Journal entry by Alan Kristal

It's been over a month since the last journal entry, because I've been waiting for things to calm down and take on some sort of clarity.  Chemo continues to be a challenge.  Round 3 went very poorly, with acute GI toxicity that forced me to skip a cycle.  I did get to Palm Springs and Joshua Tree, hiking or bicycling every day and enjoying the sun.  Round 4 was better: 2 drugs, both half dose, and no acute symptoms.  But it is a struggle to tolerate.  The first 3 days are like being drawn and quartered, pulled in every possible direction by the myriad of drugs.  The steroids make you manic, the chemo shuts down your GI tract and suppresses red blood cell production, the anxiolytics are a bit calming and the narcotics are stupefying.  Days 4-6 are a haze, as the steroids stop and the chemo drugs really grab hold.  Then you get a few days to gradually return to normal and it starts all over again.  There are two cycles left, and then we use imaging to evaluate.  Since my cancer antigen 19-9 shot up to 7600, it likely that the tumor is growing despite the chemo.  So I don't expect to continue.

Every day, regardless of its overall tenor, contains something unexpectedly delightful.  Often it's a note from a friend or past student, or a walk to see a new building in Seattle that (seemingly) materialized overnight, or a restaurant meal that is so corny that it makes you laugh or piece of theatre that is somehow much better than expected.  And putting mind over matter, I'm back to exercising and playing piano every day.  I do miss the adventure travel (last year Christmas was on a wilderness mountain plateau in Ethiopia), but there are trips planned: to Hood River to visit Ruth and Bill and ski on Mt Hood; to Fort Lauderdale to visit Jack and get out of the damn winter gloom; to London to hear Akhnaten at the English National Opera and Katya Kabanova at Covent Garden; and to Whistler.  There are rare moments of feeling sorry for myself, which are fleeting. 

Happy New Year

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