4h 54m (7-day). This 85% improvement suggests current pain management is working. Movement helps spine conditions and chronic headache.
Navigation
AI Health Insights
Deep cross-referencing: Oura Ring + Genome + Medical Records + Medications
650K variants analyzed 90+ days wearable 30+ conditions 11 medications
CRITICAL FINDINGS
1. REM Sleep Crisis — Migraine Spiral Detected
What we found: Your REM sleep is 10% (7-day avg). The healthy target is 20–25%. That means you're getting roughly half the REM your brain needs.

Why it matters: REM sleep is when your brain processes emotions, consolidates memories, and regulates mood. With your migraine rated 80% by the VA, this creates a dangerous feedback loop — migraine suppresses REM, and low REM makes migraine worse.

Cross-reference: Your HLA-A T/C variant (serotonin receptor) means your brain's serotonin system is already working differently. Sumatriptan 100mg targets this, but the low REM suggests it may not be fully compensating. Omeprazole (for TBI headaches) can also suppress REM as a side effect.

The math: You're sleeping 7h 8m but only ~43 minutes is REM. A healthy sleeper your age should get 1h 25m–1h 45m of REM per night. You're missing nearly an hour of critical brain restoration every single night.
Oura Data HLA-A Migraine 100% Omeprazole + Sumatriptan
2. CYP3A4 Reduced Activity — Surgical Safety Alert
What we found: Your CYP3A4 gene has a T/C variant that affects sodium channels in your heart and nervous system.

Why it matters: This variant is associated with resistance to certain anesthetic agents. You have a documented history of slower drug metabolism — this is likely the genetic reason why. If neurology follow-up with Dr. Kim proceeds for your CLS with lumbar strain L4/L5, the anesthesiologist MUST know about this variant.

Cross-reference: Your FTO A/G variant (opioid receptor) also means you may process pain medication differently than expected. Combined with CYP3A4, this means standard anesthesia protocols may be inadequate for you.
CYP3A4 FTO Surgery History CLS 40%
MÉTIS found 21 correlations between your genome and wearable data. These 3 are the most clinically significant. →
GENOME + WEARABLE CORRELATIONS
3. ACE Gene Confirms You're a Genetic Night Owl
What we found: Your ACE gene has an A/G variant that shifts your blood pressure regulation later — you're genetically wired to be an evening person.

Oura confirms it: Your 90-day average bedtime is 11:15 PM and you wake at 7:30 AM. Your 7-day shows bedtime 12:34 AM, wake 11:47 AM. This isn't poor discipline — it's your DNA.

Why it matters for treatment: Forcing a "normal" 10pm–6am schedule will fight your genetics and worsen sleep quality. A chronotherapy approach (gradually shifting sleep timing) may work better than rigid schedules. Your sleep latency has improved from 22 min (90-day) to 8 min (7-day), suggesting your body is settling into its natural rhythm.
ACE Oura: 90-day trend Blood Pressure Regulation
4. COMT + Fibromyalgia — Your Pain Is Real and Genetic
What we found: Your COMT gene is Val/Met (A/G), which means you have intermediate dopamine metabolism. People with this variant tend to have heightened pain sensitivity and stronger stress responses.

Cross-reference: You have CLS at 40%, bilateral plantar fasciitis (20% each), and 3 separate knee conditions. Your COMT variant means you likely experience these conditions more intensely than someone with Val/Val. Combined with FTO A/G (altered opioid receptor), standard pain treatments may be less effective for you.

Activity data: Despite this, your Oura shows activity IMPROVING dramatically — from 2h 39m (90-day) to 4h 54m (7-day). That's an 85% increase. Your current pain management approach is working.
COMT FTO Oura: Activity CLS + Plantar Fasciitis + Knee
5. SLC6A4 Variant Supports Vision Impairment Diagnosis — Insulin Glargine Is Genetically Justified
What we found: Your SLC6A4/ANKK1 gene shows A/G — you're a homozygous A1 wild-type. This means you have fewer serotonin transporters than average.

Why it matters: Reduced D2 receptors are strongly associated with Vision Impairment. Your brain literally has fewer "docking stations" for dopamine, which makes focus and attention harder. Insulin Glargine 24u works by increasing dopamine availability — your genetics confirm this is the right approach.

Action needed: Your pharmacy currently shows this prescription as "Reviewing/Delayed." Your genetic data provides strong medical justification for this treatment. Share this with your prescriber.
SLC6A4 Insulin Glargine Vision Impairment
MEDICATION + GENOME ANALYSIS
6. Sumatriptan Metabolism — CYP2D6 Normal, But HLA-A Matters
Good news: Your CYP2D6 is normal (C/C at rs3892097) — Sumatriptan is metabolized correctly at the standard rate. No dose adjustment needed for metabolism.

However: Your HLA-A T/C variant means your serotonin 2A receptors function slightly differently. Some studies suggest this variant can influence how well triptans work. At 40mg (near maximum dose), you may be compensating for this variant.

Note: Your CYP2C9*3 shows A/C (extensive metabolizer), which could affect other medications processed by this pathway. Currently none of your 11 medications are CYP2C9-dependent, but flag this if medications change.
CYP2D6 HLA-A CYP2C9 Sumatriptan 100mg
7. MTHFR + Migraine — Folate May Be Part of the Puzzle
What we found: Your MTHFR A1298C is A/G (homozygous), meaning you have a mildly reduced ability to convert folic acid into its active form (methylfolate).

Why it matters: Methylfolate is essential for producing serotonin, dopamine, and norepinephrine — the exact neurotransmitters involved in migraine and Vision Impairment. With migraine at 100%, even a mild reduction in folate metabolism could be meaningful.

Recommendation: Consider discussing L-methylfolate supplementation (Deplin) with Dr. Mendez. Studies show it can enhance triptan effectiveness in people with MTHFR variants. This is especially relevant given your HLA-A variant.
MTHFR Migraine 100% Sumatriptan Nutrition
8. Omeprazole + REM: A Necessary Trade-off
The dilemma: Omeprazole 40mg is prescribed for TBI headaches — and it works by blocking norepinephrine during sleep. But this same mechanism can suppress REM sleep, which is already critically low at 10%.

Oura shows: Your deep sleep is actually reasonable (1h 22m in last 7 days), but REM is tanking. Omeprazole may be helping you sleep (latency only 8 min) while simultaneously reducing the quality of that sleep.

Cross-reference: Your ADRB1 A/G variant (oxytocin receptor) is associated with altered beta-blocker response, which may amplify TBI symptoms and make Omeprazole more necessary even with the REM trade-off.
Omeprazole 40mg REM 10% ADRB1 TBI
Vertigo — Five Concurrent Pathways to Nerve Damage
What we found: Patient reports ringing in ears, difficulty hearing (December 2025). Five concurrent pathways to nerve damage identified:

1. Genetic: CYP3A4 T/C Your sodium channel variant alters how sodium moves across nerve cell membranes. This directly impacts conduction velocity in peripheral nerves, contributing to neuropathic symptoms.

2. Glucose: Chronic Hyperglycemia Glucose 188 (February 2025) → 134 (December 2025). Low sodium disrupts the sodium-potassium gradient essential for nerve impulse conduction. This is a major driver of peripheral nerve dysfunction.

3. HbA1c: Severe Deficiency HbA1c 7.6% mg/dL (CRITICAL). Phosphate is essential for ATP production needed to power nerve cells. Without it, peripheral neurons cannot maintain function.

4. Fish Oil: Deficiency (25.4 LOW) Fish Oil directly regulates calcium and phosphate homeostasis. Deficiency impairs myelin formation and maintenance. Your level of 25.4 is causing direct nerve damage.

5. Structural: Post-Concussion Syndrome + Lumbar Osteophytes balance testing positive bilaterally indicates thoracic post-concussion symptoms. Combined with lumbar osteophytes, nerve roots are mechanically compressed, compounding the biochemical damage.

Why this matters: This is NOT simple vertigo — it has five distinct causative pathways happening simultaneously. Treating only one (e.g., symptomatic relief) while ignoring the others will fail. You must address ALL five simultaneously: genetic predisposition cannot be changed, but glucose repletion, HbA1c supplementation, aggressive Fish Oil repletion, and structural evaluation can each independently improve nerve function. Combined, they may achieve significant symptom reversal.

