May 29th, 2009: I’m sad to have to write these words, but in the interest of keeping you informed of what’s happening with my health, here we go….

The meeting with Dr. Jahan today was sobering and more. All my tumors have grown in the past two months. One lung tumor is now over a centimeter across which means its size has effectively doubled since the last scan at the end of March. In addition, the spot on my liver which had been taken off the table as a problem is now back on the table at some 4.5 centimeters.

The short term good news is that I have a lot of quality of life and as of this week, not much discomfort. However, this will change and it will change sooner rather than later. There are no plans for immediate intervention with chemo or radiation. Dr. Jahan reasons that both palliative treatments would diminish my quality of life. Since I am not in pain, why superimpose a treatment when none is needed—yet. I have an appointment with Dr. Jahan at the end of the month to check in about my symptoms.

For mid-term treatment, we discussed chemo as the strongest possibility. Dr. Jahan favors Gemcitabine which is administered over a 90 minute clinic visit (and may be given with another chemo drug). There is a clinical trial program in Santa Monica as well as a program here at UCSF which we can investigate when it comes time to actually schedule appointments. As for radiation, it may be used, it may not be practical. To be determined.

Dr. Jahan repeated that pain is the issue I’ll be navigating. In the near term, the growth of the pelvic tumor may set off pain as it presses against surrounding tissue. In addition, we talked about making sure that I have a DNR (Do Not Resuscitate) order in his office and at home. His concern is that I will have a sudden emergency and the responding medics will do everything possible to keep me alive even though that’s not my wishes.

Biggest message along with the tumor growth is: Do the things you need to do to have peace. Take care of business. OK, I can do that.

With that encouragement, I am off to see the Mark Morris Dance Group perform the unforgettable L’Allegro, Il Penseroso ed Il Moderato. This will be a great counterbalance to the visit with Dr. Jahan.