November 2: Day T+8

Ryan slept well with adequate Morphine doses last night.  Today the Pain Management Team was consulted to start PCA (Patient Controlled Analgesia) - a pump where Ryan can dose himself with a computer programmed to give a certain amount each time he pushes the button but with limits so he can't overdose.

Now he's getting what he needs.  There was a snag in getting the PCA dose right, and I was delighted to see that the nurses and resident were pushing really hard to get him what he needed and really apologetic that there have been so many problems getting him pain relief.  Sounds crazy, but even though there was a delay, I felt like I could relax because others were advocating for him and willing to get him what he needs.

Today his platelets hit 5,000 (normal: over 150,000), so he got a platelet transfusion. 

His temp hit 100.5 at midnight last night.  The resident called to say that they had done cultures and were starting antibiotics.  His temp has been below 100 all day today.

He's still able to take some of his medicines by mouth, but is not taking much nutrition at all.  I suspect that TPN will be started in the next day or two.  The attending says the mouth sores will subside about day 16-18.

All in all, things are progressing exactly as expected.  The mouth sores, inability to eat, transfusions and fevers are par for the course.  The attending says he couldn't be doing any better. 

Knowing this, it's reassuring to watch him relax and sleep now that he's got with adequate pain control.  The more of this he can sleep through, the better. 
---Barb