Not a regular Saturday

Mary joined us for breakfast and ate a reasonable portion of Reenie's blueberry pancakes and strawberries. She then returned to the chaise lounge and shortly thereafter, moved to bed.  We could not wake her up but thought she needed the rest.  At 2PM, we gave her the daily dose of gabapentin and mscontin and it was clear was she was not fully conscious.  We continued to watch and observe and she continued to not be responsive.  Her blood pressure was good, pulse was consistent and respiration rate was good.  


We called Stanford and when we described the situation to the on call doctor, his instructions were to get her to the closest ER as quickly as possible.  Better yet, call 911 so the help comes to us.  Given Good Sam is seven minutes from the house, I thought we'd just take her.  However, given the difficulty of getting her from the bedroom to the garage door in the TV room, I told Reenie we were calling 911.  Basically, she could not stand as in I was lifting her full body weight. We put her in a wheeled desk chair and rolled her to the TV room.  


The EMT and Paramedics were superb, firing questions and carefully listening to the answers. It was a surprise to Reenie and me that Mary was answering some of the questions herself when five minutes earlier she would not respond to us in any way!  They took her away, we chatted briefly with the neighbors who had noticed a huge white Emergency Response truck and a large ambulance both with flashing lights in front of the house--kinda hard to miss. 


At the ER, they didn't put her on an IV but they did have a needle stuck in her arm just in case. They drew blood and ran a brain CT scan.  It was clear she was becoming more and more alert and awake during the entire episode.  She was bantering with us and also making a joke or two as we waited for test results.  By 9PM the test results had returned and the diagnosis was as Reenie and I suspected--drug interaction between gabapentin and mscontin.  


The theory is straightforward.  We are ramping up the gabapentin (aka neurontin) per a schedule.  Every other day we add a pill and we will stop adding pills when she hits the recommended dose. As of today, she went from four to five pills taking 2 in the morning, 1 after lunch and 2 in the evening.  We have been following the plan to not change the mscontin (aka morphine).  Apparently, we hit a crossover point between the two painkillers today--not unexpected.   We'll proceed with the plan but slowly reduce the mscontin while continuing to increase the gabapentin--in fact, we had already done that with the 2pm dose today reducing the mscontin by about one third and about two hours later she woke up.  The objective is to get her off the narcotic while not blasting her with breakthrough back pain. 


Mary told us while in the ER that she didn't remember anything from breakfast to the moment she woke up in the TV room with the paramedics hustling around her.  After that and through my writing of this blog entry, she has been fully awake, good memory and good appetite--given the late hour Reenie fixed simple scrambled eggs and toast. Mary ate all of her portion.  


Thanks to all who expressed concern and offers of help, especially the neighbors.