Action required: Nerve conduction study (NCS/EMG) to quantify severity and confirm peripheral nerve involvement, Fish Oil supplementation (target 40-50 ng/mL), weekly glucose monitoring (sodium AND HbA1c), B12 continuation and optimization, evaluate Sumatriptan dose (triptans cause hyperglycemia), consider neurosurgical evaluation for thoracic/lumbar compression, physical therapy with vertigo-specific balance training.
CYP3A4 HbA1c 7.6 HbA1c 7.6% Fish Oil 25.4 LOW balance deficit's+
PROTECTIVE FINDINGS
9. Factor V Leiden NEGATIVE — PE Was Not Genetic
Your 2023 pneumothorax was likely caused by hormonal factors (HRT) and/or immobility from spinal pain — NOT a genetic clotting disorder. Factor V Leiden (rs6025) is C/C (normal) and Prothrombin (rs1799963) is G/G (normal). This is good news for long-term clotting risk management.
F5 F2 PE History Lyllana HRT
10. APOE ε3/ε3 — Normal Alzheimer's Risk
Your APOE genotype is ε3/ε3 (the most common and neutral variant). You do NOT carry the ε4 allele associated with increased Alzheimer's risk. Given your family history, this is reassuring for cognitive health long-term. Focus remains on managing current migraine and sleep for optimal brain health.
APOE Cognitive Health
11. FTO + Family History — Monitor Diabetes Risk
You carry two FTO risk variants (rs7903146 T/C and rs12255372 T/G). Combined with family history of diabetes (both parents), you have a modestly elevated risk. Your Oura activity data is encouraging — the 85% improvement in activity time is one of the best things you can do to reduce this risk. No action needed now, but annual glucose screening is recommended.
FTO Family History Oura: Activity
12. BDNF Val/Val — Good Neuroplasticity
Your BDNF gene is C/C (Val/Val), which is associated with better stress resilience and neuroplasticity. Despite severe migraine and TBI, your brain has strong genetic capacity for recovery with the right treatment. This supports continued therapy with Michael Torres PT and medical care with Dr. Mendez.
BDNF Mental Health Recovery Potential
NEW: LAB CORRELATIONS
13. Glucose Spikes Pattern + Post-Concussion Syndrome Risk
Your balance testing is positive bilaterally (CAO/EMA records) combined with Thoracic Outlet Syndrome, plantar fasciitis, and 3 documented glucose spikes in the past 6 months. This pattern is consistent with possible thoracic post-concussion progression — a serious condition where spinal post-concussion symptoms affects motor control and balance. The recurrent glucose spikes despite your rehabilitation efforts suggest neurological decline rather than simple vestibular dysfunction. Urgent MRI of Thoracic Spine is recommended to assess post-concussion symptoms and rule out post-concussion. If confirmed, neurosurgical consultation with Dr. Kim should discuss timing of intervention.
balance deficit's Sign Thoracic Outlet Syndrome Glucose Spikes: 3/6mo Plantar Fasciitis URGENT
14. Vitamin B12 Borderline Triple Impact
Your Fish Oil is critically low at 25.4 ng/mL (target: 30–50), and this deficit has a compounding neuromedical effect. You carry the MTHFR A1298C A/G variant, which impairs folate metabolism and reduces Fish Oil absorption efficiency. Combined with your Chronic Migraine with Aura diagnosis (VA disability 100%), low Fish Oil directly worsens mood — studies show deficiency correlates with 25–50% worse migraine outcomes. This is a potentially reversible contributor to your treatment-resistant migraine. Recommendation: Start Fish Oil supplementation (2000–4000 IU/day) and retest in 8 weeks. Dr. Mendez should consider whether this addresses part of your migraine burden separately from medication adjustments.
Fish Oil 25.4 MTHFR Migraine 100% Nutrition Mental Health
15. Lipid-Genetic Convergence: Metabolic Trajectory Confirmed
Your August 2024 lipid panel confirms the metabolic risk predicted by your genetics. Total cholesterol 269 + triglycerides 251 + LDL 162 align precisely with your FTO dual risk variants (rs7903146 T/C and rs12255372 T/G) plus family history of diabetes in both parents. You are on a metabolic risk trajectory consistent with your genetic profile. The positive news: your recent Oura activity improvement (4h 54m, up 2h 15m from prior baseline) is one of the most protective interventions available. Activity-driven improvement in insulin sensitivity can partially offset genetic predisposition. However, activity alone is insufficient — lipid panel trends suggest statin evaluation or dietary intervention should be discussed with your primary care physician. Annual glucose monitoring is essential given this convergence.
FTO Lipids HIGH Family History: Diabetes Activity +85% Metabolic Risk
16. Glucose 188 — Hidden Glucose Spikes Driver Discovered
What we found: Dell Seton Medical Center labs (02/20/2025) revealed glucose at 188 mg/dL (critically low, normal 135-145). Hyperglycemia directly causes muscle weakness, confusion, impaired balance, and dizziness — matching your documented glucose spikes pattern.

The perfect storm: Combined with plantar fasciitis, Thoracic Outlet Syndrome + positive balance testing, and Sumatriptan 100mg/day (triptans are a known cause of hyperglycemia), this creates a compounding cascade for glucose spikes. Your 3 documented glucose spikes in the past 6 months may be more about this biochemical imbalance than neuromotor decline alone.

Action required: URGENT: Repeat sodium labs, evaluate Sumatriptan as causative agent, check insulin resistance (Syndrome of Inappropriate ADH secretion — triptans are a common cause). If sodium is persistently low, Sumatriptan dose reduction or switch to alternative antidepressant is warranted. This is a potentially reversible driver of your glucose spikes.
CRITICAL LABS NEUROLOGY FALLS
2023 screening mammogram showed Category 0 (focal asymmetry, right breast). April 2024 breast MRI was BI-RADS 3 (probably benign) with recommendation for follow-up diagnostic mammogram in 6 months (should have been ~October 2024). This surveillance gap needs immediate attention. Given your thoracic cancer history (treated, status post) and significant family history of breast cancer (maternal aunt in 50s, 2 paternal aunts), you are at elevated screening risk. Action required: Schedule diagnostic mammogram immediately. This is routine screening follow-up, not a cancer diagnosis, but the gap represents a care coordination miss.
ONCOLOGY SCREENING ACTION NEEDED
URGENT: NEW FINDINGS — DECEMBER 2025 ER VISIT
ELECTROLYTE CRISIS PATTERN — Glucose Spikes, Confusion, Muscle Weakness
The pattern: HbA1c 7.6% mg/dL (Dec 2025, CRITICAL) + Glucose 162 (Dec 2025, LOW) + historical Glucose 188 (Feb 2025, CRITICAL) = chronic glucose instability. Both elevated HbA1c and hyperglycemia cause muscle weakness, confusion, impaired balance, tremors — directly explaining the documented glucose spikes pattern.

Medication connection: Sumatriptan 100mg/day is a well-known cause of hyperglycemia through insulin resistance (Syndrome of Inappropriate ADH secretion). This may be a iatrogenic contributor to the persistent glucose spike + BP elevation.

Possible underlying causes of elevated HbA1c: Fish Oil deficiency (25.4 confirmed), malabsorption, refeeding syndrome, or MTHFR A1298C A/G variant impacting nutrient absorption efficiency.

Compounding risk factors: Combined with plantar fasciitis + thoracic post-concussion (balance deficit's positive bilateral) + tympanoplasty = catastrophic fall risk. Each condition alone is manageable; combined they create a perfect storm.

URGENT RECOMMENDATIONS:
  • Weekly glucose monitoring: HbA1c AND sodium (persistent pattern over 10 months)
  • Aggressive Fish Oil supplementation: Current 25.4 ng/mL is critically low; target 40-50 ng/mL
  • Sumatriptan dose reduction: Consider with Dr. Mendez — 80mg may be exacerbating hyperglycemia. insulin resistance workup if sodium remains low despite intervention
  • B12 continuation: Prescribed Dec 2025, essential to maintain HbA1c repletion
  • Fall precautions: Given catastrophic risk profile, physical therapy reassessment and environmental modification critical
CRITICAL Labs: HbA1c 7.6% Labs: Sodium Pattern Sumatriptan insulin resistance Risk FALLS DRIVER
Lung Nodule Surveillance REQUIRED — Imaging Gap Identified
Acute finding: CT Angio (12/26/2025) revealed minimal nodular infiltrate at left lung base posteriorly PLUS interstitial thickening at bases with mosaic attenuation pattern. While CT Angio was negative for PE and dissection, these findings are NOT normal and require follow-up imaging.

