OK, I'm officially dying now.

Not to be melodramatic, I think it's realistic.

Misha's was wonderful this morning. She put a lot of needles in my upper chest, front and back. My lungs opened up, and I stopped coughing. It felt so great. But as soon as I walk out I'm coughing again, though it probably won't be back in full force until tomorrow. I slept for an hour there, and I slept when I got home. I am much more tired lately.

I suspected there were more metastases, but since I am usually wrong at such guesses, I placed no wagers. But I was right. As with the new mets in my lungs, the reality went beyond my imagination.

Dr. Nelson called at around 4:30. We didn't even talk about my lungs. There is a 2 cm. tumor in the left lobe of my liver, and disease in my spine, mid-upper back to the sacrum. There are also 'spots' - not totally certain that they are cancer - in my spleen and next to my adrenal glands. I pasted the report, or most of it,  below.

I told Dr. Nelson I had warmed up a bit to the idea of chemotherapy. I did say of the various options available for chemo, I'd like us to pick the one least associated with neuropathy. She said Topotecan and Avastin are good, which was what she had in mind anyway after talking to Dr. Brooks at UCSF.

She said if I am going to do treatment, it would be good to start in the next week or two. I told her I'd let her know next week.

Next week I will also ask her:

1. What would a decline look like for someone with my condition?
2. What can I hope to gain from chemotherapy at this point?

I had to tell Paramananda that I couldn't talk about the phone call until I was done packing and we were in the car. I'm at Jikoji now, it is very beautiful. But trying to figure out how to navigate among 30 people, many of whom will automatically say when they see me, after the American fashion, Hi, how are you? which is really quite terrible for me. (I know that it's just what people say! But I'm pretty sure at our brief check-in, I'm going to ask them not to.)

Some of the report from the PET scan:

FINDINGS:

CT scan was primarily used for attenuation correction and

registration of landmarks, and will not be reported separately

here. If clinically indicated, a diagnostic CT scan should be or

should have been performed within 3 months of the PET-CT scan.

The brain appeared grossly normal. Imaging through the head and

neck showed symmetrical physiologic labeling in the salivary

glands, pharynx and larynx without abnormality. There was no

abnormal uptake in the lymph node groups, including the

supraclavicular and axillary groups.

Imaging through the thorax now showed more than 20 foci of intense

labeling, SUV up to 17, several lesions coalesced to form masses

up to 4 cm in size. A 3.5 cm mass with SUV 13 indented the right

heart border. Hypermetabolic nodes were located in the

paratracheal, precarinal and hilar positions.

A 2 cm lesion in the lateral segment of the left liver lobe had

SUV 10 and a small lesion in the spleen had SUV 6. Heterogeneous

labeling was otherwise noted in the liver and spleen without other

focal abnormality. A 2.5 cm lesion was identified in the right

adrenal with SUV 13, and two smaller foci were noted at the left

adrenal with SUV up to 6.2. A focus superior to the metallic seeds

had SUV 6.3. Other areas of uptake within the abdomen and pelvis

appeared to be related to expected bowel and urine activities.

Many intensely hypermetabolic lesions were now located in the bony

skeleton, on the left side of C3 with SUV 7.5, the T1, T9, L1, L5

vertebrae, multiple sites in the sacrum, the left anterior iliac

bone, the right acetabulum, right pubic ramus and the left ischial

bone.

** IMPRESSION **:

PET-CT study showed wide dissemination of malignancy since PET-CT

scan of 8/16/12, to the lung parenchyma, mediastinum and hilar

regions, the adrenals, liver and spleen and in multiple skeletal

sites.