(e-mail from B. Parady)
The word for the day is opioids. The doctors, nurses and I had some long conversations today about all of this. Bottom line, the increase in storm activity could be and is likely to be related to sharp decreases in doses of Fentanyl and related opiods. There were sharp drops both after bone flap replacement and a week ago or so.
What does this all mean? For one it can mean an altered and perhaps more optimistic prognosis. For another, it charts a course to both manage the storms, and get her back to rehab. Basically the opioids make Sabina more sensitive to storms, since withdrawal mimics storms to a significant degree. It also explains the mechanism of why opioids modulate storms. Two nurses thought independently that this looked like drug withdrawal. One nurse expected storms for perhaps another 50 days.
She had one storm early and one late today, both stanched by Fentanyl.
So, my optimism returns a bit, and I am encouraging the staff to see her through the storms and manage her fentanyl much more closely. Amazing how this sort of thing can slip through.
So, my prayers for Sabina to recover and make progress in measurable ways.
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