Here we are still in the now familiar role of trying to find an appropriate combination of drugs to fight pain for an appropriate amount of time. Oxymorphone, Lyrica, Ativan, Percocet, Tylenol, Morphine… the list goes on… how much, how often… still no answers. The Anesthesia Pain team, Aida and company, have been working hard to get things under control but just like a trial and error experiment, medicine is given, there is a delay until it takes effect and then it is monitored to see its efficacy and its duration. With long-acting and shorter-acting drugs in her already, it is difficult to separate out the performance of each drug independently yet this is one of the determinants as to whether or not we go home tomorrow (Friday Oct 10th).
Dr. John Healey stopped in to see us before he begins a trip tomorrow to attend a conference in Chicago. He prescribed a series of exercises to keep Debbi’s left elbow in good working order and to make sure it does not stiffen by staying stationary in the sling day after day. Dr. Healey had to detach the deltoid muscle from the collarbone in order to repair the space between the base of the coracoid process and the glenoid following which he reattached the deltoid. Therefore Dr. Healey cautioned Debbi to use her arm for certain exercises but to be careful to avoid all actions for which the deltoid would be called upon to counteract gravity. One exercise involves leaning over and letting her left arm trace out circles as it dangles by her side. Not allowed would be raising her left elbow in front of her until her upper arm is parallel to the floor. To help her visualize the various permitted and restricted activities, an occupational therapist came by with a helpful set of exercises and illustrations.
Despite the frustrations, Debbi is making progress. She gets in and out of bed with fluid motions… “runs” laps around the floor… everything goes well until the pain breaks through. Then …. WATCH OUT!!. One thing better about being home is that when Debbi wants a pill she can take it right away. Here she has to wait for the nurse (who very well might be attending to the needs of other patients), the nurse has to check the computer to make sure that Debbi is due for whatever medication, request the drugs from the pharmacy, collect the drugs, and bring them to Debbi. Now, knowing Debbi, is it any surprise that she has her entire pharmacy from home with her here in the hospital. Yet, any even slight hint that she might reach into her purse and take one of her own pills (self-medication) draws the nastiest gnarls from whomever happens to hear her remark. And with good measure. Debbi can be doing something (like eating or drinking) and then pass out for a 20 minute nap. Imagine if she took her own Oxycondone and then awoke to a nurse’s request for her to take a second one. Anyway, I think Debbi is just using the back-up drugs as a threat such as the following: “If they don’t get here in 30 minutes with my meds, I am just going to take my own!” The nurses have always arrived in time. Whether or not the drugs actually work is another matter.
Throughout the chemo, Debbi lost a very small amount of hair. During this hospital stay it has become apparent, basically due to the linoleum floor, that she seems to be losing small clumps of say 10-15 hairs at a time. She still has a very respectable pony tail and a quite full head of hair but it seems that after some two months post-chemo… some hair is starting to fall out.
Our thoughts are now centered on reviewing the steps to be discharged tomorrow. Dr. Healey enumerated 4 key items as the determining factors. (1) Be able to be weaned from the IV pain medication. (2) No fever in 24 hours. (3) Removal of the surgical drain from the incision. (4) Pain treated by oral medication.
Debbi has not been receiving pain meds via the IV for over 12 hours so #1 is satisfied. 7pm-8pm has been the witching hour since the chemo began. Like the Bermuda Triangle, in this hour anything can happen. Most trips to Urgent Care began in this time slot. Yesterday, Debbi’s temperature in the witching hour was 100.1 which qualifies here as fever. Today however, her temperature was 98.6 so if all stays stable we may have satisfied #2. This morning, one of Dr. Healey’s fellows came by and adjusted her drain saying he would be back Friday morning to remove it so we should be good on #3 as well. That leaves #4 which as I have described, in probably monotonous detail, is the $64 question. Will the pain be under management such that Debbi can be sent home with a suitable plan to control her discomfort?
Stay tuned for another episode of Debbi’s Journey to find out.