As part of the initial call today, Kelly wondered if I should take Mary into the Emergency Room because the pain is so much out of control and Mary is in this narcotics cloud. Frankly, I think part of the reason for even thinking about bringing her in is to gain priority on the Medial Branch Nerve Block procedure. Patients in the hospital have near instantaneous call on resources while outpatients have to wait for their appointments. For those who remember way back at the beginning of this journey in April last year, it took several weeks to see the Stanford specialist who would perform the ERCP and then another week for the outpatient ERCP appointment. Then, 36 hours after the first Stanford ERCP, Mary was in ER due to abdominal pain and "voila!", her second unscheduled and unplanned Stanford ERCP happened within a day in the same facility and same doctor we had waited weeks for previously. (Trivia: Mary had 4 ERCPs last April, two at Good Sam and two at Stanford.)
Anyway, Kelly excused herself and promised to call back, which she did several hours later. I told Mary I thought Kelly was asking the various doctors on Mary's team their opinion on what to do next.
The result of this confab was a change in Mary's painkillers--again. We stopped the morphine which was not terribly effective against the pain anyway and put her in the depths of the narcotics cloud. Instead, she has switched to Oxycodone (aka Roxicodone). Yes, Oxy, our old friend used successfully after surgery last year and we used it (unsuccessfully) for a couple days at the end of January as part of this pain treatment. It worked well after surgery. But, appeared to cause Mary huge gastric distress when we used it recently for this pain.
The situation now is that Mary's body is used to being loaded up with narcotics so she may not encounter so much gastric distress--hey, she is taking liquid morphine up to 10 times a day without tossing her food. The theory is that three to five days were needed to get "used to" the additional narcotic (above the fentanyl transdermal patch) in the system. The morphine treatment will provide an "umbrella" to allow a switch from morphine sulfate to Oxycodone without a lot of discomfort. As of the first 8 hours, it appears to be a viable theory.
The Oxycodone routine will be every six hours. The reading I have done on the web says that for breakthrough pain, it is better to keep the patient at a constant dosage of Oxy rather than try and chase the pain when it appears. Frankly, once the pain starts, the painkillers are not terribly effective in minimizing the pain for some relatively long period of time. It works when proactive, it is less than helpful if it is reactive. I now have Mary's iPhone programmed to sound out every six hours for her to take her Oxycodone pill. And, it is also set to sound the alarm 30 minutes prior to the Oxy pill so she can take the stomach settling Zofran pill to help with stomach discomfort from the narcotic. We're going to do this on a firm schedule with the expectation that a regular schedule will be more helpful to her.
Mary went to bed early tonight. I am not surprised, she basically slept for about an hour last night before the pain woke her up. She then got me up to dispense the morphine at 3, 4, 5 and 7AM. Not a very restful night for either of us.
Tomorrow is Maids' day. Ingrid will either take Mary and the dogs out at lunchtime OR Mary will stay in her office (barely used these days so no cleaning required) while the Maids scrub down the rest of the house and Ingrid plays nice with the four-foots. It appears I may have a nearly normal day at work too!
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