The ultrasound discovered a Blood Clot in traceys left calf. The will be starting her on Heparin this afternoon. She will be on strict bed rest for 24 hours.

Christy has started packing up the room for the move.

Insurance has approved 1 more week - Dr. Tabish want 2

30 mg Oxycodone

I just called tracey and she is having a ultrasound on her calf's.

30 mg Oxycodone

100 mg oxycontin

Nurse came in to see if tracey needed her oxycodone. Tracey has no pain so she refused... good thing the nurse mentioned as the entire UCLA hospital only could round up 20 mg. The have run out of Oxycodone.... they should get some this morning.

I am off to work.

Tracey woke up with some pain asked for oxycodone

30 mg oxycodone

pain 3

Traceys passed on midnight oxycodone

pain 0

the nurse doesn't think its anything to worry about, but she did call the dr. just in case.

Tracey is complaining of calf pain similar a muscle pull... We need to inform Dr. Stein... my concern is that her back pain is 0 and her left calf pain is 5, shouldn't the narcotics take care of both pains. If the calf pain is that much greater then the back pain do we have new more pressing issue... I called the nurse and she is on her way.

Back 0
Calf 5

Nurse Casey doing nightly meds and vitals

nurse casey is giving tracey her nightly meds.

Fixed problem with RED PICC line - bad cap.. replace now working fine.

100 mg Oxycontin, Kytril and the rests

Pain 2

Tracey only ate 3 bites of her chicken. Then she went back to sleep. she is pretty high again. I don't see any reason why sometimes she get high and sometime she doesn't. There is nothing we are doing in the meds schedule or amounts to see such a dramatic change. The only thing I can think of is a fluctuation oxycodone / oxycontin absorption efficiency.

if anyone has any ideas email me.... thanks

pain 0

pain 0

30 mg oxycodone

Traceys ate 6 Doritos.

Slept from 2:30 to 6

Fetal heart tone 142

Pain 0

pain 5

1 mg Dilaudid

Pain 8

Back at the hospital... I was late and missed the transport guys picking Tracey up. I did run across the street and meet her as she was getting out of the ambulance. more on transport guys later... Tracey did her treatment and then asked to talk to the nurse about the nausea and dry mouth. The nurse told her that the nausea could be caused by the radiation but not the dry mouth. So, she is suspecting the cause to be the meds. her pain has been around 4 most of the day. She just took 30 mg of Oxycodone an hour early in an attempt to reduce the pain. She still is not eating, and all the dr's do is tell her that she needs to force herself to eat... I don't know but i don't think tracey follows orders put to her in that manner.

Okay - the crack ambulance crew - they show up 45 minutes early Tracey isn't dressed and hasn't taken her meds yet. they rush her and the nurses. Tracey leaves without her meds. then they didn't know where they are going. I meet them as they arrive at 200. and lead them to the Radiation dept. EMT Sermeno said to his partner "I don't want to go in there and get zapped". I don't think that was very considerate. They were told it would be 10 minutes so they decided to go to lunch. They come strolling back 45 minutes later and bring her back to the hospital... the nurse walked in after they left and asked Tracey if they know what they were doing.... another day in the medical industry...

Pain 7

30 mg OxyCodone

10 mg Compazine

80 mg Oxycontin, Kytril.. and all the rest

Tracey is having vitals and blood draw

Pain 0

30 mg Oxycodone

3o mg oxycodone

Tracey is up pain is rising... she has requested 3o mg oxycodone now!

Pain 6

Tracey is finally asleep. Her pain level was 8 at 22:35. They really want her to stop the dilaudid and she had just taken 2 mg an hour ago. I didn't what her to have anymore Oxycodone because she had just taken 80 mg 45 minutes earlier. I didn't what all 11o mg hitting her at once. I asked her to wait 11 minutes and we will re evaluate. She fell asleep... oh she is awake... pain is at a 4 or 5. looks like the oxycontin kicked in. I have the nurse coming in at 2 with 30 mg Oxycodone...

