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Medical Care Team and Medications

Elliot Landry’s medical care team was assembled beginning in 2032, the year he turned twenty-nine, when Jacob Keller hired him and Elliot gained access to consistent, quality healthcare for the first time in his adult life. Prior to this, Elliot had received minimal medical oversight since his late teens, with years of poverty, geographic isolation in rural Alabama, and medical trauma resulting in his complete withdrawal from the healthcare system. Logan Weston was instrumental in rebuilding Elliot’s trust in medical professionals and helping him navigate appointments, specialist referrals, and the medical language that had historically been wielded over him rather than shared with him.

The majority of Elliot’s care is coordinated through the Mount Sinai Health System, whose Pituitary Care and Research Center serves as the anchor for his endocrine management. Mount Sinai’s multidisciplinary structure—with integrated cardiology, rheumatology, pain management, and sleep medicine under one institutional umbrella—provides the cross-specialty coordination that a patient with Elliot’s complexity requires. Having his specialists within the same system means shared records, coordinated prescribing, and the ability for his cardiologist and pain management doctor to actually talk to each other about the cardiovascular implications of his NSAID regimen without Elliot having to carry the message between them.

Care Team

Dr. Adebayo—Pain Management (Mount Sinai)

Dr. Adebayo became Elliot’s pain management specialist through Mount Sinai after Jake facilitated access to quality care. She was the first doctor to look at Elliot’s imaging—the knees, the hips, the spine—and sit with what she saw before speaking. Her assessment was direct: “Elliot, the joint deterioration in your knees is what I’d expect to see in a seventy-year-old with severe osteoarthritis. You’re twenty-nine.” She prescribed his multimodal pain regimen, including the breakthrough opioid medication, and told him to take it when he needed it and not to wait until the pain was unbearable, because by that point the medication had to fight through the inflammation to work and required higher doses with more side effects.

She and Elliot have the same conversation at every appointment—she tells him not to ration the pain medication, he nods and says “yes ma’am,” and they both know he’s going to ration it anyway. Dr. Adebayo understands the layers behind the rationing: the medical trauma, the pharmacy encounters, the fear of dependency, the need to stay alert for Jake and Clara. She doesn’t push past his boundaries, but she documents them, and she adjusts the regimen to account for the reality that Elliot will use less than prescribed.

Cardiology—Mount Sinai Fuster Heart Hospital

Monitors Elliot’s cardiomegaly, hypertension, elevated resting heart rate, and overall cardiovascular risk. The cardiologist prescribes metoprolol succinate for heart-rate and blood-pressure management and coordinates with other specialists so pain treatment and other prescriptions account for cardiac and renal risk. Monitoring includes echocardiography and other assessment adapted to Elliot’s mobility.

Endocrinology—Mount Sinai Pituitary Care and Research Center

Manages the ongoing hormonal and tumor surveillance for Elliot’s pituitary gigantism through Mount Sinai’s Pituitary Care and Research Center, whose multidisciplinary team spans neurosurgery, endocrinology, neuroradiology, and neuro-ophthalmology. The endocrinologist monitors GH and IGF-1, pituitary imaging when indicated, other pituitary hormones, and metabolic indicators including Elliot’s insulin resistance. His current disease-directed medication is monthly octreotide LAR. Endocrine care began with his diagnosis at fifteen but was interrupted through his late teens and twenties by poverty and access barriers. The Pituitary Center also coordinates his research participation.

Rheumatology—Mount Sinai Rheumatology

Manages Elliot’s progressive joint arthropathy—the GH-driven cartilage and bone changes affecting his knees (worst), hips, spine, and increasingly his hands—through Mount Sinai’s rheumatology department. Monitors joint deterioration, adjusts anti-inflammatory protocols, and assesses when surgical intervention (joint replacement) may become necessary. The rheumatologist works closely with Dr. Adebayo on the pain management approach, particularly the interaction between inflammatory pain and neuropathic pain. As joint replacement becomes a more immediate prospect for Elliot’s knees, the rheumatologist coordinates with Mount Sinai’s orthopedic surgery team.

Neurology and Sleep Medicine—Mount Sinai Sleep Disorders Program

Manages Elliot’s peripheral neuropathy (progressive numbness and tingling in hands and feet) and his obstructive sleep apnea through Mount Sinai’s integrated neurology and sleep medicine services. Prescribes and monitors the CPAP settings, tracks nerve conduction over time, and manages the gabapentin component of his pain regimen. The neuropathy and the sleep apnea are both direct consequences of the gigantism, and both are progressive. Mount Sinai’s sleep medicine program coordinates with his cardiologist on the cardiovascular implications of his OSA, ensuring the CPAP settings are optimized for both airway patency and cardiac workload.

