Back to hospital... again!

Both doctors - the pain management specialist, as well as the hospice doctor - have been rather concerned at the rapid increase in pain levels experienced by Husband and, of course, the concurrent need for increase of pain medication. Mind you, I think they are also a little surprised at how mobile and 'compos mentis' Husband is, especially considering the high dosages of morphine and fentanyl he is on!

Anyway, our wonderful pain management doctor recommended two alternatives, and the hospice doctor (another wonderful doctor with a great deal of empathy!) came down to see us today, to discuss these two alternatives.

Alternative 1: Ketamine infusion. Done via IV, over a 5-day period
Alternative 2: Epidural (into spine) to cater for continuous 24-hour morphine infusion.

So, what does this mean?
Alternative 1: Ketamine is a drug that has been around for a long time. Is used sometimes as an anaesthetic, and also used in treatment of heroin addiction. It has been found that ketamine actually 'resets' the pain centre in the brain with the result that pain is drastically reduced, in some cases for life, and in some cases for several months at a stretch. This should mean that Husband may actually be pain free for at least a short while and any pain subsequent to the ketamine infusion can be managed by far lower dosages of the medicines he is currently taking. The down-side is that he has to be in hospital for 5 days while the ketamine is infused and during the infusion period he is very likely to have hallucinations - which, obviously, can be managed much better in a hospital where there are medical personnel on call, rather than at home by myself :-p.

Alternative 2: This would mean an epidural/catheter inserted into the spine, connected via a subcutaneous tube to a battery powered pack of morphine. With this method, the dosage of morphine is drastically reduced (100 times less!!) and the morphine goes straight to the brain where (of course) pain is 'recognised', thereby reducing the pain. Morphine administered orally or subcutaneously has to be much higher dosages as it goes all over the body, not just the brain, and that is why side effects occur. With the drastically reduced dosages via the epidural, the side effects are also drastically reduced. The down-side here is the need to have a small operation to have the catheter inserted into the spine, the fact that having anything inserted into the spine carries its own risks, and, of course, the need to have the battery operated pack attached all the time!

After discussion with the doctor, we decided to go for Alternative 1, and to save Alternative 2 for a point of time where the pain is so bad that it cannot be controlled by any other means.

Anyway, end result - Husband goes into Selayang (govt) hospital tomorrow, the Palliative Care Unit. Dr Mary (our pain management doctor) has asked us to be in before 1pm, so that she and Dr Richard (who manages the Palliative Care Unit) can come and see us after 1pm and get the treatment started asap. So, my Dad will be at our home by 11am, to come with us to the hospital, so that he can get a wheelchair for Husband, and wait with him while I go find somewhere to park my car!!!! Once we have Husband settled in, and the doctors have gotten him started on his treatment, I will bring my Dad back so that he can get his car and head home, and I will pick up whatever Husband and I need for the 5 days in hospital, and head back to the hospital.

Yes, I am staying with him in the hospital.... Dr Mary says they will provide me with a recliner... sigh... I will miss my bed, but I sure ain't leaving Husband alone in the hospital!

For those of you who are on Skype or MSN with me every day (or every other day!) please note that there is not much chance of my being online for the next 5 days. This being a govt hospital, the chances of there being wi-fi or wired internet available are very very slim (more like non-existent). Of course, if I find that there IS wi-fi, then I will be online. If not, sorry folks, you are just going to have to wait till we are home again to get any further updates... or, of course, you can sms or call me.

So, please please, keep Husband in your thoughts and prayers, that this Ketamine infusion WILL work and at least help to reduce, if not eliminate, the pain for long enough for Husband to have some "quality" in his day to day life. And by "quality" we are only referring to simple things - like being able to sit up to read, or watch a movie; or being able to go out for a meal; or just to go for walks in our favourite shopping malls! Nothing major - just the simple pleasures of life.

And, till next time, stay safe, stay HEALTHY!