Clyde take a look at the half life of oxycodone vs oxycontin. from what i found its only about .6 of an hour different. I must be missing something because if they are only .6 of an hour different how can the time between dose differ so much (oxycontin every 12 hours and oxycodone every 3)

Pain 4/5

80 mg Oxycontin - Made a plan with the nurse to wake us every 3 hours with Oxycodone... If Tracey's pain is a 2 or above she will take 30 mg Oxycodone.

I hope this helps.

Pain 6

2 mg dilaudid and Kytril

Pain 7

Tracey ate 1 bite... She vomited today so I think she is afraid to eat, but she needs to get some food in her...

Pain 2

picking up dinner at chili's...

picking up dinner at chili's... Tracey ordered ribs. I hope she eats them... Or anything

Pain is getting better... But now she is knocked out... I guess its better then in pain.

Pain 1, Nausea 0

Okay, New order is 2 mg Dilaudid every 3 hours as needed... until pain management comes back tomorrow....

1 mg Dilaudid now because she just had 1 at 17:00.

Tracey still wont let me yell at anyone.... wait tell I tell you the PICC story.... WOW

Tracey has again reached her maximum amount of pain meds and her pain level is at a 6 and rising. Per the order she can not have any more pain meds for an hour and 10 minutes.... I am having the nurse get the dr to increase both her 3 hour Oxycontin and Dilaudid max....

I really want to start yelling at people, but tracey doesnt want me to piss anyone off...

pain is out of control.............

1 mg Dilaudid

Pain 7

Here is my big concern:

Yesterday 00:00 to 16:30-
90 mg Oxycodone
40 mg Oxycontin
03 mg Dilaudid
From 10:00 to 23:50 Pain level Zero (0)

Today 00:00 to 16:30 -
110 mg Oxycodone
60 mg Oxycontin
02 mg Dilaudid

Pain level has not dropped below 3 and is at 5 and 6 most of the time


she is on more Oxy's and the pain is not as good as it was yesterday.

30 Oxycodone

Pain 6

We arrived back at 241 at 2:45 and at 3:00 she started vomiting. We don't know what the cause is - it could be that she got car sick, or side effects of the radiation, or just the same stuff we have been dealing with. the difference is that once she finished she didn't feel nauseated any more.

I called over to Radiation and the resident is going to call me back.

tracey is back in her

tracey is back in her room

1 mg dilaudid

I am back at the Hospital.

Tracey has eaten lunch and getting ready to go across the street.

Pain 5, Nausa 0

10 mg Oxycodone

Pain 6, Nausea, 2

11am 20mg oxycodone (pain - 4). nurse, susie, frantically searching for the remaining 10mg i requested

10am pain mgmt team came in. will recommend raising oxycontin to 80mg and told me to hang in there

9:40am 60mg oxycontin (pain 2-3)

7:30am Dr Stein came in. I felt great so she was happy with my report out to her. She thinks I should try 80mg of oxycontin.

30 mg Ocycodone

1 mg Dilaudid

pain 5

20 mg oxycodone

pain 4

Tracey is going to sleep... Not as high. Looks really good and normal. we are hoping she can get though the night without any Oxycodone.

I will be working tomorrow so updates will be less frequent.

60 Oxycontin and rest of the night meds.

Vitals

pain 0

Christy and Alexa just left. Tracey had a very nice visit and laughed a lot.

Still high - may be having some fatigue from the radiation

Pain 0

Nurse Casey tried to pull the clogged PURPLE PICC. Looks like the Purple one is clear.

Tracey still high.

Tracey Sleeps

Tried to unclog PICC - Injected .5 ml of Alteplase, Would not go into the RED line - PURPLE line injected fine. Will need some else to check RED line. PURPLE line will need to be pulled back @ 20:15.

Fetal Heart Tones OK - 148

Pain 0

Tracey is eating dinner - Lasagna and Brussels Sprouts.