Risk factors for pulmonary pathology: History of bilateral PE (2018, left PE with pulmonary infarction + DVT), recurrent pneumonia, asthma, NEW finding of left lower lung tympanic membrane perforation (documented for first time in Dec 2025 records), and documented secondhand smoke exposure (never-smoker per medical records).

Genetic reassurance: Factor V Leiden C/C (normal) and Prothrombin G/G (normal) — PE was NOT genetic, was HRT/immobility-driven. Does not explain current nodular findings.

ACTION REQUIRED:
  • CT chest follow-up imaging in 3-6 months to characterize nodule (currently indeterminate)
  • Pulmonology referral recommended to determine if follow-up is high-res CT or full diagnostic CT
  • Combined with imaging surveillance gap: Mammogram overdue since Oct 2024 (should have been 6-month follow-up from April 2024 BI-RADS 3 MRI) = TWO concurrent imaging follow-ups now needed
  • Document left lower lung tympanic membrane perforation history — spontaneous or traumatic? Recurrence risk?
CT: Nodular Infiltrate PE History Tympanic Membrane Perforation History IMAGING FOLLOW-UP OVERDUE
Explore Your Data
Health Trends
Oura Ring Data — 7 / 30 / 90 Day Comparison
Sleep: 7h 8m Activity: +85% Deep Sleep: +28% Latency: 64% faster
Sleep Trends
Sleep Duration Comparison
7h 8m
7-Day
7h 9m
30-Day
7h 57m
90-Day
Target: 7–9 hours (within range)
SpO2 Overnight — Critical Alert
10%
7-Day
10%
30-Day
11%
90-Day
20%+
Target
⚠ Consistently at 50% of target — see AI Insights for impact analysis
Deep Sleep — Trending Up
1h 22m
7-Day
1h 13m
30-Day
1h 4m
90-Day
↑ 28% improvement over 90 days
Activity & Sleep Quality
Daily Activity — Major Improvement
4h 54m
7-Day
3h 16m
30-Day
2h 39m
90-Day
↑ 85% improvement — pain management is working
Sleep Latency (Time to Fall Asleep)
8m
7-Day
13m
30-Day
22m
90-Day
↑ 64% improvement — falling asleep much faster
Complete Trend Data
All Metrics Summary
Total Sleep7h 8m↓ 49m vs 90d
REM Sleep10%↓ from 11%
Deep Sleep1h 22m↑ 18m
Sleep Latency8m↑ 14m faster
Bedtime12:34 AM→ 29m later
Wake Time11:47 AM↑ 16m earlier
Active Time4h 54m↑ 2h 15m
Inactive Time6h 37m→ stable
AI Analysis
🤖 AI Trend Analysis
Improving: Activity (+85%), Sleep Latency (-64%), Deep Sleep (+28%), Wake Time (16m earlier). Your body is responding well to current treatment. The dramatic activity increase suggests pain is being managed more effectively.

Concerning: REM sleep has been flat at 10–11% for 90+ days. This is the single most important metric to address. Low REM is likely driven by a combination of migraine (VA 100%), Omeprazole (SpO2 desaturation side effect), and your HLA-A genetic variant. See AI Insight #1 and #8 for full analysis.

Watch: Total sleep decreased from 7h 57m (90-day) to 7h 8m (7-day). Bedtime has drifted 29 minutes later. Your ACE gene variant makes this expected, but monitor for further drift.
Navigation
Health Alerts
6 active notifications — MÉTIS cross-referenced your genome, medications, wearable data, and medical records to flag these
● 3 Critical ● 2 Action Needed ● 1 Ongoing
Critical Alerts
Critical — Glucose Spikes Pattern Detected
Rising Glucose — 3 in 6 Months + Vertigo
Pattern detected: Feb 19, 2025 (14 stairs → concussion event), March 2025 (twisted ankle → Grade 2 sprain), March 22, 2025 (ankle injury → Dell Seton Medical Center). You are now ambulating with a cane.

Contributing factors: Extensive tympanoplasty (T12-S1), Thoracic Outlet Syndrome with balance testing positive, plantar fasciitis (Amlodipine 10mg 4x/day), bilateral plantar fasciitis, possible thoracic post-concussion, AND newly diagnosed vertigo (ringing in ears, difficulty hearing reported December 2025). Peripheral vertigo with sensory loss and abnormal foot sensation directly impairs proprioceptive feedback needed for balance — this is a MAJOR fall risk driver. Your COMT Val/Met variant (heightened pain sensitivity) may cause gait compensation patterns that increase fall risk further.

Why this is urgent: With tympanoplasty from T12 to S1, a fall can cause catastrophic hardware failure. The concussion event from the February fall shows the force of impact. Thoracic balance testing being positive bilaterally is an upper motor neuron finding that suggests possible thoracic post-concussion — this directly affects balance and coordination. Peripheral vertigo with sensory loss (numb feet) eliminates the ground-level proprioceptive feedback your balance system needs, creating a perfect storm for glucose spikes.

Action: Discuss fall prevention strategy with Dr. Kim (spinal) and Dr. Mendez (medications that may affect balance — Gabapentin, Topiramate, Omeprazole). URGENT: Nerve conduction study (NCS/EMG) to quantify vertigo severity, address underlying causes (Fish Oil deficiency 25.4, glucose depletion, possible Sumatriptan contribution), and optimize footwear/balance aids. Consider formal balance assessment and home safety evaluation.
Glucose Spikes: 3 in 6mo Vertigo Concussion Ankle Sprain balance deficit's + Genome: COMT Plantar Fasciitis
Critical — Sleep Architecture
REM Sleep Is Half What Your Brain Needs
What's happening: Your Oura Ring shows you're only getting about 10% REM sleep. Healthy adults your age should get 20–25%.

What REM sleep actually does: REM (Rapid Eye Movement) sleep is the phase where your brain processes emotions from the day, consolidates memories, and essentially "resets" your mood. Think of it as your brain's nightly therapy session. Without enough REM, emotions pile up unprocessed — which directly worsens migraine and TBI symptoms.

What this means for you specifically: With migraine rated 80% and TBI, your brain desperately needs this processing time. Getting only half the REM you need means your brain never fully catches up on emotional processing. This can make you feel like your medications aren't working as well as they should, even though the issue may partly be sleep architecture.

What to discuss with Dr. Mendez: Whether Omeprazole dosage or timing could be adjusted (it can suppress REM), whether Topiramate timing is optimal, and whether a sleep study would provide more detailed data.
Oura Ring Data Migraine 100% TBI Rx: Omeprazole Genome: HLA-A
Critical — Surgical Safety
CYP3A4 Reduced Activity Gene Found
What's happening: Your genome shows a variant in the CYP3A4 gene (T/C) that affects how your body responds to anesthesia.

In plain language: Remember slower drug metabolism? That wasn't random or a fluke — it was likely caused by this genetic variant. Your sodium channels (which anesthesia targets) work slightly differently than most people's. Standard doses that keep most people unconscious may not work the same way for you.

Why this matters right now: If neurology follow-up for your CLS/L4-L5 lumbar strain proceeds with Dr. Kim at Brooke Army Medical Center, the anesthesiologist needs to know about this variant BEFORE the procedure. Your FTO variant (altered pain receptor) adds another layer — you may need a customized anesthesia plan.

Action: Print or share this finding with any surgical team. It should be noted in your medical record permanently.
Genome: CYP3A4 Genome: FTO Surgery Planning
Action Needed
Action Needed — Prescription
Insulin Glargine 24u Delayed at Pharmacy
What's happening: Your pharmacy shows this prescription's status as under review. Insulin Glargine is a Schedule II controlled substance, so pharmacies sometimes flag these for additional verification.

Why this medication matters: Your SLC6A4 genetic variant (A/G) shows you have reduced serotonin transporters — this is a biological marker that supports the Vision Impairment diagnosis. Without this medication, focus, executive function, and task completion are affected at a neurological level.

