T Plus 9

The past two days have not been good. While the abdominal pains which I reported on earlier have subsided, they have been replaced with severe sores on Jan’s throat. This is one of the side effects of Methotrexate. The nurses say her throat is “a mess”. As a result, Jan can not eat, drink, take pills, or even swallow saliva without pain and discomfort. Yesterday they hooked her up to a “pain pump” which administers the drug Dilaudid twenty-four hours a day, and has a push button which can be activated by Jan every ten minutes if additional relief is needed. However, they started out with a very low dosage of the medication and it had very little effect on Jan’s pain yesterday and last night. She could not sleep most of the night, and was awake every fifteen minutes or so pushing that pain button. Each button push results in a very loud beep, so I woke up about every other beep. The doctors monitor the amount of pain medication to administer by the number of times the patient pushes the button for extra relief. In Jan’s case it was obvious that she was up most of the night in discomfort. So, this morning they doubled the strength of the Dilaudid and gave her something for anxiety. Thankfully, right now she is sound asleep. They promise to give her whatever pain meds she needs to take the edge of her throat pain. It’s a bit of a balancing act since they want to control the pain, but not to the extent of making the patient incoherent and susceptible to other problems. The Methotrexate is given on Days +1, +3, +6, and +11. Since we are on Day +9, she has received three of the four doses and will be due the last one on Saturday. However, if her throat is ulcerated and bleeding, they will fore go the last dose. Jan's white count today is 600 (normal 4,000 to 10,000), her hemoglobin is 7.6, and her platelets are 9,000. Since her hemoglobin is below 8, she will require a blood today, and since her platelets are below 10,000, she will also require one or two bags of platelets. Speaking of bags………..as I look at her I.V. pole I currently count nine different bags of “stuff” running. These include fluids, antibiotics, various minerals, and pain meds. Since she is not eating, I suspect that either today or tomorrow they will start to feed her I.V. as well. Now to focus on the bright side. We have now been here two weeks and one day, and Jan has completed her chemotherapy, received her bone marrow transplant, has survived every inconvenience, and by this time next week we’ll be very close to being discharged and moving to our temporary housing.