Vitals · Physical Health

03 · Body composition

Body composition — Withings ScaleComposição corporal — balança Withings

18 bio-impedance weighings between October 2025 and April 2026 (one failed reading filtered). Height 1.74 m on file. Most recent reading: 1 April 2026.18 pesagens por bioimpedância entre outubro de 2025 e abril de 2026 (uma leitura falha foi filtrada). Altura 1,74 m em ficha. Última leitura: 1º de abril de 2026 — 81,4 kg.

Body weight

81.4kg

Target 69–70 kg · Above target

Body fat

24.2%

Target <18% · Above target

Muscle mass

58.6kg

Flat since October (+0.04 kg)

BMI

26.9

Target <23 · Overweight

Body composition trend — Oct 2025 → Apr 2026

Withings Scale · n=18 readings

Trend reading. Body composition has been essentially flat across the recorded period: weight 81.7 → 81.4 kg, body fat 24.5% → 24.2%, muscle mass 58.6 → 58.6 kg. Since 1 January 2026 weight is +1.4 kg, body fat −0.9 pp, muscle +1.7 kg — directionally fine but modest. Quetiapine-driven appetite remains a known headwind.

04 · Sleep architecture

Sleep architecture — Oura RingArquitetura do sono — Oura Ring

184 long-sleep nights (≥3h) tracked between 18 October 2025 and 24 April 2026.184 noites de sono prolongado (≥3h) registradas entre 18 de outubro de 2025 e 24 de abril de 2026.

Total sleep (median)

8h 37m

IQR 7h26m – 9h55m

Deep (median)

1h 36m

IQR 1h09m – 1h56m

REM (median)

1h 21m

16% — Low (benzo-driven)

Light (median)

5h 37m

65% — Quetiapine signature

Awake (median)

1h 23m

Normal <30m · Elevated

Sleep score

82/100

IQR 76–87

Efficiency (median)

85%

Target ≥85% · At target

Bedtime SD

±2.6hrs

High circadian drift

Sleep stage distribution — boxplot (±1.5 × IQR)

Oura · n=184 nights · long-sleep events ≥3h

Box: Q1 – Q3 · Centre line: median · Whiskers extend to the furthest point within 1.5 × IQR · Dots: outliers

Clinical note. REM sleep median 1h24m sits below the healthy 20–25% threshold. Benzodiazepines are potent REM suppressors, directly impairing emotional memory consolidation and PTSD recovery. Light sleep at 65% is a Quetiapine signature. As the diazepam taper progresses, expect REM rebound — vivid dreams and initial fragmentation — before sustained improvement.

05 · Exercise

Exercise trackAtividade física estruturada

157 structured workouts auto-recorded by Oura Ring between October 2025 and April 2026. All sessions logged at moderate intensity. Note: lap-pool swimming and many gym sessions are not auto-detected and may be under-counted. 157 treinos estruturados registrados automaticamente pelo Oura Ring entre outubro de 2025 e abril de 2026. Todas as sessões em intensidade moderada. Observação: a natação em piscina é a modalidade principal do paciente (3×/semana, 30–45 min), mas não é detectada pelo anel; aparece apenas em passos e VFC.

Total sessions

157

~26 weeks of data

Walking sessions

126

2,321 min total

Cycling sessions

27

710 min total

Strength sessions

3

109 min · Very low

Swimming sessions

1

60 min logged

Avg session length

20min

All intensities = moderate

Exercise modality mix — total minutes

Oura workouts · Oct 2025 – Apr 2026

Programming constraints. Avoid overhead loading and barbell back squat pending cervical MRI clearance. Cycling and swimming preferred for cardio; lower-body compound lifts (goblet squat, hip thrust, leg press) for strength. The data shows the programme is currently walking-dominant — strength and swimming are far below the osteopath's recommendation of 150 Zone-2 minutes/week and 2× lower-body sessions.

06 · Movement

Movement trackAtividade ambiente

190 days of Oura ambient activity, 17 October 2025 → 24 April 2026.190 dias de atividade ambiente do Oura, 17 de outubro de 2025 → 24 de abril de 2026.

Steps / day (median)

5,772

IQR 3,808 – 8,222 · target 10k

Steps / day (mean)

6,196

Target 10,000 · Below target

Days ≥10k steps

26/189

14% of days

Days ≥5k steps

113/189

60% of days

Sedentary time / day

8h 06m

Mean across 190 days

Active calories / day

331kcal

Mean

Daily steps — every recorded day

Oura activity · n=190 days

<3,000 3–5k 5–7k ≥7k

07 · Cardiovascular & recovery

Cardiovascular healthSaúde cardiovascular

184 nights of Oura HRV / lowest-RHR readings, October 2025 → April 2026.184 noites de leituras de VFC e FC em repouso mínima do Oura, outubro de 2025 → abril de 2026.

Resting HR (median)

65bpm

Healthy 50–65 · Borderline

HRV (median)

17ms

Age 55–65 · Critically low

HRV (mean)

21.1ms

Pulled up by occasional spikes

Readiness (median)

78/100

Mean 75.4 · Sub-optimal

HRV & resting heart rate — monthly mean

Oura Ring · n=184 nights

HRV findings

59% of nights (108 / 184) below 20 ms — chronic autonomic dysregulation
Only 2 nights reached ≥60 ms across the entire period
Mean (21 ms) is pulled above the median (17 ms) by sparse high-HRV nights

Trend by month

Oct 19.4 · Nov 19.0 · Dec 19.5 ms
Jan 24.5 · Feb 24.6 · Mar 23.7 ms
Apr 15.1 ms — sharp regression

What changed in April

April BP also worsens — 154.8 / 110.8 mmHg mean
Coincides with cervical protrusion crisis (March) and ongoing pain
Suggests the gains of Jan–Mar are not yet stable

Electrocardiograms (Apple Watch · 57 single-lead recordings · Oct 2023 – Apr 2026)

Sinus rhythm

39/57

68% — Normal

High heart rate

15/57

26% · Watch — 4 in last 30 days

Poor recording

3/57

Re-record needed

Atrial fibrillation

0

None detected

Most recent eight ECGs:

Date	Classification	File

08 · Blood pressure

Blood pressure — Withings cuffPressão arterial — monitor Withings

233 readings, 13 November 2025 – 6 April 2026.233 leituras, 13 de novembro de 2025 – 6 de abril de 2026.