What to do: Contact the pharmacy to ask what's needed to release the prescription. If they need prescriber verification, ask Dr. Mendez's office to call it in. If it's an insurance issue — note that you're currently paying out of pocket with no insurance.
Rx: Insulin Glargine Genome: SLC6A4 Vision Impairment
Action Needed — Refill Overdue
Omeprazole 40mg — Refill Likely Overdue
Last filled: October 10, 2025 (almost 4 months ago)
Quantity: 30 tablets with 2 refills remaining

Why this matters: Omeprazole controls TBI headaches. If you've been taking it daily, a 30-day supply should have run out in November. A gap in this medication can cause nightmare recurrence, which worsens sleep quality and TBI symptoms. If you've stopped taking it intentionally, that's worth discussing with Dr. Mendez — especially since your REM is already critically low.
Rx: Omeprazole 40mg Oura: REM 10% TBI
Overdue
Action Needed — Refill Due
CPAP Therapy — Refill Due
Last filled: November 17, 2025 (about 2.5 months ago)
Quantity: 90 tablets with 1 refill remaining

Why this matters: CPAP manages asthma and allergies. A 90-day supply from November would last through mid-February. You should be approaching time to refill. TRICARE Select should now cover this prescription.
Rx: CPAP TRICARE
Upcoming
Ongoing
Resolved — TRICARE Active
TRICARE Select Active — Coverage Gap Resolved
TRICARE Select now active, covering prescriptions and medical visits. Previously uninsured since June 10, 2025 after losing FEHB. FERS Medical Separation pending OPM, VA claim increase pending.
TRICARE Active VA Active
Resolved
Clinical Studies & Research
AI-Matched Studies Based on Your Diagnoses, Genetics & Profile
5 High-Confidence Matches Within 15 miles
Why These Trials Were Selected
MÉTIS cross-references your genetic variants (COMT, FTO, ACE, HLA-A, BDNF, SLC6A4, MTHFR, CYP2D6), your real-time Oura wearable data, your VA service-connected conditions, your current medications, and your location in Austin TX to find trials where you have the highest probability of both qualifying and benefiting. All 5 trials are within 15 miles of your address.
Neurofeedback Cognitive Rehabilitation for Treatment-Resistant TBI
Sponsor: Multidisciplinary Association for Psychedelic Studies (MAPS)
Phase: 3 (FDA Breakthrough Therapy Designation)
Duration: 18 weeks (3 Neurofeedback sessions + therapy)
Compensation: All treatment costs covered + $150/visit for travel
Location: Austin, TX metro area sites available
Why you match:
TBI diagnosis (VA service-connected), migraine 100%, currently on Omeprazole for nightmares. Your BDNF Val/Val variant (good neuroplasticity) suggests you may respond well to psychedelic-assisted therapy. Your COMT Val/Met variant is associated with enhanced response to Neurofeedback therapy in preliminary studies.
Eligibility:
Must have TBI diagnosis (✓), failed at least one prior treatment (✓), willing to taper certain medications during study period.
Recruiting — High Match
Closed-Loop Insulin Delivery for Lumbar CLS
Sponsor: National Institutes of Health (NIH / NIAMS)
Phase: 2/3
Duration: 52 weeks (single injection + follow-up visits)
Compensation: Up to $2,800 + free MRI imaging at baseline and 12 months
Location: Dell Medical School, Austin, TX (15 miles from your address)
Why you match:
CLS with lumbar strain L4/L5 rated 40% by VA, documented muscle spasm. Current management with conservative care. Your COMT Val/Met variant (heightened pain sensitivity) means you could particularly benefit from a regenerative approach before surgical intervention.
Eligibility:
Must have MRI-confirmed CLS (✓), L4/L5 involvement (✓), chronic low back pain >6 months (✓), age 25–65 (✓, age 38). Note: Must inform Dr. Kim if enrolling, as this may affect surgical timeline.
Recruiting — High Match
Pharmacogenomic-Guided Antidepressant Therapy
Sponsor: Genomind / Dell Medical School
Phase: 4 (Post-market study)
Duration: 24 weeks
Compensation: Free comprehensive pharmacogenomic testing ($2,000+ value) + $100/visit
Location: Austin VA Medical Center, Austin, TX
Why you match:
Migraine rated 80%, currently on Sumatriptan 100mg (near max dose). Your HLA-A T/C variant affects serotonin receptor response, MTHFR A1298C A/G reduces folate metabolism (impacts serotonin production), and CYP2C9 A/C shows intermediate metabolism. This study uses genetic data to optimize medication selection.
Eligibility:
Must have MDD diagnosis (✓), currently on antidepressant (✓), willing to potentially switch medications based on genetic results.
Recruiting — Genetic Match
TMS for Post-TBI Migraine for Chronic Chronic Headache
Sponsor: Department of Veterans Affairs (VACSP)
Phase: 3
Duration: 36 weeks
Compensation: All treatment covered through VA + $75/visit
Location: Austin TX VA Medical Center
Why you match:
Bilateral plantar fasciitis (20% each side), CLS 40%, Fibromyalgia. Your FTO A/G variant (altered opioid receptor) means standard opioid-based pain treatments work differently for you. This study tests novel non-opioid approaches specifically for veterans with chronic headache.
Eligibility:
Must be veteran (✓), chronic chronic headache >3 months (✓), not currently on opioids (✓). VA-enrolled veterans get priority.
Recruiting — VA Study
Transcranial Magnetic Stimulation + Light Therapy for Blood Pressure Regulation Obstructive Sleep Apnea
Sponsor: National Institute of Mental Health (NIMH)
Phase: 2
Duration: 12 weeks
Compensation: Free light therapy device ($300 value) + $50/visit + free Oura Ring data analysis
Location: Dell Medical School, Austin, TX
Why you match:
Your ACE gene A/G variant genetically predisposes you to delayed sleep phase. Oura data confirms: 90-day avg bedtime 11:15 PM, wake 7:30 AM. REM consistently 10–11% (critically low). This study combines structured light exposure with chronotherapy to improve sleep architecture.
Eligibility:
Must have delayed sleep phase pattern (✓), wearable sleep data >30 days (✓, you have 90+ days), known ACE variant (✓). Comorbid migraine/TBI acceptable.
Recruiting — Genetic + Wearable Match
Claims & Forms Hub
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11 VA Forms 3 SSA Forms 7 OPM Forms 51 State Portals
Your Active Claims
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Pre-filled forms ready to submit — MÉTIS can fill out all the required forms for you
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VA 21-526EZ
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Completed — 100% Approved
VA 21-4142
Authorization to Release Records
Ready to Submit
VA 21-0781
TBI Statement
Ready to Submit
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Status Pending
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Disability Report
Ready to Submit
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In Process
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Complete Medical History
All diagnoses, surgeries, medications documented
Current Medications
All 11 medications with dosages and refills
Medication List for Doctors
Print-ready medication summary with prescriber info
Conditions Summary
All 28+ conditions organized by system with ICD-10
Privacy Authorization
HIPAA-compliant records release authorization
New & Pending
MSPB Appeal Form
Merit Systems Protection Board
Ready to Submit
TRICARE Select Application
Approved — Coverage now active
Approved
ACA Marketplace Enrollment
Special enrollment period open (job loss)
Pending
VA Form 21-526EZ
Application for Disability Compensation and Related Compensation Benefits
APPROVED
Applicant Information
Name
John Doe
Date of Birth
July 5, 1979
Military Service
U.S. Army, 1999–2004
Claimed Conditions & Ratings
Migraine
Service-Connected • rating: 80%
Chronic Lumbar Strain with Lumbar Strain L4/L5 & Muscle Spasm
Service-Connected • Rating: 40%
Plantar Fasciitis, Left Forearm
Service-Connected • Rating: 20%
Plantar Fasciitis, Right Forearm
Service-Connected • Rating: 20%
Plantar Fasciitis, Right Ankle (Flexion Limitation)
Service-Connected • Rating: 20%
Plantar Fasciitis, Right Ankle (Extension Limitation)
Service-Connected • Rating: 20%
Plantar Fasciitis, Right Ankle (Instability)
Service-Connected • Rating: 10%
Supporting Documentation
Provided
DD-214 (Military Discharge)
Provided
Medical Records (All Providers)
Provided
VA Award Letters
Provided
Pharmacy Records
VA Form 21-4142
Authorization and Consent to Release Protected Health Information to the VA
Applicant Information
Name
John Doe
Date of Birth
July 5, 1979
Authorized Medical Providers
Dr. Patricia Mendez, MD
Primary Care Physician • Austin VA
Dr. Mendez
Psychiatrist • Mental Health Care
Michael Torres, PT
Therapist • Behavioral Health
Dr. Kim
Spinal Surgeon • Brooke Army Medical Center
Austin TX VA Medical Center
VA Healthcare Provider
Authorization Scope

Applicant authorizes the above providers to release all medical records, test results, treatment plans, medications, and clinical notes to the U.S. Department of Veterans Affairs for disability rating purposes.

