Full Stat Day:

AM Blood Glucose:     Time:  1508     Reading:  184

AM 60" Dig Temp:     Time:  1528     Reading:  97.1

PM Blood Glucose:     Time:  2122     Reading:  215

Medication Changes:

• 325 mg acetaminophen before nap for lower back ache
• Extra 10 mg of glipizide with dessert because of high BG readings
• 500 mg acetaminophen just before bed for another episode of hard pain in the same place as last time
• I've been forgetting to note this, but today was a Detox tea day. I haven't been keeping to a strict every-other-day schedule, so I'll start noting when I use it

    Dinner:  Rest of the KFC from last night; a scoop of German Chocolate Cake ice cream
    Miscellaneous Note on Recent BG readings:  I am concerned about her high BG readings, but we are also in the middle of negotiating one glucometer malfunction and, thus, having to use expired strips on the other. I am awaiting delivery of fresh strips. I am hoping that this will take care of the problem.
Sleep:

• Awake at 1500
• Down for nap at 1900
• Up from nap at 2115
• Down for night at 0200
• Awake 8.75 hours

Full Stat Day:

AM Blood Glucose:     Time:  1410     Reading:  148

AM 60" Dig Temp:     Time:  1430     Reading:  97.1

PM Blood Glucose:     Time:  2127     Reading:  193

PM 60" Dig Temp:     Time:  0145     Reading:  98.4

Medication Changes:

• Extra glipizide before going down for a nap, to address a sweet roll she had at breakfast
• 325 Acetaminophen before bedtime for "coldish" symptoms, including a slight rise in temperature

    Dinner:  1 KFC Original Recipe thigh; some of their Mac & Cheese; Some of their cole slaw. No dessert. I didn't mention it, because of her high BG in the evening she didn't ask for it.
Sleep:

• Awoke at 1400
• Down for nap at 1730
• Up from nap at 2100
• Down for night at 0200
• Awake 8.5 hours

Full Stat Day:

AM Blood Glucose:     Time:  1434     Reading:  190

AM 60" Dig Temp:     Time:  1454     Reading:  97.4

PM Blood Glucose:     Time:  2102     Reading:  228

Medication Change:

• Extra glipizide at dinner to cover high BGs that morning and evening and her choice of dinner.

    Dinner:  Another "Just Dessert" dinner. After I suggested several possibilities for "healthy" dinners, Mom stuck to her guns, "All I want is a big bowl of ice cream." That's what she got; German Chocolate Cake Ice Cream, to be exact.
Sleep:

• Awoke at 1400
• Down for nap at 1830
• Up from nap at 2045
• Down for night at 0000
• Awake 7.75 hours

Morphine Manual

Important Caveat:  The following instructions are eccentric to my mother and her peculiar pain and health profile. They should not be used by anyone else to any purpose, including self-administration of narcotic pain medication or as a substitute for or adjunct to one's own physician's orders. If you are suffering pain, seek the advice of your physician.

Sliding Scale for Morphine Administration for Pain Experienced on 11/12/08:

Scale Parameters	Amount in mL	Amount in mg
*Low (beginning)	0.125	2.5
Can give up to:
High (end)	0.250	5.0

Further Instructions:

• A dose will start to work within 10 - 20 minutes.
• This scale and these instructions are for first time use for Mom in her present "narcotic naive" (meaning, someone who has never taken narcotics for pain) state.
• *  This amount can be taken every 20 minutes until Mom is comfortable. This strategy is known as "loading up" and helps create a dose overlap effect until a comfort level is reached.
• Once the dose which achieves comfort is reached, this dose, up to 5 mg, can be administered every hour as needed.
• If pain continues to escalate despite above dosage instructions, call Hospice and check to see if any of the following symptoms apply:
  1.  Any increment of loss of lower extremity use
  2.  Increased urinary incontinence beyond normal
  3.  Bowel incontinence
  These could be signs of a spinal compression fracture.
• Stop administration in the absence of pain and the presence of comfort if these two conditions last beyond 1 hour.

Possible Side Effects:

• Nausea: Can administer metaclopramide
• "Loopiness"
• Sedation
• Keep in mind the typical adjustment period for someone who is "narcotic naive" is 3 days. After adjustment period, above symptoms should disappear.

Additional Notes:

• The morphine to which the above instructions apply is Morphine Sulfate, an Oral Solution to be taken by mouth or under the tongue.
• A syringe is provided in the package which is marked from 0.25 mL - 1.0 mL, in .25 mL increments. This means that I have two dosage increments up to 0.25 mL. Obviously, the above scale is designed for low usage.

    Morphine Manual Update:  The immediately previous link will take you to a post at my main journal which details a conversation I had with a Hospice RN that elucidated, in detail, the use of morphine for air hunger, including what effect morphine should and, more importantly, shouldn't have on the patient.