Only real issue is Tracey is super High!

Pain 0

Dr. Stein came in and informed Tracey that her Oxycontin has been increase to 60 mg twice a day.

Dr. Garon talked with Tracey in regards to Pain issues. Left to speak with pain management people

30 mg Oxycodone

We are back. 2 down 13 to go. Tracey did better then yesterday. Just hard for her to deal with. understandably.

tracey on the move

tracey on the move

650 mg Tylenol and 1 mg Dilaudid

Radiation Appointment was at 2 pm but Transport still hasn't arrived. I called over to radiation and they are looking into it... This is quite the well oiled machine...

Tracey only ate 2 bites of the El Polo Loco - I need to talk to Dr. Stein about getting her something for her appetite.

Pain 1,

Trace is having her vitals done... Still waiting for PICC people to come by and clear the PICC line.

Eating El Polo Loco

Pain 0

BTW, I am back at the hospital

ok, so took the dilaudid when you were on the phone, but the oxycondone did not come until just now - 10:45. took 30mg. having pharmacy issues. the hold up this morning was the anti-emetic. that seems to be getting harder and harder to get. other issue, courtney has called the picc line nurse to look at my picc. ports seem to be clogged or resisting more than normal.

oh, and can't get my kindle to reset.

i'm going to take a nap!!

-- Tracey

spoke with Dr. Garon and asked him to get back involved with the pain issues. he said he would meet with Tracey today and discuss the pain management with the OB team. I asked him to change the dosing from every 12 hours to every 8 as Tracey is only getting about 4 hour relief from the Oxycontin.

pain 7 and rising.

40 mg Oxycontin

1 mg Dilaudid

Called Tracey - Pharmacy can not find Kytril waiting 10 minutes.

pain 4

I am headed to work. I will do my best to update. I am going to be back, hopefully, before treatment.

1 ml dilaudid

Blood Draw and vitals

30 mg Oxycodone

Nurse lisa came in to let us know that she had 10 mg Oxycodone, and if Tracey wants more lisa would have to go to the pharmacy. Tracey told lisa she needs 30 mg

Pain 5

Care partner came to give tracey vitals... Sent her away to get lisa and pain meds.

Called nurse lisa no answer... Used nurse button spoke with someone who said they would tell lisa.

Tracey needs 30 mg Oxycodone. Called Nurse Lisa no answer. used nurses call button tryed to speak with someone that didnt understand me.

Pain 4

After a weeks vacation Traceys bowels are on the move.

Pain 4

1 ml dilaudid

Pain 6

20 mg oxycodone

All in all Tracey had a good day. Pain was reasonably managed.

It started rough with the first treatment but she has been in good spirits and humor most of the day.

I will be working tomorrow, so the blog updates will not be as frequent. I will try to give an update an hour.

Tracey's treatment is at 2:00 pm.

Correction on the flowers one was from Kevin and family and one was from Joey (my sister)

Thanks

Tracey just finished nightly meds. 40 mg Oxycontin, Kytril and the rest.

Pain 3

Tracey is taking her vitals. We don't know who tonights Nurse is.

Pain 3

Tracey and I just finished watching Cloverfield. It was very interesting. Tracey felt pretty well throughout. She is now reading.

Christy came by but we were napping.

Pain 3

Fetal Heart tone done (132)
Tracey Requeted 20 mg Oxycodone.

Pain 3

She is finally awake... she got some really good sleep.

Pain 0 - Wow!

I was out taking care of apartment stuff and lunch - I came back and tracey is high as a kite and sleeping. She says she only had 5 mg oxycodone.

Received flowers - 2 sets both from Kevin, Anne and Kids

5 mg Oxycodone

15 mg Oxycodone

As a side note - Tracey's Kindle does not ever wake up from standby or when you turn it on without using the reset button. I called tech support this morning and they are sending out a new one. Just thought you should know...

