Joshua’s pain is still very high, and on most days uncontrolled during the night time hours. This morning the team discussed admitting him back to CHOC for intervention. After careful consideration and several phone calls with the specialists and the in patient palliative care team, they have no other pharmacological interventions at this time for Joshua. They don’t have higher doses of opioids they can manage the pain with. They have been unable to provide in-home Paliative care - they either do not treat pediatric patients and/or are not contracted with the state to come to Chino. They have sent urgent referrals for out patient pain management at CHLA as well as Radys children’s in San Diego. 
The team expressed the system is not set up to handle and manage pediatric patients with complex and chronic pain. Most pain management drs won’t accept Joshua as a patient based on his age and the complexity of his conditions. They have also sent urgent requests for Respite caregiver support since Paliative is not available. 
He has his first appt with Chinese medicine on Friday. 
Please continue to pray, and if you can use our meal train to sign up. We are all exhausted providing bedside support and comfort for Joshua.