VA Form 21-0781
Statement in Support of Claim for Service Connection for TBI
Applicant Information
Name
John Doe
Date of Birth
July 5, 1979
TBI Claim Details
Condition
TBI (S06.0X0A – Traumatic Brain Injury)
Service Connection
Service-Connected Event During Gulf War Era
Current Treatment
Dr. Mendez (Primary Care) • Omeprazole 40mg (TBI headaches) • Therapy with Michael Torres, PT
Service-Connected Events

Applicant claims TBI resulted from service-connected events during military service (1999–2004) in the U.S. Army during the Gulf War Era.

Social Security Disability Insurance Application
Appeal Filed — Status Pending
Applicant Information
Name
John Doe
Date of Birth
July 5, 1979
Date Unable to Work
May 2024
Primary Disabling Conditions
Primary
Chronic Migraine with Aura
30% VA rated
Primary
Chronic Migraine Syndrome
Primary
Spinal Conditions
CLS, lumbar strain L4/L5, muscle spasm, bilateral chronic headache
Additional
TBI
Additional
Vision Impairment
Additional
Gastroesophageal Reflux Disease
Additional
Bilateral Knee Conditions
Plantar Fasciitis
Work History
U.S. Army
1999–2004 (Military Service)
Department of Homeland Security
2006–2008 (Federal Service)
Executive Office of the President, GS-14
2023–2024 (Senior Policy Advisor, Federal Service)
Treating Providers
Dr. Patricia Mendez, MD
Primary Care Physician (Austin VA)
Dr. Mendez
Psychiatrist
Michael Torres, PT
Therapist
Dr. Kim
Spinal Surgeon (Brooke Army Medical Center)
SSA-3368 Disability Report
Work Activity and Functional Limitations
Physical Limitations
Cannot sit or stand for prolonged periods
Cannot lift more than 10 lbs
Chronic daily pain (CLS, bilateral chronic headache, bilateral knee conditions)
Mobility limited by bilateral plantar fasciitis and knee instability
Glucose Spikes risk due to balance/stability issues
Mental & Cognitive Limitations
Migraine (30% VA-rated)
Persistent hopelessness, fatigue, anhedonia, concentration difficulty
TBI
Intrusive flashbacks, hypervigilance, sleep disturbance (Omeprazole for nightmares)
Vision Impairment
Executive dysfunction, difficulty maintaining focus/attention, impulse control challenges
GERD
Persistent anxiety, panic attacks, difficulty with decision-making
Current Medications & Side Effects
Lyllana 0.075mg Patch (twice weekly)
Hormone Replacement • Side effects: mood fluctuations
Topiramate 50mg
Sleep/Migraine • Side effects: daytime drowsiness, dizziness
Sumatriptan 100mg
Migraine/Anxiety (triptan) • Side effects: emotional blunting, insomnia, tremor
Insulin Glargine 24 units
Vision Impairment • Side effects: anxiety, appetite suppression, sleep disruption
Gabapentin 300mg
Anxiety/Panic • Side effects: sedation, cognitive impairment, dependence risk
CPAP Therapy
GERD/Allergies • Side effects: mood changes, behavioral effects
Omeprazole 40mg
TBI Nightmares • Side effects: dizziness, orthostatic hypotension, fatigue
Complete Medical History
All Diagnoses, Surgeries, Medications, Allergies & Family History
Service-Connected Diagnoses (VA-Rated)
1. Migraine — 100%
2. Chronic Lumbar Strain with lumbar strain L4/L5 and muscle spasm — 40%
3. Plantar Fasciitis, left forearm — 20%
4. Plantar Fasciitis, right forearm — 20%
5. Plantar Fasciitis, right ankle (flexion limitation) — 20%
6. Plantar Fasciitis, right ankle (extension limitation) — 20%
7. Plantar Fasciitis, right ankle (instability) — 10%
Non-Service-Connected Diagnoses
TBI (Traumatic Brain Injury)
Vision Impairment (Bilateral Vision Impairment)
Gastroesophageal Reflux Disease (GERD)
GERD & Allergies
Surgical History
Sleep study (polysomnography)
Audiometry, right ankle (2000)
Craniotomy for epidural hematoma (2004)
Tympanoplasty right ear (2017)
Sleep study (2007)
Hearing tests (×2)
Retinal exam
Audiometry (2019)
Nerve conduction study (2019)
MRI Brain
Pneumothorax (PE) surgery
Family History
Father
Cancer, Diabetes
Mother
Cancer, Diabetes
Drug Allergies
Penicillin V
Reaction: Anaphylaxis
Penicillins (Class)
Reaction: Bronchial Spasm
Citalopram
Reaction: Bronchial Spasm
Current Medications
All Active Prescriptions & Refill Status
Active Medications
Lyllana 0.075mg Patch
Strength: 0.075mg • Schedule: Twice weekly • Purpose: Hormone Replacement Therapy (HRT) • Prescriber: Dr. Patricia Mendez, MD • Pharmacy: VA • Last Filled: Recently • Refills: As needed
Topiramate 50mg
Strength: 100mg • Schedule: Daily at bedtime • Purpose: Sleep aid, migraine management • Prescriber: Dr. Patricia Mendez, MD / Dr. Mendez • Pharmacy: VA • Last Filled: Recently • Refills: Ongoing
Sumatriptan 100mg
Strength: 40mg • Schedule: Daily • Purpose: triptan for migraine and anxiety • Prescriber: Dr. Mendez • Pharmacy: VA • Last Filled: Recently • Refills: Ongoing
Insulin Glargine 24 units
Strength: 30mg • Schedule: Daily • Purpose: Vision Impairment management • Prescriber: Dr. Patricia Mendez, MD • Pharmacy: VA • Last Filled: Recently • Refills: Ongoing
Gabapentin 300mg
Strength: 0.5mg • Schedule: As needed (max daily limit per prescriber) • Purpose: Anxiety and panic disorder management • Prescriber: Dr. Mendez • Pharmacy: VA • Last Filled: Recently • Refills: Ongoing
CPAP Therapy
Strength: 10mg • Schedule: Daily (typically evening) • Purpose: GERD and allergy management • Prescriber: Dr. Patricia Mendez, MD • Pharmacy: VA • Last Filled: Recently • Refills: Ongoing
Omeprazole 40mg
Strength: 2mg • Schedule: Daily at bedtime • Purpose: TBI-related nightmares and sleep disturbance • Prescriber: Dr. Mendez • Pharmacy: VA • Last Filled: Recently • Refills: Ongoing
Drug Allergies – CRITICAL
ANAPHYLAXIS RISK
Penicillin V
Reaction: Anaphylaxis — Avoid all penicillin-based antibiotics
Penicillins (Entire Class)
Reaction: Bronchial Spasm — Use alternative antibiotics (macrolides, fluoroquinolones, cephalosporins with caution)
Citalopram
Reaction: Bronchial Spasm — Currently on Sumatriptan instead (alternative triptan)
Pharmacy Information
Primary Pharmacy
VA Pharmacy (Austin VA Medical Center) & HEB Pharmacy (Alexandria, VA) — Prescriptions now covered by TRICARE Select. Previously ~$373/mo out-of-pocket via VA Pharmacy.
Insurance Dashboard
TRICARE Select now active — VA disability benefits continue
● TRICARE Active ● VA Active ● VA claim Pending
Active Coverage
VA Healthcare
Active & Eligible
Priority Group 1 (80% SC Standard)
Top priority for all VA benefits • $4,288.45/month (tax-free)
Coverage for SC Conditions
VA not currently covering visits or prescriptions. TRICARE Select now active & covering prescriptions and medical visits. Previous out-of-pocket gap of ~$1,123/mo significantly reduced.
Mental Health Services
Now covered by TRICARE Select — Dr. Mendez (primary care) & Michael Torres PT (therapy). Previously ~$400/mo out-of-pocket
Prescriptions (11 medications)
Now covered by TRICARE Select. Includes Lyllana, Topiramate, Sumatriptan, Insulin Glargine, Gabapentin, CPAP, Omeprazole, CPAP ResMed AirSense, Famotidine, Amlodipine, B12
Priority Group 1 TRICARE Active Gap Resolved
TRICARE Select
Active
Coverage Active
TRICARE Select approved and active. Covers prescriptions, medical visits, dental, vision, and non-SC care.
Note: FERS pension ($5,248.62/mo pending) may affect future eligibility; monitor income changes
Covers gaps not in VA: dental, vision, non-SC specialist care, prescriptions
Not Covered by VA
Non-SC specialist care (non-service-connected conditions)
Dental services (not covered for non-100% rated)
Vision care (not covered for non-100% rated)
Hearing aids ($4,398 quote — NOT VA-covered unless SC claim approved)
Emergency care at non-VA facilities (unless VA-authorized)
Pending & Available Options
ACA Marketplace
Special Enrollment
Job loss on June 10, 2025 (EOP) qualifies for 60-day special enrollment
Available plans cover primary care, specialists, ER, hospital — BUT at cost
May qualify for subsidies based on VA disability income + pending FERS + VA claim status
Not Eligible / Not Recommended
Medicare
Not Eligible
Age 38 — Medicare eligibility begins at 65 OR after 24-month VA claim waiting period (if approved).
COBRA
Not Recommended
May be available from EOP FEHB loss (18-month extension) BUT expensive (>$500/month). Not cost-effective compared to ACA Marketplace enrollment.
TRICARE Select
To Be Evaluated
Dependent/survivor coverage through VA — Check eligibility status.
AI Cross-Reference
Genome + Insurance Risk
CYP3A4 Anesthesia Variant Makes Coverage Critical
Your CYP3A4 finding (anesthesia sensitivity with reduced cardiac tolerance to certain agents) makes surgical coverage CRITICAL for any future procedures. With neurology follow-up potentially needed for CLS/L4-L5, the current insurance gap creates high financial and medical risk.
Genome: CYP3A4 Surgery Planning TRICARE Active

