14 January 2015 - 11:00 PM

After some visits from a few doctors, including the "Pain Team", whose job is to help manage cancer pain, they decided to do a few things that have seemed to work.

1. They increased her PCA dose from .2mg of dilaudid to .5mg.  She can receive this dose whenever she pushes the button (subject to constraints mentioned in the previous post).  This is only step one because she has been on some pretty heavy narcotics for the last few days with no relief
2. They put her on a continuous drip of Ketamine.  This seemed to help a little better.  One of the nurses said "this drug has a great street value."  We can understand why.  Alisa is having all sorts of vivid dreams and even started singing happy birthday to Sam when she called him (his birthday was yesterday.)  She was a little upset with me that I didn't stop her immediately and tell her it was yesterday (apparently Sam was a little confused), but I couldn't, she seemed to happy.  After 5 days of being miserable and in pain, it was refreshing to see her happy again (if a bit delusional.)  I decided delusional is better than constant un-yielding pain, as long as it isn't permanent.
3. They gave her some nerve blocking injections.  I am sure there is an official name for this, but I must have missed it.  Basically they injected lidocaine into the nerves in her back (between her ribs) and it magically stopped the back pain (the worst of the pain she has been experiencing).  the doctor told her he could do that every 2-3 days.  She came back from this procedure feeling better than I have seen her since last week.

The last couple of hours have been much better than the previous couple of days and I even think Alisa will get a good nights rest.  The downside is that we are really just masking her pain, we haven't done anything yet to try and address the cause (the tumor).

We have a plan to try 2 things.

1. Embolization - I think I got this term right.  Basically they thread some wires and other tools up the femoral artery until they get INSIDE the tumor.  They find the blood supply to the tumor and shut it down.  This effectively kills the tumor.  They were going to try this tonight but it requires that Alisa lay still for 4 hours after the procedure, and the pain she was experiencing was not going to allow that.
2. PD-1 - We are still hoping she can get a dose of PD-1, but they can't do it while she is in the hospital, so she will have to be discharged first.  If her pain is under control tomorrow, we could still get the PD-1 tomorrow afternoon.

The goal today was to get her pain under control.  Success! 

Tomorrow we will come up with a new plan.

-Josh