Tracey is back in her room. She seems to be in good spirits. She is reading comfortably.

She is in mild pain. she has requested 20 mg of Oxycodone but the Pain people did not increase the dose as they said they would this morning. So Tracey has opted of 15 mg. Her 4 hour Max.

Pain 5, Nausea 1

tracey is having her radiation. She is very scared. Tracey was crying when she told me to leave. I am worried what her mental state will be

we have arrived at 200 medical plaza

Tracey is getting her dilaudid 1 ml and a xanax.

She has requested Tylenol.

Pain 4, Nausea 1

Julianne is doing vitals

pain 2

Tracey getting her morning meds. 40 mg Oxycontin and the standard regiment.

Pain 4

Tracey Radiology appointment is not until Noon.

Pain is still increasing - waiting for kytril to take Oxycontin.

Pain 6

15 Oxycodone

Tracey is eating breakfast... Cream of Wheat, hard boiled egg, and peaches.

Pain 5

The Pain guys came in without looking at the chart. They seem clueless. Tracey does not have confidence in there ability. They don't listen to her.

They have increased her Oxycontin to 40 mg twice a day for base pain. Oxycondone will be used for breakthrough pain up to 20 mg every 4 hours.

Pain 5

1 ml dilaudid

Pain 3

Oxycodone 15 mg.

Pain 4

Dilaudid is here... Tracey feels better.

Pain 1

Traceys pain has increased - she has asked for 1 ml Dilaudid.

Tracey has stopped reading and preparing to sleep. She is scared about tomorrow.

Waiting for nurse (jennifer) with Dilaudid

Pain 5

Tracey finally got enough Oxy to feel good. She ate 2 big Slices of Pizza. Still reading her kindle (Thousand Splendid Suns) and I think she might stay up all night to finish this book... She just heard about George Carlin's death and is saddened. Tracey and I have spent a lot of quality time together today. It has brought us even closer together. Tracey is a better wife then I ever wished for.


Pain 0, Nausea 0 !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Pain is reducing - Tracey still reading Kindle.

Pain 3

Tracey is in moderate pain reading her Kindle.

Pain 6, Nausea 0

Tracey is getting her nightly meds. Also her 20 mg Oxycontin and Kytril, which is not available orally at this hospital (whatever that means) I hope we can get it at a pharmacy.

She is having a real problem managing the pain. She again has reached her max doses on all her pain meds that are on the order.

Vitals were done.

Pain 6, nausea 0

15mg Oxycodone.

Pain 4, nausea 0

Okay - They wont give tracey anymore Oxycodone until 19:30, so they are giving her 1 ml Dilaudid IV push. Works for tracey, but doesnt get us any closer to home.

Pain 5, Nausea 0

Tracey is up. She had good solid sleep. Requesting 15 mg of Oxycodone. Nurse (courtney) not being very cooperative.

Pain 4, Nausea 0

Good nap - I'm up, tracey is still napping

Pain 2, nausea 0

Nap time!

1 ml Dilaudid IV push...

Pain 1, Nausea 0

Tracey has not got any relief from the most current breakthrough. Tracey has asked what her pain options are as she has reached her max Oxycodone order.

We were expecting this to happen as tracey and I did the IV dilaudid to oral Oxycontin last night and we figured she would need between 100 and 160 mg of Oxycontin to maintain the pain at a 1 or 2. Her current dose is 40 mg. We did discuss this with the pain guys and they said that they order as little as possible like 30% and manage the rest with breakthrough meds... The pain guys will need to increase her Oxycontin in order to manage her pain. ---

The Dr. just approved dilaudid IV push - just not sure of the dose.

Tracey is also worried about pain management while at radiation. we will talk to Dr. Stein in the morning.

pain 6, nausea 0

Tracey is reading her Kindle.

40 minutes later the Oxycodone is here! Courtney also did vitals and fetal heart tones (132). Tracey skipped her prenatal vitamins because she is worried about the nausea.

