But let's not get ahead of ourselves and start jumping around in glee. Yep, he slept all right! BUT, this morning, he is still twitching and jerking and hallucinating.
Anyway, back to the beginning. Husband slept from 11pm last night, to 6am this morning. I was supposed to give him his usual 4am dose of opiate, but when I saw how soundly he was sleeping I just did not have the heart to wake him up. I figured he needs the sleep desperately, and I can skip the dose till whatever time he wakes up. As it turned out, he woke up at 6am, so I gave him the opiate, in a lower dose (4ml, just for 2 hours), and he went back to sleep again.
HAD to get him up for breakfast before 8am, because otherwise he gets gastric pains and he really does NOT need any more "pains" to add discomfort to his already much abused body! Gave him the (hopefully) FINAL dose of the liquid opiate at 8.10am. Next round of meds is at 10.30am, and that will be 30mg of oxycontin. THEN the slow release capsules take over :-)
He is back to dozing again - still tired out from not sleeping for so many days and nights in a row. Still depressed because he is still having hallucinations and the twitches. BUT he is not as hyperactive as the last 2 days, probably because he just too physically exhausted after the hyperactive-ness of the last two days!!!
My Dad is probably already at the hospital by now, waiting to see the pain management doc, to pick up the slow release pills for Husband. First dose, at 3 or 3.30pm. Then we see how it goes over the next 1 week.
So, please continue to keep Husband in your thoughts and prayers, that the slow release capsules work well for him, and that he can be completely lucid and completely pain free.
Till next time, stay safe, stay HEALTHY!
Showing posts with label oxycontin. Show all posts
Showing posts with label oxycontin. Show all posts
Wednesday, December 09, 2009
Sunday, December 06, 2009
One small step forward
Husband is slightly more used to the opiate now. When he is sitting up, there are zero hallucinations, and he talks absolute sense. It is only when he is lying down that he still has the hallucinations, the imaginary conversations, the twitching, etc. I have also adjusted dosages and timings slightly. Each opiate dose is (as of 4am today) at 6ml, so that he can go for 3 hours without being disturbed for the next dose. So, at 4am and then at 7am, 2 doses of 6ml each. Then at 10am, 3 Oxycontin tablets, which keeps him going for about 4 hours. Then at 2pm, 5pm and 8pm, opiate doses at 6ml each. Then at 11pm, 3 Oxycontin tablets and one Amitryptilline tablet which keeps him going till 4am again!
The target is to increase the dosage slowly, till he can go for at least 4 - 5 hours at a stretch. Can't rush it, as I also need him to get used to the side effects first!! I have had reassurance from 2 different sources, who have had first hand experience of seeing their loved ones going through similar situations, that the body DOES get used to the side effects, and once the body is adapted, then the pain killer aspect of the opiate continues, without the dozy aspect! Of course, each person takes different durations to adapt, but it DOES happen. So that was quite reassuring!
Husband's son (J) called yesterday and asked a question which he has been wanting to ask for a long time, but was a little bit scared to ask. Since Husband was not up to taking the call, J talked to me and finally asked me that question "What is the REAL prognosis". That is a slightly oblique way of asking "Is my Dad going to die?" The same question has been asked by Husband's younger daughter as well, and I am sure the same question is in a lot of peoples minds too.
Well, I guess everyone has to die at some point or other, and Husband is already 70 (still the best looking 70 in the world!!!). BUT, not anytime soon!!! The oncologists are still amazed at the cancer progression in his body. For one thing, all his soft organs (liver, kidney, lungs) are CLEAN. There is very very little cancer in the body. Even the cancer in the bone seems to be stable as it has not spread (just hit enough to cause the extreme pain he is in!!!!). As the onco's say "The disease weight in his body is VERY VERY light". The other thing that puzzles the onco's is the fact that it spread to the bone, without touching the soft organs. For colon cancer, metastasis to the bone is rare already... and metastasis to the bone without TOUCHING the soft organs - now that really is an impossibility as far as they are concerned. But then, trust Husband to be that 1 in 10 million! He will have to do chemo for the rest of his life, to ensure that the cancer is kept under control, but... he and I still have a few years to go together :-D.
My most fervent prayer is that we are able to ENJOY the time we have together, without the awful pain that Husband is suffering. I want to take him to the UK again next year (possibly our last trip there) to meet his family again, and our closest friend there (Kevin), and a few other close friends. I want to take him to Tg Rhu at Langkawi again, and to Phuket Pavilions on Phuket, and to Berjaya on Tioman Island. I want to be able to take him to see all our family and friends in both KL and SG, who have been here for us in this very very difficult time, and who I know will continue to be with us. For that, he needs to be pain free, and able to travel... so, please pray for him that he should find total relief from this pain, and that the cancer be eradicated.
That's it for now... till next time, please continue to keep Husband in your thoughts and prayers, and... stay safe, stay HEALTHY!