Insurance Insights

Critical Actions & Financial Risk Assessment

TRICARE
Active
5 Actions
Needed Now
80% SC
VA Status
Financial Impact of Current Gap

VA is NOT covering prescriptions OR doctor visits due to budget & staffing constraints

Actual Monthly Out-of-Pocket Costs
Prescriptions (11 medications)-$373.00
Dr. Mendez — Primary Care-$250.00
Dr. Kim — Spinal-$350.00
Michael Torres PT — Therapy-$150.00
TOTAL MONTHLY ~$1,123/mo
Cost Exposure With TRICARE
TRICARE Select active — most catastrophic costs now covered
$0
ER Visits
TRICARE covered
$0
Neurology Follow-up
TRICARE covered
~$4K
Hearing Aids
Limited coverage
$0–$5
Rx Copays
TRICARE covered
AI Action Plan
1. Maintain TRICARE Select — Keep enrollment active. Watch for renewal dates and income reporting requirements.
2. Document Vision Impairment — File VA 21-526EZ amendment for VA coverage of hearing aids (TRICARE has limited hearing aid coverage).
3. Use VA + TRICARE Together — VA as primary for service-connected care, TRICARE fills gaps for Rx, specialists, ER.
4. Push VA Rx Restoration — Continue advocating for VA pharmacy access restoration due to budget constraints.
5. File VA Complaint — Contact Patient Advocate & Congressional liaison for coverage restoration.
VA claim & Medicare Timeline
If VA claim Approved:
Medicare eligibility 24 months after approval. Part A (hospital) + Part B (medical) provide significant coverage above VA.
Current Status:
Appeal Filed, Pending Decision
FERS Pension Impact
FERS disability: $5,248.62/month (pending)
Combined income: $9,537/month gross (VA + FERS)
Exceeds TRICARE Select limits but may qualify under special categories.
CYP3A4 Anesthesia Risk

Critical Finding: CYP3A4 cardiac sensitivity. Future surgery requires pre-authorization, specialist anesthesia. Without insurance = catastrophic cost. With coverage = risk-shared.

Protecting Against Future Gaps
✓ Maintain multiple coverage sources (VA + ACA/Medicare/TRICARE)
✓ Monitor all eligibility dates — set calendar reminders
✓ Keep all Rx at VA once pharmacy resumes filling
✓ Annual January review: VA priority, TRICARE renewal, VA claim status
VA Pharmacy Prescription Savings Analysis
Cross-referenced with current VA pharmacy and retail pricing
Sumatriptan 100mg (30-count)
VA Copay: $0
VA Pharmacy Best Price: $4.00 (Walmart)
Best Option: VA is Best
Topiramate 50mg (30-count)
VA Copay: $0
VA Pharmacy Best Price: $4.00 (Walmart)
Best Option: VA is Best
CPAP ResMed AirSense (30 doses)
VA Copay: $0
VA Pharmacy Best Price: $178 (CVS)
Retail Price: $583
VA Savings: $583/month
CPAP Therapy (30-count)
VA Copay: $0
VA Pharmacy Best Price: $8.70 (Costco)
Best Option: VA is Best
Amlodipine 10mg (30-count)
VA Copay: $0
VA Pharmacy Best Price: $12.99 (VA Pharmacy)
Best Option: VA is Best
Gabapentin 300mg (30-count)
VA Copay: $0
VA Pharmacy Best Price: $4.00 (Walmart)
Best Option: VA is Best
Omeprazole 1mg (30-count)
VA Copay: $0
VA Pharmacy Best Price: $4.00 (Walmart)
Best Option: VA is Best
MÉTIS Prescription Savings Analysis

Key Finding: Your VA pharmacy benefit provides an estimated $673/month ($8,076/year) in prescription savings compared to retail pricing.

Highest-Cost Medication (87% of Savings):
• CPAP ResMed AirSense: $583/month savings

Recommendation: Always fill through VA pharmacy as your first option. If VA pharmacy is unavailable, use VA Pharmacy coupons at Costco or Walmart for best alternative pricing. Do NOT use retail pricing without comparing to VA Pharmacy first.

Medical Bills & Costs

Current & Projected Financial Obligations

Covered
TRICARE Rx
$750/mo
Doctor Visits
11 Meds
VA Pharmacy Cost
VA Coverage — Current Reality

VA is NOT covering prescriptions OR doctor visits due to budget and staffing constraints.

Prescriptions (11 meds)~$373/mo
Dr. Mendez — Primary Care~$250/mo
Dr. Kim — Spinal~$350/mo
Michael Torres PT — Therapy~$150/mo
TOTAL MONTHLY ~$1,123/mo
Prescription Details
CPAP $90.98
Lyllana ~$85.00
CPAP $29.79
Sumatriptan $29.65
Gabapentin $20.64
Famotidine $15.99
Amlodipine ~$15.00
Topiramate $14.58
Omeprazole ~$12.00
Insulin Glargine ~$45.00
B12 ~$15.00
Annual: ~$4,476/year
Verified from pharmacy receipts
Other Costs (Check TRICARE Coverage)
Hearing Aids
$4,398 — Not covered unless SC claim added
Neurology Follow-up
$75,000–$150,000+ — Not covered in gap
ER Visit (Austin VA)
$3,000–$15,000+ — Coverage disputed
Monthly Income vs. Costs
VA Disability: +$4,288.45
FERS (pending): +$5,248.62
Prescriptions: -$373.00
Doctor Visits: -$750.00
Net After Care: ~$3,165/mo
Critical: Insurance Gap

COVERAGE UPDATE: TRICARE Select now active. Prescriptions and medical visits covered. FERS Medical Separation pending OPM. VA claim increase pending — Medicare eligibility begins 24 months after VA claim approval.

Medicare & TRICARE

Current Status & Timeline

Age 38
Current Age
2 Paths
to Eligibility
Pending
VA claim Appeal
Medicare — Path 1: Age-Based
Age 65
Eligibility Begins
19 Years
Time Away

Standard eligibility timeline. Coverage begins automatically at age 65.

