So what is going on?

Mary was admitted to Stanford Hospital today.  This is the summary backgrounder and you can read prior posts to get a sense of how the day progressed.  

Mary has been on MSContin (Morphine Sulfate) starting Feb 19 and we were hoping to get her off of the narcotic and onto a different pain killer.  As a result the pain clinic docs recommended a ramp up of Neurontin.  

Mary started building up her Neurontin (gabapentin) at a rate of one additional 300mg pill every other day.  When we stepped up from 4 pills a day to 5 pills a day, Mary went somnolent (quasi-comatose) and that happened last Saturday (read the blog entry here).  The on call pain doctor from Stanford said, "Head to the closest ER now!" so we had the 911 EMT/Paramedic team take her to Good Samaritan.  

Good Samaritan ER did a blood test and ran a CT Scan. And the conclusion was the CT Scan was clean and the blood test showed her electrolytes were off and she was slightly anemic.  So they sent us home with a conclusion of 'drug interaction'.  In hindsight, if we had driven her to Stanford's ER on Saturday, we may have picked up a few days on this problem. Or, it was so early they would have not read the signs as well.

Sunday was not great but not bad. Monday, Mary was back approaching comatose again but Reenie and I said, "Well, this is like Saturday, further drug interaction."  The ER doc told us to reduce the gabapentin from 5 to 4 pills a day and, in fact, I did that.  It appears reducing to 4 was not enough.  On Tuesday, Mary struggled to get ready for the visit to the Stanford's Pain Clinic in Redwood City. And, she made it.  The result of that visit are written here on the blog.

Starting on Tuesday night, Mary stopped taking gabapentin and switched to Lyrica (pregabalin) and that builds up by adding one pill every seven days so a much slower ramp. 

Wednesday was also not great and I was frustrated, as was Reenie, with the Pain Center's doctors sort of laid back solution approach coupled with a "We only recommend, your primary has to set the direction."  So I called the head of the Cancer Center's Patient Services and she mainlined us to Margareet who has been on Mary's paperwork for ages but not visible in her roll.  Margareet is, it appears, the senior PA, RN, chief of staff, walking medical encyclopedia, mother hen and den mother for our oncologist's patients and staff.  After I described the scenario to her, she recommended observation for one day and then a call back. We called her back on Thurs afternoon, reporting our findings and she recommended we call back early on Friday and request a "sick call" in the Cancer Center.  

Margareet set us up for 11:30AM and we arrived on time.  After a lot of buzzing and testing and waiting for test results, Margareet told us that the liver functions were abnormal and therefore Mary was being admitted.  During this three hour wait, I ran into Mary's Oncologist in the coffee shop and he seemed a bit surprised to see me but later I saw him and Margareet in the hallway discussing something to be immediately followed by Margareet walking up to me to tell me that Mary was being admitted.  

Mary was admitted at 6PM and she is now a patient at Stanford Hospitals.  Reenie and I met a Resident and the Fellow and the Fellow stated that the issue is an apparent blockage of the biliary system.  This blockage is preventing Mary's liver from processing the medications and flushing them into the intestines.  Thus, when we stepped up the gabapentin and she went comatose, it was the liver's inability to flush the medications that caused the problem. 

What could cause the blockage? Well, that is why they admitted her to figure it out.  She has already had x-rays, more blood draws and is set for CT Scans and whatever in the morning. 

More later.