The target is to increase the dosage slowly, till he can go for at least 4 - 5 hours at a stretch. Can't rush it, as I also need him to get used to the side effects first!! I have had reassurance from 2 different sources, who have had first hand experience of seeing their loved ones going through similar situations, that the body DOES get used to the side effects, and once the body is adapted, then the pain killer aspect of the opiate continues, without the dozy aspect! Of course, each person takes different durations to adapt, but it DOES happen. So that was quite reassuring!
Husband's son (J) called yesterday and asked a question which he has been wanting to ask for a long time, but was a little bit scared to ask. Since Husband was not up to taking the call, J talked to me and finally asked me that question "What is the REAL prognosis". That is a slightly oblique way of asking "Is my Dad going to die?" The same question has been asked by Husband's younger daughter as well, and I am sure the same question is in a lot of peoples minds too.
Well, I guess everyone has to die at some point or other, and Husband is already 70 (still the best looking 70 in the world!!!). BUT, not anytime soon!!! The oncologists are still amazed at the cancer progression in his body. For one thing, all his soft organs (liver, kidney, lungs) are CLEAN. There is very very little cancer in the body. Even the cancer in the bone seems to be stable as it has not spread (just hit enough to cause the extreme pain he is in!!!!). As the onco's say "The disease weight in his body is VERY VERY light". The other thing that puzzles the onco's is the fact that it spread to the bone, without touching the soft organs. For colon cancer, metastasis to the bone is rare already... and metastasis to the bone without TOUCHING the soft organs - now that really is an impossibility as far as they are concerned. But then, trust Husband to be that 1 in 10 million! He will have to do chemo for the rest of his life, to ensure that the cancer is kept under control, but... he and I still have a few years to go together :-D.
My most fervent prayer is that we are able to ENJOY the time we have together, without the awful pain that Husband is suffering. I want to take him to the UK again next year (possibly our last trip there) to meet his family again, and our closest friend there (Kevin), and a few other close friends. I want to take him to Tg Rhu at Langkawi again, and to Phuket Pavilions on Phuket, and to Berjaya on Tioman Island. I want to be able to take him to see all our family and friends in both KL and SG, who have been here for us in this very very difficult time, and who I know will continue to be with us. For that, he needs to be pain free, and able to travel... so, please pray for him that he should find total relief from this pain, and that the cancer be eradicated.
That's it for now... till next time, please continue to keep Husband in your thoughts and prayers, and... stay safe, stay HEALTHY!
Wednesday, December 02, 2009
We met the Pain Management Specialist today!
First of all, I must say that the pain management specialist (Dr MC) is a really nice lady! She made us go through a very thorough de-brief on what has been happening to date, plus all the info about what meds Husband is on now, which, as I told her, are as follows:
- 9am : 20mg Oxycontin
- 3pm : 2xUltracet, 1x200mg Celebrex
- 9pm : 30mg Oxycontin
- 3am : 2xUltracet, 1x200mg Celebrex
She says there are several options to try, starting with the most straight forward and working our way up to the most 'complex'. In fact, when she heard that Husband is already on Oxycontin, she said that already ruled out the simplest meds, as that would have been her first options. So, we have gone straight to the slightly stronger options: For now, she has put Husband on liquid morphine, to be administered as necessary, 5ml initial dosage. If not enough to kill the pain, then another 5ml when the pain breaks through... Which also means that subsequent daily first dosage could then be 10ml. If the 5ml makes him 'high' and hallucinatory, then reduce to 2.5ml. In addition, she recommended that we continue with the oxycontin I am already giving him (20mg at 9am, 30mg at 9pm), discontinue the Ultracet, but continue with the 200mg Celebrex ONCE a day at 3pm. If he can handle more pills, then to take 2 normal Panadol at every meal (4 times a day) - though, given the choice, Husband does not want to add MORE pills unnecessarily to his overall dosages! She has also prescribed something called Amitryptilline, HALF-tablet to start, to be taken at night, before sleeping. If he handles it well (ie, he doesnt wake up the next morning feeling like he has had a hangover), then increase the dosage to ONE tablet nightly.
She wants me to adjust the opiate dosage till we find one that suits him, at whatever interval that suits him (eg, she said if 5ml works perfectly, but only works for 1 hour, then take another 5ml every hour.). I dont think it will come to that frequency, but I have a feeling that it will be at least 4 times a day, once we find the right dosage. I know that the Oxycontin only seems to work for about 6 - 7 hours, which is why I had the Ultracet/Celebrex combination dosage set for 6 hours after the Oxycontin! So if the morphine is similar (since they are both opiates), then 6 hourly might work well. We will have to see how it goes. So far, since we got home, it seems that the 5ml dosage keeps Husband going for TWO hours. I will continue with the 5ml dosage for the rest of the day, till he goes to sleep, and tomorrow morning, start with an increased (10ml) dosage to see how long that can keep him going. Dr MC did warn us it will be all trial and error, as every single person responds differently.