She only ate a couple of bites. I will get with the Dr. and work on some appetite solutions.

Pain 6, Nausea 1

30 minutes and still no Oxycodone... if she cant get the meds when she needs them - this will never work.

I need to see the Dr.

Tracey is eating CPK - Pasta and lemonade. She is in mild pain. she just asked for 10 mg of Oxycodone. Her nausea is maybe starting she isn't sure, Tracey is thinking about adding Zofran prophylactically.

I went to the apartment - it is perfect. Thanks Pat and Diane. It has everything she needs. I am going to bring some of her personal stuff to make it feel like home.

Pain 4, nausea 1

Oxycodone needed 5 mg

10 mg Oxycodone needed

Pain at 6

Good morning.

After the morning Oxycodone Traceys pain level dropped to 1. The only problem is that from the time she call for the meds and the time she gets relief is just over an hour. Tracey thinks that she can overcome that by planing and getting her meds before she needs them.

Cortney (todays nurse) is giving Tracey this mornings meds.

I am going to go look at the apt this morning and see what I have to do to get it ready for her. I think she is only a couple of days for leaving

Pain is a 2. nausa is 0.

Tracey woke up at 05:10 at a level 4. I ordered 10 mg Oxycodone. It took the nurse 15 minutes to bring it in. Tracey was at a 5 before she took the Oxycodone.

Vitals taken, blood drawn.

Tracey is sleeping.

pain is down to a 1

Pain is at 6 and rising.

10 mg Oxycodone was given at 11:30 when pain was at 5.

Tracey took a shower and is feeling clean. She is wearing her new PJ's

Okay - PCA has been discontinued... Tracey is now on oral pain meds 20 mg Oxycontin was given at 21:10 along with IV nausea meds. Tomorrow we will move to oral nausea meds.

Sorry Correction - I have been saying Tracey is scared about tomorrow, I meant Monday.

She is planing on taking a shower in a couple of minutes.

Well its 21:00 and no Kytril or Oxycontin.... its here... I will let you know how its going

Dr. Stein is great.

Tracey is scared about tomorrow.

Pain 2 - nausea 0

Tracey is done with the elephant book...

Nurse just did the fetal heart rate - 142

Just read Tracey some emails... thanks everyone...

Tracey is now reading her elephant book again..

ate Doritos and fell asleep...

Tracey is reading... Almost done with her elephant book...

Tracey is up.

Tonight we are changing her Pain and nausea regiment. She will begin Kytril at 20:00 and Oxycontin 15 ml at 21:00 every 12 hours. For breakthrough pain she will be using Oxycodone.

Tracey is still sleeping...

Tracey is sleeping.

Tracey's appetite is still decreasing. She ordered chili and a sandwich from corner bakery and she only ate one bit of the chili and two of the sandwich.

The pain management people came back. Again new people, we have now seen 6 different pain people. All of them say they will make recommendations to the OB team but nothing has ever come of there recommendations. This time the pain team is leaning toward oxycontin.

Tracey is wondering when she should transition to the oral meds. she is very worried that the nausea is not managed. In her mind without the nausea managed she cant even start on the pain. I agree.

Tracey is now reading and pain is at 1 and nasuea is 0.

Just waking up... thinking about lunch...

Tracey ate oatmeal and banana... now sleeping.

Dr. Stein the new resident spoke with Dr. Tabish in regards to Tracey's pain and nausea. Dr. Tabish order Tracey back on the Steroids only if the nausea come back.

Pain is another issue... tracey used 19 ml yesterday. The pain management people are coming by today to figure out what we can do.

6/21/08 00:00 to 10:00

another 4 am wake up to tracey's tears. Pain was at a 10 nausea a 7. call nurse Wendy and had 2 ml dilaudid bolused to reduce the pain. She was also given all three nausea drugs between 4 and 5 am, Zophran, phenergan , and kytril.

By 6am her pain was reduced to a 2 and nausea 0.