I took Lisa to the cancer center again for the palliative meds, but they didn't initially help her, even though they have for the last three days.  Today they gradually bumped up the morphine until it was triple the previous days' doses, and she was still in pain.  They then gave additional steroids until it was double the previous days' doses, and that did provide some relief.  The oncologist came into the treatment room (which he doesn't very often) to see Lisa multiple times during today's infusions, since she was having so much trouble.  The increase in pain is likely due to the tumor growing past some size factor where it exerts more pressure on the neighboring structures, causing more pain, which is one of the reasons that the steroids help so much.  After Lisa's pain level was finally brought down, her heart rate rose to over 170 beats per minute and stayed there for close to two hours.  They wanted to hospitalize her, but after conferring with a cardiologist, they decided that since Lisa's blood pressure and oxygenation were ok, that we could go home but monitor her closely and give her a beta-blocker at bed time and again first thing in the morning before we go in for the appointment we already have scheduled at the cardiologist.  After we got home, by around 6pm Lisa's heart rate was back down in the 120s (normal for her in her condition).

The swelling of Lisa's arm continues to get worse from the upper vessels that the tumors are constricting around her heart, and Lisa's legs and feet are swelling from the constricted lower vessels, though they don't cause her as much discomfort as her arm and hand do.

The oncologist has given us some different pain medication, including a patch which provides a more consistent baseline of pain relief so there are less major swings, and prescribed a stronger at-home pain medicine to take care of those times when the pain increases above the baseline.

We also got a surprise that although the doctor was suggesting and authorizing Hospice Care ("comfort care"), the Hospice organization said that Lisa is not eligible as long as she continues to go to the cancer center for comfort care, even though she has a critical illness and is too weak to get any actual cancer/chemo treatment.  We'll be following up so that we have a better understanding of it all.