Ordinarily, at this stage in the Coma, the patient would be"under" with only ketamine. However, in about 20% of Coma patients, propofol (if that sounds familiar, it is because that was the drug that killed Michael Jackson) is needed to keep the patient completely "under". At some point during the night, Elana actually sat up and tried to remove the tubes from her mouth. Again, this is not uncommon for Coma patients. Regulating the amount of ketamine is both a science and an art. It is impossible to know beforehand how much ketamine will be needed to snow the patient over.
However, the amount of ketamine she is receiving on an hourly basis is staggering compared to how much she received in Tampa during her 3-day infusion treatments last June and October. I can tell you that at 200 mg /hr, which is the highest dosage you can receive at any point during the 3-day infusion treatment, your mind has left the planet and you are severely hallucinating. For those of you who prefer colloquial terminology; you are tripping your face off and have no idea who or what is real. And Elana only was receiving that highest dosage for 1 1/2 hours of the 4 hour infusion. Over the course of a 4 hour infusion in Tampa, Elana would get between 550 -600 mg of ketamine (approx 135 - 150 mg / hr). As Hans and Franz used to say, "Hear me now & believe me later", that is a lot of ketamine.
By comparison, On Sunday, she started with 240 mg /hr on a continuous basis. On Monday it was raised to 320 mg / hr & today it was raised again to 400 mg / hr. Today she will receive in excess of 9000 mg of ketamine. You can only imagine the party going on her head at that level. All kidding aside, she is probably having extreme and terrifying hallucinations. At the same time she is beginning to go through the severe effects of withdrawal from all the opioids (Vicadin, Morphine & Oxycontin) that she was taking in heavy dosages each day. This is a good thing, because it would have been almost impossible, and probably not so safe, for her to remove the addiction in a conscious state. The reality is that when she wakes up she is still going to be going the effects of withdrawal and the hallucinations. According to the doctor and those who I have spoken to who have gone through this, the toughest days will be after she wakes up. At that point I have to be with her 24 hours a day so she has something and someone familiar and calming with her at all times.
Sorry for all the medical talk. Time to call Jesse and find out who is favorite basketball player is. Some days it's Kobe other days it's D-Wade.