Last night was a looooong night. Not a hard night; a long night.
We had several objectives:
1: IVIG (Norwalk Treatment) - Represents about 4 hours of the nurse coming in and out.
2: Bag of Platelets (Due to some rectal bleeding I discovered on Fri.) - Represents about an hour of nurse coming in and out of room.
3: Two units of blood transfused (Hematocrit is at 26 -- bah, I could go way lower, but I guess it's better to be safe than sorry). Plus, those bags are liquid energy -- like the stimpacks from video games - "Let's get some!" Two bags represents 6 to 8 hours of the nurse coming in and out of the room.
4: All the usual stuff -- Antibiotics, hydration, etc...
Calculate the fact that the PICC line has only two lumens, and you have a long evening indeed -- We just finished a couple of ours ago.
So where does Fentanyl come into play? Where doesn't it! Well, I would fall asleep, the nurse would wake me up and ask me my current pain -- I'd usually say something like 4 or 5 (because the psin is usually high upon awakening). Then, I'd click the Fentanyl clicker. This would, in turn, lower my respiration and make me feel a heckova lot better.
But the respiration going lower wasn't a good thing if I was to be going to sleep -- ya gotta keep breathing in those dreams of yours!
Accordingly, they put be on oxygen durning the night.
Despite the respiration, I was in pain, so I continued to click away. Maybe I'm worse at night because there is no mental acuity/pain tradeoff when I am asleep...
Anyhow, I got a little Fentanyl lecture. Not a stern one, just a "Hey, don't be reckless with this stuff -- it's dangerous" lecture. In a way, it was quite disappointing, because I like this nurse and I most certainly do not use Fentanyl recreationally - I may joke about it, but it is really all about pain relief.
I recall a nurse answering a question from my mom on the suject of chemical dependency... The nurse replied, "As long you as take the drug as prescribed: to relieve pain, anxiety, or whatever it is indicated for. there is zero percent chance of addiction.
You may be able to tell my writing is being influenced by Fentanyl at present, but should that prevent me from taking more if I am in pain?
No Way!
P.S. - I finished assembling my metal praying mantis that Barbara got for me -- it's awesome!
[9:54am]
I just had to be instructed in general ass care and proper application of lotions. This is because of the previously mentioned problem in the rear. *sigh* How embarassing.
6 comments:
Hmmm, I'm curious about the lecture. They set up those PCA's (patient controlled analgesics) so that you CAN'T click more than the recommended dose, so why the lecture? Perhaps it has more to do with a state of mind that could be carried over into the future, than what you are going through right now. Which is what its there for!
Tante Laurie
P.S. Sorry about the long night. Maybe you'll get more sleep today?
I think perhaps the nurse didn't agree with the doctor's recommended PCA levels. His philosophy: "No pain; no exceptions." Her Philosophy: "There exists 'excessive' pain relief."
As for the long night -- don't worry about it! It was just a long night, not necessarily a bad one :P
Well, as you mentioned, respiratory depression is an extremely valid concern, and the nurses need to closely monitor that to make sure you keep breathing. But our nursing school has the same philosophy as your doctor: there is NO REASON for anyone to go through pain with the arsenal of painkillers available. The dosing ranges are all based on evidence-based research. If you had a hypersensitivity to Fentanyl, that would be a different story . . . Okay, just my brand-new nursing student's two-cents worth . . .
Tante Laurie
Glad you enjoyed the Praying Mantis Metal Kit. (I had originally typed "Preying Mantis" but this is a type of rhyming-and-almost-fits substitution called an Eggcorn. I will try to get you another one of the kits. They were discontinued at Kinokuniya though, so it is possible I will not find any more of them.
You have not been reporting your platelet, hemoglobin, and white blood count regularly. I and others can measure your progress based on those numbers. Marie said by phone your WBC today is about 0.6. That is great, and shows that your stem cells are already working I guess - how low did it get at the lowest? Did it go to 0.1 or lower, and which day?
Sorry to hear about the extreme skin toxicity you are experiencing from the Etoposide. That was what they gave you before you went into ICU, wasn't it. It is reasonable to suspect the E caused your high fever, then, since all your cultures were negative.
In the past you have felt that your chemo was being delivered at levels below what you really needed for effectiveness. Do I now detect in your posts some satisfaction that you finally have gotten a maximum, massive dose? Technically speaking, your dose was a lethal one - it is the stem cell transplant which is saving you.
In fact, I should state the obvious for visitors to your blog. Note that the stem cell transplant does NOTHING to cure cancer. Instead it is the "cure for the cure". The generalization is that whenever a cancer responds to a chemo treatment by shrinking, you can assume that for a large enough dose of the chemo the cancer would disappear entirely. Sometimes "large enough" is a dosage which would be lethal. BMT just means that the lethal doseage can be redefined to a higher level, hopefully a level which is curative for the patient. BMT is difficult, dangerous, and expensive, though, so there is a lot of motivation for researchers to find better chemo agents, ones which do not require BMT to work for cases like Austin's. Other brave cancer patients who could not use BMT as a treatment are even now being treated with some promising new drugs. Someday, BMT will be unnecessary because targeted therapies will exist, ones which are lethal only to cancer cells, and harmless to the patient. Research like that is worthy of our support.
In the news today, a man who survived cancer when he was young, but who had the foresight to place his sperm in a sperm bank, successfully fathered twins after 13 years.
Article:
TAIPEI (Reuters) – A Taiwan woman has given birth to healthy twins using the 13-year-old frozen sperm of a former testicular cancer patient, local media said on Saturday, setting a record for the island.
The twin boys were born using the sperm taken from a man surnamed Chen, then 23, who was diagnosed with testicular cancer and told chemotherapy could make him infertile, Taiwan newspapers said, citing sources at a Taipei medical university.
Chen, who is in good health at age 36 but cannot produce sperm naturally, got his wife pregnant with two of the four embryos used for artificial insemination, newspapers said. Last month's delivery followed a 37-week pregnancy.
"Never before had a case involving such a long period of time between the freezing of male sperm and procreation been reported in Taiwan," the island's Central News Agency reported, citing the college of medicine dean at Taipei Medical University.
Article is here.
That mantis is awesome.
Boo on the lecture about your pain meds. I bet if your mouth felt better, you'd have been biting your tongue. The clicker won't let you overdose, so click to your heart's desire. No reason to suffer if there is a med that works. I'm sure the ars care instructions were fun!
Hoping this evening is not so long and you get some uninterrupted sleep. Sleep does a body good.
You Rock!
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