Friday, January 11, 2013

Trials of the very New Year

My darling Pammy returned home from hospital on Monday 7th and after 3 subdued days was once again regurgitating her overnight PEG feed just before it was due to finish yesterday morning at 7:20am.

It sounded like a very substantial event and I sat up expecting to see stomach contents all over Pam’s bedding – ah but no.  Pam managed to keep her mouth closed and was busily swallowing its contents as I quickly reminded her “Don’t breathe in whilst you’re swallowing!”  But she apparently already had.

What followed next was the pitiful experience of watching poor Pam trying to cough up that which had gone down the wrong way.

I thought “Here we go again” and even notified our daughters to expect their Mum being shortly returned to hospital.  The stress of coughing certainly knocked Pam around, causing her to become excessively tired – and all that could be done (before seeking medical help) was to regularly monitor her temperature to detect the almost-inevitable onset of subsequent aspiration pneumonia.

I’m writing this at 5:45pm, Friday 11th January and so far, her temperature has been stable and Pam appears bright and happy during the short moments she is awake.

Adding to the above story, it's important to mention that I am aware that one of the main dangers to Pam is her nightly PEG feeds. Prior to Pam's most recent visit to hospital, she had been accepting 500ml of PEG feed delivered at a rate of 48 ml/hr. That actually used roughly two and a half boxes of "Resource 2.0" (it used to be "Novasource 2.0" until a week ago - the change being imposed by the supplier), with the extra half box volume having to be discarded.  However, when I got Pam back from hospital I noted they'd only been giving her 2 boxes each night - and that got me thinking...

Pam returned home with a healthy weight of 61.6kg. This is in excess of the 60kg recommended by her Dietician and so I reasoned it would be OK, at least for a while, to not only keep the feed at two boxes (registering on the PEG feed pump as 400ml even though each box allegedly contains 237ml) – and this represented a 20% reduction of food intake per night.  Now the prospect of it finishing the feed in the wee-wee hours of the morning got me realising that by reducing the feed rate also by 20% would have the feed finishing at a time to which I was accustomed.  So as well as being convenient, it was a potential double remedy for Pam’s nausea – she was to get a lesser amount delivered at a slower rate.

That was the regime until the latest regurgitation on the morning of Thursday 10th, but since this event I’m lucky to get Pam to accept just one box (registering as 200ml) and being delivered at just 20ml/hr.

I have discussed this with our GP and Pharmacist and from this coming Wednesday, Pam’s anti-nausea medication will not be Motilium, three times per day nor Pramin, four times per day – but instead each of the above on alternate days.  It will be Pramin one day, Motilium the next etc.  Pam accepts that when this regime is in place she’ll once again be brave enough to attempt consuming 400ml at 40ml/hr.

I hear you – you want to know why wait until Wednesday?  Well, it’s the normal weekly start day of Pam’s medication dosette packs and while I acknowledge that the Pharmacist (Tim DeBoo of Flannigan and Poole Pharmacy, Lime Ave Mildura) was willing to update the dosette pack that I was currently using, I reckoned (with Pam's agreement and without medical backup) the little potential weight loss would not be an issue.


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