From: Paul Balfour [mailto:paul.balfour@gmail.com]
Sent: Monday, February 07, 2011 2:11 AM
To: Alex's Doctors
Subject: Alex is in 2B
Sent: Monday, February 07, 2011 2:11 AM
To: Alex's Doctors
Subject: Alex is in 2B
Room 4.
Not for mucositis. But general pain.
He did develop some sores on one side of his tongue as noted on Friday but it hasn’t seemed to get any worse. Alex had a great Saturday, was up and quite active (for him) not too much of the dex blues. Ate well. Best day of the week.
Today was similar, he was in a decent mood, up and around including watching his sister’s soccer game from the car at noon.
We did some of his physio exercises before noon and Alex said he had some minor pain in his groin. “Not like a pulled groin” but different. It doesn’t seem serious and he doesn’t complain about it again until about 4:30 . Here’s what happened after that.
4:30, complains that groin is sore and heads up to room from basement where we were watching the football game.
5:00 p.m. I check on him and he seems to be in a fair bit of pain. The pain is on both sides of the inner groin, right where the leg meets the torso. After a while it subsides. I wonder if it has anything to do with him having been doing more walking than the previous number of days. He has a hot bath which he says helps.
6:15 p.m.. Pain returns with a vengeance, he is really in huge distress. No temperature, no nausea Just pain. I call in and speak with the oncologist on call. We discuss it a bit and decide that I should give him 5 mg of morphine, and see if that gives relief. Before I give it to him, in just a few minutes, the pain spreads, first his back hurts, then shoulders then his thighs. He has the 5 mg of morphine at 6:30.
7 p.m. - Morphine seems to have helped a bit but then the pain returns towards 7:20 or so. I talk to Dr. T again and we decide to monitor things for a bit longer. But after just a few minutes Alex is in real agony and I get him in the car and drive to Emerg. Still no temperature.
8:15 (? approx.) arrive at Emerg and Alex is still in a great deal of pain. Nurse does an assessment and suddenly there’s about 3 docs and two more nurses in the room. Turns out his heart rate was 200 and blood pressure “Low” (I never did get the numbers) and suddenly we’re being zipped into the trauma unit. Emerg doc M tells me he’s quite sure it’s a septic infection as he examines Alex. T arrives a little later, not sure who everyone else was. By the time he’s hooked up to a monitor Alex’s HR is down to 145 and BP more normal. Still no fever. He’s accessed and blood taken, bolus and a/b started (Vancomycin) and gets 2 mg morphine.
9 p.m. Emerg Docs have drifted off. Gets 4 mg more morphine by IV which seems to help pain a lot. He looks better. Blood work appears to all be normal. WBCs still 0.8 like past Monday, Hgb 105, platelets 160 something, electrolytes okay. Waiting for other blood results. Seems like they are thinking pancreatitis. I talk to Tanya about the difficulties he’s had with morphine and that while I know it’s only a dose or two, 24 hours can go by pretty quickly and soon it could be 48. She talks to the pain care people about using hydromorphone (sp?) instead which they have started doing.
10 p.m. Abdominal and Chest x-rays done, pain is pretty much under control but after quite a bit (I lost track) of painkillers. Any pain he does have seems to be primarily in the groin.
11 p.m. Surgeon visits. X-rays look normal, liver and pancreas enzymes or whatever from the bloodwork look normal. Prety sure not pancreatitis. She can’t see anything unusual. Head scratcher to her. T returns and they discuss. Alex points out pain was always symmetrical, both sides of groin, both sides of lower back, both shoulders, both thighs.
We get to 2b about 1:00 a.m. plan being to keep pain under control and reassess in the morning.
Never a dull moment.
paul
