Mayo Clinic, Day 2

A Positron Emission Tomography (PET) scan employs a radioactive isotope which acts like a tiny lighthouse within the body. The body is transparent to this radioactive light (gamma rays), so the PET scanner can see it and can locate the isotope with precision. The isotope is attached to sugar (glucose) molecules, which are injected into the body and taken up in greater amounts by hungry cancer cells than by the body's other cells. Thus the scanner can see a lot of these tiny lighthouses wherever there are concentrations of cancer cells. In myeloma patients, the PET scan can spot hot spots capable of causing bone damage, before the damage is ever done.

PET scans are expensive, Sandy the nurse said $3500, and for myeloma patients they are not covered by Medicare. However, Medicare is currently funding a study of the usefulness of PET scans for myeloma, so scans are available to a Medicare patient if the patient's doctor is willing to do the paperwork required for the study. Happily, Dr. Lacy was not only willing but suggested the PET scan, for which I will always be grateful.

I was seated in a recliner chair, and Sandy first took a blood sample from a finger, and then injected the isotope (looked like clear water) into a vein. There was no sensation from the injection, except a slight, momentary coolness at the site. Then I sat for an hour, mostly dozing, to give time for the body to distribute the isotope to the organs that were most hungry for the glucose. During that hour I was instructed to be as still as possible, to avoid using muscles, because working muscles demand a refill of glucose, and we wanted as much of the glucose as possible to be free to go elsewhere.

Then I walked to the scanner and laid on a table in front of a big horizontal tube that looked like an MRI scanner, except larger in diameter and shorter in length. As with an MRI, the table scooted me in and out of the tube, but unlike an MRI it was almost silent. It was far less intimidating than a normal MRI. My arms were in an uncomfortable position over my head, or else I would have gone to sleep. The scan itself took about 30 minutes, after which I waited a few minutes more while they checked to see if they got what they wanted. I did ask the technician if there was anything that she could tell me, but she winked "that's what the doctors get the big bucks for."

For me, this seems like the big test. My blood tests have thus far always been negative for the other C.R.A.B. symptoms (organ damage), as have all of the x-rays, so this one is most likely the key test. Sunshine and I agree - whatever the answer, we want to know it, and treatment decisions will probably hinge on it. We'll know in a few days.



Recent lunch: Organic chard with pistachios and cranberries, organic vegetable mix with shredded asiago cheese, two clementines.