The Train Derails

Jon continued to have an excellent day on Monday. Martin spent the night so he and Jon went out for breakfast before Martin caught his plan to guide in Alaska. I took a long lunch to take Jon to some appointments the brought him back to my office for a one hour massage. My parents picked him up and they took him to all the local sporting goods stores to find a double-barreled shot gun for Wyatt and then to Dairy Queen for Peanut Buster Parfaits.

We all arrived home around the same time and when I walked in the door Jon was talking on his phone a yelled "Quick Doc, get me a long one (oxycotin)." By the time I got there with the medication he was doubled over in pain. I got him up to bed and gave him another 20mg of oxycodone, none of which touched the pain. No matter what position he tried to move he experienced severe, sharp pain in his right lower abdomen. I called the hospice hotline and they were able to send the nurse out within an hour or so. The longest hours of our life. I continued to give Jon more and different meds per the nurses instructions but they only seemed to make him dopey but not alleviate his pain. Any time he moved it was the same searing pain. When the nurse finally arrived she evaluated him and found his stomach hard and distended. Jon kept telling me he thought his ascites was improving but my mom and I both thought it was looking worse since the return from the camping trip. His abdomen also went from soft and squishy to hard and tight. The doctor had discontinued his lasix and spirolactone (diuretics) last week because his blood pressure was dangerously low. The nurse checked it tonight and we decided to give him those meds to take some of the pressure off his abdomen. She catheterized him and got him in a comfortable position. He slept through the night and was so dopey at 4 am when his next pain meds were do I had a very difficult time getting them down. I think we may need to switch to a patch or IV for pain meds if this doesn't improve quickly. A call has been place to Dr. Lin and his regular nurse will be out today. They are not sure what exactly is causing this pain but are going to rule-out appendicitis with bloodwork today. We know that his cancer has spread to his abdominal cavity and it is possible the pain is a combination of cancer and pressure from ascites. I should know more by noon today.