We are still excited about the prospects with this new device, but the first day was not as...comfortable as we would have hoped. I might be a little slow when it comes to medical stuff, because I really thought she would have been almost pain free as soon as they got the pump in, boy was I wrong.
Yesterday might have been her most miserable day since we got to the hospital. We could not get her out of pain. The general pain management plan since we have been here is to find a pain medication that is long acting and consistent to handle the on-going pain, and then to supplement that with "break-through" medications for the times the pain gets worse. We did this primarily with the fentanyl patch (long-acting) and oxycodone (break-through). It was relatively effective and Alisa found some comfort, the challenge was managing those medications while at home (she was basically taking the break-through meds every 3 hours)
The beauty of the pain pump is that it handles both the long-acting pain control as well as the breakthrough pain. There is a little reservoir of medication in the device and some gears that rotate once in 24 hours constantly releasing a determined amount of medication. In addition there is a little remote control device that Alisa can press a button and it will indicate to the pump to release additional medication. This is regulated so that she can only press it once per hour. The idea is that you would only press it occasionally when the pain was at its worst.
Well with that little bit of background here is how our day went. The night after the surgery seemed ok. At about 8:00 in the morning she started to be in pain, we pushed the button, still in pain, we asked for some additional medication (oxycodone and dilaudid), sleepy, loopy, and still in pain (when not asleep). So the cycle through the day was; pain pump button, oxycodone, dilaudid, over and over. She was never really out of pain. The pain doctor (that implanted the device) came in the afternoon and increased the dosage on the pain pump. Still no relief.
Then Joan stopped by. (Have I mentioned she is the best). She only stayed for a few minutes but before she left she made it clear we needed to have our nurse page the pain doctor and have her increase the dosage again. So we did. The nurse came back and told us that the pain doctor would be down a little later (it was about 2:00 when all this happened, and the pain doctor came around 5:00 or 6:00). The nurse also asked why we were using the pain pump only every 90 minutes instead of every 60 minutes (is anyone else asking themselves how they knew this???) The remote control for the pain pump is connected to the hospital wireless and can be monitored remotely. That's cool.
So...(is anyone bored yet)...the pain doctor came. I explained that we weren't pushing the button every 60 minutes because she would make it 30 minutes and be in so much pain we would get some other medication and she would be fine for a while, and when it was bad, we push the button again, about 90 minutes from the time before. She explained that the best way to calculate how much to adjust the dosage is to just push the button every 60 minutes, even if you have to use other meds to control some of the pain. This was music to my ears. I feel pretty helpless around here most of the time, but pushing a button every hour...piece of cake. So I started pushing the button every hour.
So I set my alarm, and we are off...until 2:00 this morning. The nurse came in to check vitals, and Alisa's oxygen saturation was 70%. I don't really know how serious this is, but alarms go off like crazy anytime the oxygen saturation is below 90%. Alisa had been off oxygen monitoring most of the day and had been fine (that's why there were no alarms, she had been off them all day), well the nurse told me we better stop being so reliable with the button because she was nervous it was causing this oxygen problem. She told me to wait 2 hours unless Alisa wakes up in pain. I think everything is pretty much under control now, they are monitoring her oxygen again and she is doing fine. I have backed down to 90 minutes for the button.
The positive news. She has not needed an additional dose of oxycodone or dilaudid since we started the reliable-button-pushing activity. I was nervous maybe this pump wasn't as great as I had hoped, but this recent success and a comment from a nurse keep me hopeful. He asked if they were doing a good job controlling Alisa's pain. We admitted that not really, but that it might have to do with this new pain pump she received. He was almost relieved and said "Those pumps are great, but they do take a couple of days to get adjusted just right, they will get it figured out." One moment he was concerned they couldn't control the pain, the next he was confident they would. It was comforting.
Here are a few pictures from Alisa's birthday party. I am sure I didn't pick the best ones, photography is not my strong point. (I almost forgot captions)
Gift box from the boys. Even in her "not perfect" mental state, she immediately recognized the hand of her friend Steph in "helping" the boys with their gift. Unfortunately they might have inherited their dads talent for gift giving. This of course turned out great, thanks to Steph.
Smiling faces. Genuine? Not sure. It is hard for those boys to see their mom in the hospital. But they are tough, and were happy to see her.
You are not really supposed to have so many visitors. it was totally worth the risk. I have to point out the big birthday banner in the background. My brother's daughters made that for Alisa. When Alisa saw it she said "I love it, I don't think I have ever had a real banner for my birthday." It was the perfect decoration.