BMs Full Stat Day:

AM Blood Glucose:     Time:  1428     Reading:  126

AM 60" Dig Temp:     Time:  1458     Reading:  97.5

PM Blood Glucose:     Time:  1947     Reading:  186

Medication Changes:

• Skipped 2nd breathing treatment; simply forgot it. However, considering her hours, today, if we'd gotten the 2nd treatment in, we probably would not have been able to get a third treatment in or, if so, just an Albuterol treatment.
• 500 mg acetaminophen at 2015 for sudden, extremely significant sharp, steady middle back pain, below ribs, on the approximate plane of her belly button, across back extending about 5 inches from either side of her spine.

Bowel Movements:

• 1st after nap at 1930. Excellent volume; slightly loose but good consistency; very easy elimination; slightly challenging clean-up.
• 2nd occurred when she was preparing for bed at about 2330. Fairly poor volume; slightly loose but good consistency; very easy elimination; slightly challenging clean-up.

    Dinner:  Carl's Jr. Guacamole Bacon Burger and medium order of onion rings with 12 oz. Ginger Beer. She ate all but half of the hamburger patty.
Sleep:

• Awake at 1400
• Down for nap at 1715
• Up from nap at 1915
• Down for night at 0000
• Awake 7.75 hours

    Miscellaneous Note:  Since it appears that her health is beginning to affect her appetite, particularly at night, I will, from now on, be reporting detail about how her eating habits change, as they change. I will most likely also be noting days when there are no changes.

Official Sleep Average Report:

    Although I published a 10 day Sleep Average report on 9/14/08, 10 days does not a trend show. I decided, last night, to see what I could do with all the data I've stored on her sleeping since 9/4/08. Turns out I was able to compare two 34 day periods, through yesterday. The report is here.
Observations from Report Data:  Although there is a very slight decrease in awake time (the figures in red) from the first period to the second, I think there are more cogent points to be noted:

• Not only has the Longest Awake Day decreased by a half hour, the Shortest Awake Day has decreased significantly. Both of her Sleep Days (10/11/08 & 10/26/08) fell in the second 34 Day Period, as well. Neither of her Sleep Days occurred when she was having serious health issues, although I thought, erroneously, that the second one was prefiguring her third bout of pneumonia (which, thankfully, hasn't yet happened).
• Aside from having no days, during the first period, that I would refer to as Sleep Days, she also had two days when she was awake for 11 hours. She had no such days during the second period.
• In addition, and surprisingly, the number of days she was up for 9 or more hours increased by two and the number of days she was up for less than 9 hours decreased by two.

    So, it'll be interesting to me to see how her sleep quotient develops over the next period. Since I've arbitrarily set the first two periods at 34 days, I'll plan my next report to cover 11/12/08 - 12/15/08.

Full Stat Day:

AM Blood Glucose:     Time:  1218     Reading:  150	AM Blood Pressure:     Time:  1330     BP:  130/70     BPM:  84
AM 60" Dig Temp:     Time:  1229     Reading:  97.5

PM Blood Glucose:     Time:  2101     Reading:  146

PM 60" Dig Temp:     Time:  2100     Reading:  98.4

Medication Changes:

• 325 mg acetaminophen at breakfast for a "coldish" feeling
• 325 mg acetaminophen at dinner for same feeling as above
• 325 mg acetaminophen before bed for same feeling as above

    Dinner:  Ham and egg with caffeinated English Breakfast tea; she only ate about 3/4's of her dinner and refused a Costco lemon Danish, so her cold has gotten the best of her appetite, which is unusual. This is the third time, I think, since she was diagnosed with lung cancer and has been on Hospice, that her appetite has failed her when she isn't feeling well. It normally doesn't.
Sleep:

• Awake at 1200
• Down for nap at 1615
• Up from nap at 2030
• Down for night at 0145
• Awake 9.5 hours

BM Full Stat Day:

AM Blood Glucose:     Time:  1433     Reading:  166

AM 60" Dig Temp:     Time:  1440     Reading:  97.8

PM Blood Glucose:     Time:  2146     Reading:  155

PM 60" Dig Temp:     Time:  2152     Reading:  98.4

Medication Changes:

• 325 mg acetaminophen at breakfast for persistent lower back ache with which she awoke
• Skipped prune juice; she finally said "no" to all the fluids I was trying to get in before her chosen early bedtime

    Bowel Movement:  Occurred just before bathing (1500). Good volume; good consistency; easy elimination; easy clean-up.
    Dinner:  A bowl of Annie Chun's Hot & Sour Soup and a slice of apple tart.
Sleep:

• Awake at 1400
• Down for nap at 1930
• Up from nap at 2130
• Down for night at 0030
• Awake 8.5 hours

Full Stat Day:

AM Blood Glucose:     Time:  1327     Reading:  154

AM 60" Dig Temp:     Time:  1345     Reading:  97.5

PM Blood Glucose:     Time:  2051     Reading:  172

    Medication Change:  Back to scheduling Detox tea; 1 cup this evening before bed.
    Dinner:  Costco Chicken Pot Pie; 1 slice egg custard tart for dessert
Sleep:

• Awake at 1300
• Down for nap at 1800
• Up from nap at 2030
• Down for night at 0130
• Awake 10 hours