What are the other options open to us? Not a lot more actually. One other drug is methadone, but that is, apparently, somewhat difficult to get here.
Final possibility, if we find that the opiates just make Husband too "woozy" and hallucinatory, would be to put an epidural (a very very fine tube) directly into the spine, with the other end of the tube connected to a "port" (somewhat like the chemoport he already has implanted in his chest for chemo infusions). This port would be embedded below the ribs, and would be used for direct opiate injection 2 - 3 times a day, into the spinal fluid - thereby bypassing the gastric and blood systems, which means it won't cause constipation and won't cause hallucinations or dizziness - and directly targetting the spine which is where all the pain is concentrated. The port could also be used for continuous infusion - where the opiate, diluted in some solution, is administered over a period of time. In such a case, the solution+opiate would be in a small bag, which can be clipped to a belt, and then connected to the port for ongoing infusion. Which also means that Husband would not be restricted in his movements, and would not need to be in hospital.
That's it for now. We are due to see her again on 30th Dec, though I can always pick up re-prescription of the morphine earlier IF required. Please continue to keep Husband in your thoughts and prayers that this change of painkiller will work, and that we will be able to quickly work out the ideal dosage to relieve him from pain on a continuous basis.
So, till next time, remember... stay safe, stay HEALTHY!
- 9am : 20mg Oxycontin
- 3pm : 2xUltracet, 1x200mg Celebrex
- 9pm : 30mg Oxycontin
- 3am : 2xUltracet, 1x200mg Celebrex
She says there are several options to try, starting with the most straight forward and working our way up to the most 'complex'. In fact, when she heard that Husband is already on Oxycontin, she said that already ruled out the simplest meds, as that would have been her first options. So, we have gone straight to the slightly stronger options: For now, she has put Husband on liquid morphine, to be administered as necessary, 5ml initial dosage. If not enough to kill the pain, then another 5ml when the pain breaks through... Which also means that subsequent daily first dosage could then be 10ml. If the 5ml makes him 'high' and hallucinatory, then reduce to 2.5ml. In addition, she recommended that we continue with the oxycontin I am already giving him (20mg at 9am, 30mg at 9pm), discontinue the Ultracet, but continue with the 200mg Celebrex ONCE a day at 3pm. If he can handle more pills, then to take 2 normal Panadol at every meal (4 times a day) - though, given the choice, Husband does not want to add MORE pills unnecessarily to his overall dosages! She has also prescribed something called Amitryptilline, HALF-tablet to start, to be taken at night, before sleeping. If he handles it well (ie, he doesnt wake up the next morning feeling like he has had a hangover), then increase the dosage to ONE tablet nightly.
She wants me to adjust the opiate dosage till we find one that suits him, at whatever interval that suits him (eg, she said if 5ml works perfectly, but only works for 1 hour, then take another 5ml every hour.). I dont think it will come to that frequency, but I have a feeling that it will be at least 4 times a day, once we find the right dosage. I know that the Oxycontin only seems to work for about 6 - 7 hours, which is why I had the Ultracet/Celebrex combination dosage set for 6 hours after the Oxycontin! So if the morphine is similar (since they are both opiates), then 6 hourly might work well. We will have to see how it goes. So far, since we got home, it seems that the 5ml dosage keeps Husband going for TWO hours. I will continue with the 5ml dosage for the rest of the day, till he goes to sleep, and tomorrow morning, start with an increased (10ml) dosage to see how long that can keep him going. Dr MC did warn us it will be all trial and error, as every single person responds differently.
What are the other options open to us? Not a lot more actually. One other drug is methadone, but that is, apparently, somewhat difficult to get here.
Final possibility, if we find that the opiates just make Husband too "woozy" and hallucinatory, would be to put an epidural (a very very fine tube) directly into the spine, with the other end of the tube connected to a "port" (somewhat like the chemoport he already has implanted in his chest for chemo infusions). This port would be embedded below the ribs, and would be used for direct opiate injection 2 - 3 times a day, into the spinal fluid - thereby bypassing the gastric and blood systems, which means it won't cause constipation and won't cause hallucinations or dizziness - and directly targetting the spine which is where all the pain is concentrated. The port could also be used for continuous infusion - where the opiate, diluted in some solution, is administered over a period of time. In such a case, the solution+opiate would be in a small bag, which can be clipped to a belt, and then connected to the port for ongoing infusion. Which also means that Husband would not be restricted in his movements, and would not need to be in hospital.
That's it for now. We are due to see her again on 30th Dec, though I can always pick up re-prescription of the morphine earlier IF required. Please continue to keep Husband in your thoughts and prayers that this change of painkiller will work, and that we will be able to quickly work out the ideal dosage to relieve him from pain on a continuous basis.
So, till next time, remember... stay safe, stay HEALTHY!
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