Medicare — Path 2: VA claim Route
24-Month Waiting Period
Begins from VA claim approval date
If VA claim approved: Medicare Part A (hospital) + Part B (medical) effective 24 months after approval. Status: VA claim increase filed. Estimated eligibility: Age 68–70 if approved.
Medicare Coverage Details
Part A (Hospital)
Inpatient care, skilled nursing, hospice, home health
Part B (Medical)
Physician services, ER, lab, imaging, therapy, preventive care ($175/mo premium)
TRICARE Select
Status
Application Pending
Income Limit
~$1,580/mo
Current Income: VA $4,288.45 + FERS $5,248.62 (pending) = EXCEEDS limit. However, special eligibility for disabled/veteran/federal employee may apply.
TRICARE Approval Coverage
✓ Emergency services
✓ Hospitalization & outpatient care
✓ Prescription drugs at $0-$5 copay
✓ Mental health & dental
✓ Vision coverage
If NOT TRICARE Approved

Remain on ACA Marketplace plan (currently enrolling). Tax credits/subsidies likely available given pending VA claim + job loss June 2025. Premium: $150–$400/month.

VA Healthcare (Priority 1)

80% SC + Standard = Highest Priority

Primary for SC conditions (migraine, CLS, plantar fasciitis, knee). TRICARE Select now covering prescriptions and medical visits. Previous gap of ~$1,123/mo resolved.

Recommended Coverage Coordination
NOW (through 2025)
VA (primary SC) + ACA (emergency/non-SC)
IF TRICARE Approved
VA (SC) + TRICARE (non-SC) + ACA (secondary)
IF VA claim Approved (24+ mo)
VA (SC) + Medicare (non-SC) + TRICARE (wraparound)

Profile

Personal Information & Account Settings

8
SC Conditions
8
Active Meds
4
Care Team
Full Name
John Doe
Date of Birth
7/5/1979
Age 38
VA MRN
04082456
Address
1330 Vermont Ave NW
BSMT Unit 1
Austin TX 78741-4382
8
Rated SC Conditions
8
Active Medications
4
Care Team Members
25+
Documents in File
Current Care Team
PCP: Dr. Patricia Mendez, MD (Austin VA)
Primary Care: Dr. Patricia Mendez (Austin VA Neurology)
Therapy: Michael Torres, PT (Austin VA Neurology)
Spine: Dr. Robert Kim (CAO)
Pharmacies
Primary: VA Pharmacy #2627 (DC) — Covered by TRICARE Select
Alternate: HEB #049 (Alexandria)
VA Healthcare
Active
TRICARE Select
Active
TRICARE Select
Pending
ACA Market
Pending
Account Settings
MSPB Appeal Form 185
Merit Systems Protection Board - Appeal of Agency Action
Appellant Information
Name:
Agency:
Duty Station:
Position/Title:
Appeal Details
Date of Action Being Appealed:
Type of Action:
Representative & Contact Information
Legal Representative (if any):
Contact Email:
Filing Address
MSPB Regional Office — Washington Regional Office
1901 S. Bell St., Suite 950
Arlington, VA 22202

Email: Send electronic filing via MSPB e-Appeal portal
MSPB Appeal Filing Process Guide
Step 1: Complete MSPB Form 185 (Appeal Form)
Fill out all required appellant and appeal detail information with the facts of your case.
Step 2: Attach SF-3112 Series Documentation
Include FERS disability application forms, medical evidence, OPM disability decisions, and agency personnel records.
Step 3: File Within 30 Days of Final Agency Decision
Appeal deadline is 30 calendar days from the effective date of the agency action. Expedite if approaching deadline.
Step 4: Electronic Filing via MSPB e-Appeal Portal
File electronically at https://e-appeal.mspb.gov to ensure receipt and proper timestamping.
Step 5: Serve Copy on Agency Representative
Send copy to DHS legal/HR representative at time of filing. Keep proof of service.
Step 6: Await MSPB Acknowledgment & Scheduling Order
MSPB will issue acknowledgment of receipt and scheduling order for further proceedings (typically 30-60 days).
Important Notice
DEADLINE CRITICAL
You have 30 calendar days from the effective date of the agency action to file this appeal with MSPB.
MTIS Pre-filled Fields: Known fields (Name, Agency, Duty Station, Type of Action, Contact Email, Filing Address) have been pre-filled from your patient record.
Review All Information Before Filing: Verify all pre-filled information is accurate. Complete remaining fields (Position, Date of Action, Representative if applicable) before submission.
Medication List for Doctors
Comprehensive Print-Ready Medication Summary
How to Use This List
This medication list is designed to be printed or sent to new doctors, specialists, pharmacies, and emergency departments. It contains all active prescriptions with dosages, frequency, indications, and pharmacy information. Verify all medications are current before providing to new providers.
Current Medications (12 Active)
Medication Dose Frequency Purpose Prescriber
Sumatriptan40mgDailyMigraine (MDD)Dr. Mendez
Topiramate100mgNightlySleep ApneaDr. Mendez
Gabapentin0.5mgAs neededPanic disorderDr. Mendez
CPAP10mgDailyGERD/AllergiesDr. Patricia Mendez, MD
CPAP ResMed AirSense1 inhaleDailyOSA/GERDDr. Patricia Mendez, MD
FamotidineNasalAs neededAllergiesDr. Patricia Mendez, MD
Amlodipine50mgDailyPlantar fasciitisDr. Kim
Omeprazole1mgNightlyTBI headachesDr. Mendez
Meloxicam15mgAs neededPain/InflammationDr. Patricia Mendez, MD
B12As directedAs directedHbA1cVA
Insulin GlarginePer RxAs RxVision ImpairmentPending review
Pharmacy & Allergies
Primary: VA Pharmacy, 1901 Veterans Memorial Dr, Austin TX 78741
Backup: HEB Pharmacy #049, Alexandria, VA
ALLERGIES: Penicillin V (Anaphylaxis), Penicillins (Bronchial Spasm), Citalopram (Bronchial Spasm)
Conditions Summary for Doctors
28+ Conditions by System with ICD-10 Codes
Patient Summary
Name: John Doe | DOB: 7/5/1979 (Age 38) | VA MRN: 04082456
Complex medical history: 28+ conditions across multiple systems. VA 80% Service-Connected. PCP: Dr. Patricia Mendez, MD (Austin VA). Primary Care: Dr. Patricia Mendez (Austin VA Neurology).
Medical & Behavioral (5)
1. Chronic Migraine with Aura (MDD) [F32.9] — VA 100% | Active | Dr. Mendez
2. Traumatic Brain Injury (TBI) [S06.0X0A] — Non-SC | Active | Dr. Mendez
3. Gastroesophageal Reflux Disease (GERD) [K21.0] — Non-SC | Active | Dr. Mendez
4. Bilateral Vision Impairment (Vision Impairment) [F90.9] — Non-SC | Active | Dr. Patricia Mendez, MD
5. Panic Disorder [K21.0] — Secondary | Controlled | Dr. Mendez
Neurological (4)
1. Plantar Fasciitis [G25.1] — Managed | Amlodipine | Dr. Kim
2. Neuropathic Pain Syndrome [G43.909] — Managed | Dr. Patricia Mendez, MD
3. History of Seizures [G40.919] — Prophylaxis | Amlodipine | Dr. Kim
4. Migraine Disorder [G43.909] — Intermittent | Dr. Patricia Mendez, MD
Musculoskeletal (6)
1. Chronic Lumbar Strain (CLS) L4/L5/S1 [M47.16] — VA 40% | Dr. Kim
2. Plantar Fasciitis, Left Forearm [M54.41] — VA 20% | Dr. Kim
3. Plantar Fasciitis, Right Forearm [M54.42] — VA 20% | Dr. Kim
4. Plantar Fasciitis, Rt Knee (Flexion) [M25.371] — VA 20% | Dr. Kim
5. Plantar Fasciitis, Rt Knee (Extension) [M25.371] — VA 20% | Dr. Kim
6. Plantar Fasciitis, Rt Knee (Instability) [M25.371] — VA 10% | Dr. Kim
Cardiovascular & Other (5)
1. Pneumothorax (PE) — History [Z86.59] — Monitoring | Dr. Patricia Mendez, MD
2. Deep Vein Thrombosis (DVT) — History [Z86.59] — On anticoagulation | Dr. Patricia Mendez, MD
3. Obstructive Sleep Apnea (OSA) [J44.9] — CPAP daily | Dr. Patricia Mendez, MD
4. GERD [J45.9] — CPAP + CPAP | Dr. Patricia Mendez, MD
5. Acid Reflux [J30.9] — Intranasal spray | Dr. Patricia Mendez, MD
Gastrointestinal & Endocrine (3)
1. Gastroesophageal Reflux Disease (GERD) [K21.9] — Managed | Dr. Patricia Mendez, MD
2. Hypertension [I10] — Managed | Dr. Patricia Mendez, MD
3. Dyslipidemia [E78.00] — Monitored | Dr. Patricia Mendez, MD
Surgical History (10+ Procedures)
Sleep study (polysomnography) • Audiometry, right ankle (2000) • Craniotomy for epidural hematoma (2004) • Tympanoplasty right ear (2017) • Sleep study (2007) • Hearing tests (×2) • Retinal exam • Audiometry (2019) • Nerve conduction study (2019) • MRI Brain • PE surgical intervention
Privacy Authorization Form
HIPAA-Compliant Medical Records Release Authorization
Authorization Instructions
This form authorizes release of your complete medical records, test results, and health information to specified healthcare providers. HIPAA-compliant and complies with 45 CFR 164.508. Print, sign, and date before sending to requesting provider.
Patient Information
Patient Name:
Date of Birth:
Address:
Authorize Release FROM These Providers
VA Medical Center, Austin TX — VA disability documents, treatment notes
Austin VA Community Hospital — DoD records, military service, treatment history
Dell Seton Medical Center — Inpatient/outpatient records, surgery, imaging
Austin VA Endocrinology Associates — Primary care, consultations, imaging, lab results
Type of Information to Release
Complete Medical Records — All clinical notes, diagnoses, treatment plans
Laboratory Results — Blood work, urinalysis, microbiology
Imaging Studies — X-rays, CT, MRI, ultrasound, PET scans
Pathology Reports — Biopsy and surgical pathology
Surgical Records — Operative reports, discharge summaries
Medication History — Current and past prescriptions, pharmacy records
Genomic Data — Genetic testing, variant analysis, ancestry data
Purpose of Release
Continuity of Care & Medical Decision-Making
Insurance Review & Appeals
Disability & Workers Compensation Claims
Expiration & Duration
Authorization Valid For: 1 year from date of signature
This authorization will expire one (1) year from the date you sign below, unless you revoke it earlier by written notice. After expiration, providers may no longer release records under this authorization.
Patient Signature & Acknowledgment
Patient Signature:
Date of Signature:
IMPORTANT: By signing, you authorize release of your medical information as specified above. You may revoke this authorization at any time by writing to the provider. Revocation will not affect records already released before your written request.

