"Have a good day!"

Robin explains that in the morning you say:

"I'm going to have a good day. That's what you say, and then that's what you have."

She's been getting progressively groggier. She continues to get small increases in her pain medication each day. Whereas last weekend we thought 1.0 mg/hr of Dilaudid was a high amount, now she's on 1.9 mg/hr continuously. We were told that it would be considered a high dose if she reaches around 4.0 mg/hr - she does have doctor's orders to go as high as 8.0mg/hr. We've been careful to not increase the dose indiscriminately, Robin has always preferred to tolerate some pain because it often turns out to be transient. We tend to give her small increases when she's been experiencing pain on-and-off during the day and the "extra dose" feature doesn't keep it under control.

We do know that increasing pain is a sign of disease progression. Increasing temperatures (fever) are also a sign, although she hasn't broken 103 since Tuesday. A third sign is increasing fatigue, but we're not entirely sure now how much fatigue is from the pain medication and how much is from the disease. On a day-to-day basis Robin still has periods where she can talk and sometimes get up out of the bed, but her naps do seem to last longer each day.

Each day seems to take a little more effort to get up the stairs. Luckily we have the hospital bed setup downstairs so she can sleep there if she chooses.