What a difference a day makes!

We dropped Mary's fentanyl trans-dermal patch to half size at 12 micrograms/hr on Thursday evening. Also on Thursday, we started the MSContin at a 45 mg per day rate. The plan was/is to increase the MSContin to make up for the reduction of the patch, going slow in both directions so we don't cause withdrawal symptoms nor overdose Mary on narcotics. And, for breakthrough pain, we'd give her oral doses of liquid MS.

As I wrote yesterday, Mary went to Stanford yesterday and visited both doctors. What I didn't write was that she was having a pretty good day so I left her unattended from 2:30PM to 6:00PM as I went to work. She called at 5:30 and asked that I come home for a liquid morphine dose. Otherwise, she took care of herself. And last night she was aware and awake but not interested in eating even though I prepared one of my culinary masterpieces. (Definition of a Pat masterpiece: 1) It was a hot meal 2) It wasn't dessicated and 3) there were no violations of bacterial contamination protocol. That is a masterpiece lately.)

Overall, she was alert last night and generally I felt positive.

Today was totally different. We got up together (actually, she woke me up), ate breakfast, showered and headed to our jeweler (Ken Gerhkins) to look at the work ups on Mary's necklace. (No laughing that the first thing Mary did when feeling good was go to a jewelry store!) When Dr. Visser told Mary about her cholangiocarcinoma last year and the expectation from the liver surgery, he said "Because you are young, active, healthy and thin, I think you have excellent chances to survive this successfully." Mary reacted stronger to his calling her "young, active, health and thin" than she did to the pronouncement of cancer, I think. Anyway, Mary said she wanted a custom neck piece made with the initials YHAT for her one year anniversary.

Ken is an artist and showed us several different mockups for Mary's piece. Once we settled on one, he started to modify it as we sat there. When he started to place many diamonds on the mock up, I heard my father's penny pinching voice but I managed to wrestle it to the ground without saying a word! We'll see the metal in a few weeks and there is a pretty good chance it will be ready for March 22nd.

As for the rest of the day, Mary was alert, interactive and generally in a state of awareness and consciousness we haven't seen for weeks and weeks! We talked to her sister and brother in law and to her son Daniel and Mary was alert and positive throughout the whole thing. Heck, she even ate lunch at the kitchen round, something she hasn't done since Christmas! The kitchen round is bar height and we have very high chairs so I was amazed that she took her place there as I fixed sandwiches...oh yeah, she hasn't asked for or had a sandwich for over a month...

Her daily breakthrough of liquid morphine has ranged from 120mg to 200mg on top of the 25 micrograms per hour of fentanyl. Today she had 40mg of liquid morphine, 90 mg of MSContin and a 12 microgram fentanyl patch. That is the least she has had since we acquired the liquid morphine. This may be a premature judgment, but it is starting to look like the fentanyl has been the bad actor here--not enough pain protection and some pretty strong side effects.

A couple days ago I wrote about Mary's different phases in the narcotics cloud with the least being a phase called "light fog". Well, if that was light fog, she is now in a light haze in full sunlight. During the phone call with Reenie, Mary made a couple of quick comments that caused Reenie to say, "Hey! My sister is back!" Mary's coordination is almost fully recovered, her jerky hand motions are gone, just about everything is much, much closer to normal. Whew!

Although she didn't go out after the trip to Gerhkins, she did click on the Olympics and watched several events that were of interest to her. She was much different today in that she clearly was concentrating, remembering names and not one moment of dozing off--heck, I was the one nodding off and forgetting which event was on the TV (BTW, don't you just love TiVo for watching sporting events? When they run highlights in slow motion, I love to set TiVo in slow motion so you get double slow mo and can really see what is happening in some of the high speed stuff.)

By the end of the day, Mary asked me to take her through all the medications in the med's box so she can take care of herself. Again, she hasn't done that for weeks and weeks...

We shall see what Sunday brings, but Saturday was an absolute, out of the park grand slam kind of day!