I wish I had a better update to post.  Ryan is really struggling.   Pain has been really bad. He is on oxygen most of the time.  He stays in bed most of the day.   Even just playing games at the table last night was too much for him and he had to lay down.   We met with Palliative Care yesterday for the first time and they increased his Dillaudid and made a couple other med adjustments so I'm hoping maybe today will be a little better.