Systolic mean

135mmHg

Stage 1 hypertension

Systolic peak

172mmHg

Hypertensive spike

Diastolic mean

89.8mmHg

Normal <80 · Elevated

Diastolic peak

116mmHg

Hypertensive crisis range

Latest mean (Apr 6)

155/111

Stage 2 — return after Feb gap

Cuff HR mean

91bpm

During measurement

Blood pressure — monthly mean

Withings BP · n=233

Month	Readings	Systolic mean	Diastolic mean	Classification
November 2025	149	137.3	91.3	Stage 2
December 2025	63	132.1	87.0	Stage 1
January 2026	11	118.1	78.1	Normal / Elevated
February 2026	6	134.2	88.8	Stage 1
April 2026	4	154.8	110.8	Stage 2

April readings are clinically actionable. Four readings post the cervical protrusion crisis show systolic 154.8 / diastolic 110.8 mmHg — Stage 2 hypertension territory, with the highest diastolic of the entire dataset (116 mmHg). Pain, restarted Diprospan (corticosteroid), Duloxetine 120 mg, and benzodiazepine fluctuations are known contributors. Worth flagging to GP at the next visit.

12 · Latest physician assessment

Osteopath assessment — 9 April 2026Avaliação osteopática — 9 de abril de 2026

Letter from Luca Galvao Bueno, M.Ost BSc — The Body Formulae Clinic, London. A three-phase treatment plan addressing nervous-system regulation, gut motility, and post-concussion neuroinflammation. Carta de Luca Galvão Bueno, M.Ost BSc — The Body Formulae Clinic, Londres. Um plano de tratamento em três fases abordando regulação do sistema nervoso, motilidade intestinal e reeducação do movimento.

Phase 1 — Nervous system & blood sugar

Protein 90–100 g/day; eat every 3–4 h
Reduce alcohol progressively
No refined carbs on empty stomach
Avoid herbal teas on empty stomach
Cinnamon as blood-sugar regulator
Zone 2 cycling 150 min/week
Daily breathing / prayer / meditation
Dim lights / no screens 1h pre-bed

Phase 2 — Gut motility & bile flow

Kiwi, soaked flax/chia, oats — fibre
Ox bile + digestive enzymes — 1 cap × 3 with main meals
Partially hydrolyzed guar gum (PHGG) — prebiotic
Bitter vegetables before lunch (rocket, radicchio, chicory)
Or bitter teas (dandelion, burdock, fennel, nettle) right before meal
Olive / avocado oil or MCTs with meals

Phase 3 — Post-concussion neuroinflammation

Largely addressed via Phases 1 & 2
Once fat digestion improves, introduce Omega 3 — 2 caps/day with breakfast or lunch
Add Vitamin C

Supplementation regime

Phase	Supplement	Dose / timing	Rationale
Phase 1	Vitamin D3	4 sprays AM with food	London latitude insufficiency.
Phase 1	Taurine	1 cap lunch with food	GABA mimetic; aids bile flow.
Phase 1	Magnesium (3 forms)	2 caps PM with food	Calming; metabolic cofactor.
Phase 1	Glycine	3 caps 60 min pre-bed	Inhibitory neurotransmitter; sleep.
Phase 1	L-theanine	1–2 caps early/mid-PM	Calm focus; if agitated, drop to 1.
Phase 2*	Methylated B-complex	1 cap AM with breakfast	B6 critical for GABA production.
Phase 2*	Zinc	1 cap lunch	Improves GABA receptor function.

* Phase 2 supplementation introduction depends on benzodiazepine taper progress and psychiatrist's directions.

Clinical formulation (31 March 2026)

1. Nervous-system dysregulation. Benzodiazepine neurochemical dependence is the clinical epicentre. Chronic diazepam + alcohol has reduced endogenous GABA production and destabilised autonomic balance. Reframe: not broken — under-buffered, and recoverable.
2. Blood-sugar / metabolic instability. Fainting episodes likely have a glucose component amplified by vasovagal response. Eat every 3–4 h with protein, fat, low-glycemic carbs. No fasting. No empty-stomach tea or alcohol.
3. Gut–liver axis dysfunction. Post-cholecystectomy: no bile reservoir. Constipation driven by sympathetic dominance suppressing motility. Sequence: nervous system first, then motility, then microbiome.
4. Cervical radiculopathy. Wrist flexor / triceps deficit (right). C7–C8 nerve root involvement; median & radial nerve. Grip 34.5 kg R / 33.3 kg L (norm ~40 kg). Symptoms driven by allostatic load + systemic inflammation, not structure alone.
5. Neuroinflammation from concussion history. Will be addressed with omega-3s and vitamin C once fat digestion is optimised.
Cranial nerve exam. All clear — no signs of brain pathology. Slight nystagmus (benign). Pupillary light reflex normal. Rules out central neurological concerns.