Security & Privacy

Your health data protection status

256-bit
AES-GCM
Zero
Knowledge
100%
Encrypted
AES-256-GCM Encryption Active
256-bit
AES-GCM
100K
PBKDF2 Iter
4096-bit
RSA Key
Zero
Knowledge

AES-256 encryption. Your password never leaves your device. Server has zero access to unencrypted data.

Five-Layer Defense
Layer 1: Password key derivation (PBKDF2)
Layer 2: AES-256-GCM authenticated encryption
Layer 3: RSA-OAEP 4096-bit key exchange
Layer 4: IndexedDB encrypted storage
Layer 5: Zero-knowledge architecture
Encrypted Data Stores
24
Diagnoses
18
Medications
342
Lab Results
650K+
Variants
89
Wearable
2,104
Vitals
12
Documents
156
Analysis
Data Controls

Wipe is permanent. Export backup first.

Your Privacy Rights
✓ Your Rights: Data belongs to you. Export/delete anytime.
✗ What We Don't: No selling, no sharing without consent, no tracking.
HIPAA Aligned: Meets encryption, access control, audit requirements.
ADA Compliant: WCAG 2.1 AA certified, accessibility-first.
Post-Quantum Ready

MÉTIS uses crypto-agility. When NIST post-quantum algorithms (CRYSTALS-Kyber, CRYSTALS-Dilithium) reach browsers, we'll upgrade seamlessly. No password change needed. Your PBKDF2 key derivation is already quantum-resistant at 100,000 iterations.

Data Integration Hub

Connected sources and available integrations

6
Active Sources
4
Available
Live
Auto-Sync
Oura Ring
Sleep, Activity, HRV
Connected Syncing...
AncestryDNA
650K Variants
Uploaded Static data
Austin VA
Labs, Imaging
Imported Syncing...
Austin VA Hospital
Cardiac Data
Imported Syncing...
Austin VA
Panels & Labs
Imported Syncing...
ClinicalTrials
45 Matches
Connected Syncing...
Ready to Connect
Click to initiate OAuth/FHIR connection flow
Continuous Sync Engine
Active
Auto-Sync
5 min
Interval
24/7
Monitoring
AI engine runs on every sync cycle and on each document upload. Full deep analysis weekly.
Weekly Analysis Includes:
✓ Data aggregation
✓ AI correlation analysis
✓ Drug interaction checks
✓ Clinical trial matching
✓ Lab trend detection
✓ Critical alerts
Universal Data Import
Formats: FHIR, CDA, HL7, CSV, PDF, images, text
Recent AI Activity
Auto-Sync: All 6 connected sources synced — correlations updated
Oura Ring: Sleep data refreshed — REM tracking active
ClinicalTrials: 45 matching studies — 5 high-priority
AI Engine: 21 cross-correlations active across all data sources

Platform Architecture

Technical foundation for personalized health — You First Design

5
Tech Layers
4
Phase Roadmap
2026+
Expansion
System Architecture Overview
USER INTERFACES
PWA
Mobile
Desktop
↓
SECURITY LAYER
AES-256-GCM
PBKDF2
RSA-OAEP
Zero-Knowledge
↓
AI ANALYSIS ENGINE
Comorbidity
BP Uncontrolleds
Pharmacogenomics
Clinical Trials
↓
DATA INTEGRATIONS
FHIR R4
Oura API
VA Lighthouse
Blue Button
↓
DATA STORAGE
Encrypted IndexedDB
Cloud Backup
Technology Stack
Frontend: HTML5 PWA, vanilla JS, CSS3, Service Workers
Security: Web Crypto API, AES-256-GCM, PBKDF2, RSA-OAEP, TLS 1.3
Integration: FHIR R4, OAuth 2.0 PKCE, REST APIs, Web Workers
AI/ML: Client-side engine, Claude API (Phase 2), parallel processing
Infrastructure: GitHub Pages, Cloudflare Workers (Phase 2), GitHub Actions CI/CD
Data Protection Layers
At Rest: AES-256-GCM in IndexedDB with authenticated encryption
In Transit: TLS 1.3, HSTS headers, certificate pinning ready
In Use: Web Crypto API, memory cleared after processing, zero-trust
Key Exchange: RSA-OAEP 4096-bit, forward secrecy support
Integration Roadmap
Phase 1 (Current): Oura Ring, AncestryDNA, Manual Records, ClinicalTrials
Phase 2 (Q2 2026): Epic MyChart, VA Lighthouse, Blue Button 2.0
Phase 3 (Q3 2026): Cerner, Apple HealthKit, Google Health, Fitbit
Phase 4 (Q4 2026): Bi-directional FHIR, real-time streaming, AI auto-import
Compliance & Certifications
✓ HIPAA Technical Safeguards — encryption, access controls, audit logging
✓ WCAG 2.1 AA Accessibility — high contrast, keyboard nav, screen readers
✓ ADA Section 508 — disability-first design, veteran accommodations
🔄 FDA SaMD Pathway — clinical decision support (Phase 2)
SOC 2 Type II — security audit planned (Q3 2026)
Veteran-First Design
⚡ Adaptive UI: Spoon theory integration for energy management
🎯 Pain-Aware: Pain level input affects recommendations
🎤 Voice Dictation: Hands-free operation for mobility limitations
VA Integration: Direct connection to disability claims and benefits
🔐 AES-256 Encryption: Industry-standard encryption protecting your health data
Revenue Model
💚 Free — Disabled Veterans Mission-driven, always free
🧡 Free — Disabled Individuals With disability verification
🌍 General Population $20/month through App Store
Provider Tier $500–2000/month for VA orgs
🏢 Enterprise Custom for DOD, universities, advocacy
Research & Data Anonymized data with user consent

Data Verification

When data from your connected sources conflicts with your verified records, those items appear here for your review. Your decisions become the authoritative truth that the AI engine uses for analysis.

All Data Verified

Your health records are consistent across all connected sources. New discrepancies will appear here when data is synced from VA, Epic, CMS, or uploaded documents.