Breakthrough

We've been using this word a lot more than we'd like to have over the last few days. It normally has a very positive meaning but for us it indicates that Pads has a spike in pain requiring additonal pain relief.
The diamorph took another hike up to 360mg on Saturday after the need for repeated breakthrough. This has been the pattern over the last weeks, the dose was increased from 150 to 180 on 13th May and then to 240 on 22nd May. There is no maximum dose.
Today he's already had three breakthrough doses of 190ug sevradol - each enough to floor an elephant. So we could be going up again soon. In spite of this, he remains chirpy and even managed, as usual, to beat Ann, the play therapist, at Skip-Bo this afternoon. She then tried Asher in the front room where I'd lit the fire because of the rather dismal June weather we're getting this week.