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Pain Killers

by on January 22, 2011

I’ve spoken to several people recently about Satomi’s health and I thought it important to go over a few important details.  Firstly Satomi’s health is very difficult to quantify in some objective manner.  The best we can consistently do is call them “good days” or “bad days”. 

We have tried to track headaches and seizure frequency and duration and intensity but the communication gap with Satomi makes this very difficult to track.  It is not at all uncommon for Satomi to forget that she just had a headache so how can we track them?

What I do to track her condition is monitor her pain-killer type and dosage.  Let’s assume that Morphine is our baseline (as I’m told that is normal practice in medicine). 

I originally was told that Oxycodone was twice as potent as Morphine.  With some professional guidance and some online research it seems that it is only half the potency.  That makes a huge difference to the perception of her condition.  In other words, two doses of oxycodone is roughly equal to one dose of morphine.  Using a bit of math, each 1ml of Oxycodone is equal to 10mg of Morphine.

Fentanyl on the other hand is significantly more powerful that Morphine.  According to an online Physicians resource, the 25mcg/hr patch that Satomi had used initially is equivalent to 60mg to 134mg of Morphine per day.  The range seems to be a function of absorption, body composition, and time.  For simplicity sake, let’s use its average equivalent or 97mg of morphine per day

As I recall, over the course of the night of the first infamous headache back on January 8th, we gave Satomi 5ml of Morphine to finally stabilize her.  Given the concentration of the liquid, that is 100mg of morphine.  This does not consider all of the Tylenol #3 she also got. 

After speaking with the RN, we gave her first 25mcg/hr Fentanyl patch the following evening and were to use Oxycodone if things went badly.  For the week of January 10th, we supplemented the patch with Tylenol #3 as needed and tried to limit the Oxy.  By the week of January 17th, we used the Oxycodone daily, as needed.  The typical oxy dose for pain is 0.25ml/day which is equal to 2.5mg of Morphine per day. 

For sleeplessness and agitation, she now gets an additional 1ml of Oxycodone at bedtime which is equal to 10mg of Morphine per day.  As her pain and sleeplessness increased, we added a second Fentanyl patch on Tuesday.

After some work with an Excel spreadsheet, I learned a few things.  Since the pain started 14-days ago back on January 8th, her pain killer dose has consistently grown to double the original dose to maintain her pain level and state of consciousness

Given the potency of the Fentanyl, it is obvious that her total morphine dosage is mostly a function of the patches.  It is also important to consider that the frequency of Satomi’s headaches have increased on Day 3 of patch usage.  In recent days, the patch only seems to be effective to within 12-hours of the 72-hour (3-day) dosage window.  In other words, we have to change the patch more frequently to maintain her pain levels.

It can be argued that this increase in dosage is necessary to compensate for the bodies increased tolerance to Morphine however, given the short time period, it seems most reasonable that it is a combination of tolerance and increased pain.  All this said, there are lots of flaws in this exercise but overall, its basic message still holds true.

So back to the question on everyone’s mind:  How is our Satomi? 

All things considered, pretty damn good.

From → Medical Update

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