Logan Weston—Unofficial Medical Advocate

Logan was not a member of Elliot’s formal care team but remained functionally essential to it. He attended new appointments with Elliot when he was in town, translated medical terminology into language Elliot could work with, and reviewed recorded appointments when he could not be present in person. Elliot texted Logan before appointments and either recorded the full visit to send afterward or had Logan on speakerphone during the appointment. Logan’s presence—even as a voice on a phone—changed how Elliot was treated in medical settings. Logan firmly redirected any researcher or specialist who attempted to go through him rather than directly to Elliot regarding study participation or care decisions.

Medication Regimen

Baseline / Daily Medications

  • Naproxen sodium, 440 mg twice daily—anti-inflammatory treatment for chronic joint pain, with renal and cardiovascular monitoring.
  • Gabapentin, 300 mg three times daily—for peripheral neuropathy and neuropathic pain rather than seizure control.
  • Metoprolol succinate, 50 mg daily—for elevated resting heart rate and hypertension in the setting of cardiomegaly.
  • Octreotide LAR, 20–30 mg intramuscularly every four weeks—clinic-administered suppression of GH and IGF-1, with biochemical, glucose, and gallbladder monitoring.
  • Omeprazole, 20 mg daily—for GERD and gastric protection during long-term naproxen treatment.

Breakthrough / As-Needed Medications

  • Hydrocodone-acetaminophen, 5/325 mg as needed, no more often than every six hours—prescribed by Dr. Adebayo for severe joint flares and post-exertional or weather-related breakthrough pain. Elliot has clear instructions to take it with food; on an empty stomach, it caused severe vomiting within fifteen minutes and a heart-rate spike to 130. He uses it sparingly because it dulls his alertness, requires food, adds respiratory risk in the setting of sleep apnea and cardiomegaly, and carries the racialized scrutiny he encountered as a Black man filling a controlled-substance prescription.

Medication Interactions and Concerns

Elliot’s medication regimen requires careful coordination across specialists because multiple prescriptions interact with each other and with his underlying conditions:

  • Opioids carry respiratory depression risk that compounds his sleep apnea—his doctors have discussed this with him, and it’s one reason the CPAP is non-negotiable on nights he takes the stronger pain medication.
  • NSAIDs carry cardiovascular risk that must be balanced against his cardiomegaly—the cardiologist and Dr. Adebayo coordinate on this.
  • Gabapentin can cause drowsiness and dizziness, which adds to fall risk for a man whose joints are already unstable.
  • Beta blockers interact with the fatigue that is already architectural in his body—managing heart rate at the cost of additional energy depletion.
  • Octreotide LAR requires ongoing GH and IGF-1 monitoring and surveillance for effects on glucose regulation and the gallbladder.

Pharmacy Dynamics

Elliot fills his prescriptions at the same pharmacy every time. He never asks for early refills. He rations the opioid prescription so consistently that he always has pills remaining when the refill date arrives. And he still feels the look every time—the hesitation, the extra questions, the way the pharmacist counts the pills. Being a Black man from Jasper, Alabama, with a controlled substance prescription carries a weight that the prescription itself doesn’t account for, and it shapes how and when Elliot takes his medication in ways his doctors can document but cannot fully solve.

Hydration and Electrolyte Management

Elliot’s daily hydration routine used plain water as its baseline. He added a clinician-informed electrolyte mix after prolonged sweating or heat exposure, sustained exertion, poor food intake, or fluid loss from illness. Logan helped him translate the guidance into a consistent system using premeasured portions matched to Elliot’s 64-ounce bottle; Elliot did not estimate concentrations, stack servings, or treat electrolytes as automatically preferable to water.

The routine changed as Elliot’s cardiomegaly progressed into heart failure and his medication regimen added a daily diuretic in the mid-2050s. From that point forward, his cardiology team individualized his fluid, sodium, and electrolyte targets rather than relying on the earlier standing routine.

Appointment Logistics

Elliot records all medical appointments on his phone and sends the audio to Logan Weston afterward. This practice began because Elliot couldn’t write fast enough to capture what doctors were saying, and because having a recording meant Logan could review the information and explain it in language Elliot could work with. The recordings also function as accountability—doctors know the visit is being recorded, and Logan is listening. When Logan is available during an appointment, Elliot has him on speakerphone so Logan can hear in real time and ask follow-up questions that Elliot might not know to ask.

This system emerged from necessity—a man who had been failed by the medical system learning to build guardrails around his own care—and it works. Elliot’s engagement with his health has improved significantly since implementing it, and his care team has adapted to the presence of recordings and Logan’s occasional remote participation.

Research Participation

Pituitary gigantism was rare enough that a 2015 international effort across forty-six tertiary centers assembled 208 patients for the largest standardized cohort then available. Researchers sought Elliot’s participation in longitudinal studies and case reports, but all requests went to Elliot directly; Logan redirected any approach made through him. Elliot refused research participation in his unstable twenties. After gaining stability through Jake’s employment and building a care team he trusted, he enrolled through Mount Sinai, motivated by the hope that his data might help other patients with the same condition.

Character Documents Medical Documents Elliot Landry