Thanks for checking in,
We learned today from Dr. Charles Eichler @ UCSF that he used a cadaver artery/vein for the fistula revision surgery three weeks ago.  This was new learning and explains why the surgical procedure took 2.5+ hours.  This was our first interaction together with Dr. Eichler since the surgery was performed.  Today the sutures were removed.  The fistula revision is performing its job at dialysis because the “stealing” has stopped but Irene’s thumb has lingering numbness which we hope dissipates over time.  She returns to UCSF for an Ultra Sound test on October 27.

Irene will also return to UCSF on October 6 in the Oncology Ward @ UCSF to see Dr. Damon for her quarterly Primary Amyloidosis test.
Thanks for caring,
Dave

The Wife of Noble Character

10 A wife of noble character who can find?
  She is worth far more than rubies.
11 Her husband has full confidence in her
  and lacks nothing of value.
12 She brings him good, not harm,
  all the days of her life.
13 She selects wool and flax
  and works with eager hands.
14 She is like the merchant ships,
  bringing her food from afar.
15 She gets up while it is still night;
  she provides food for her family
  and portions for her female servants.
16 She considers a field and buys it;
  out of her earnings she plants a vineyard.
17 She sets about her work vigorously;
  her arms are strong for her tasks.
18 She sees that her trading is profitable,
  and her lamp does not go out at night.
19 In her hand she holds the distaff
  and grasps the spindle with her fingers.
20 She opens her arms to the poor
  and extends her hands to the needy.
21 When it snows, she has no fear for her household;
  for all of them are clothed in scarlet.
22 She makes coverings for her bed;
  she is clothed in fine linen and purple.
23 Her husband is respected at the city gate,
  where he takes his seat among the elders of the land.
24 She makes linen garments and sells them,
  and supplies the merchants with sashes.
25 She is clothed with strength and dignity;
  she can laugh at the days to come.
26 She speaks with wisdom,
  and faithful instruction is on her tongue.
27 She watches over the affairs of her household
  and does not eat the bread of idleness.
28 Her children arise and call her blessed;
  her husband also, and he praises her:
29 “Many women do noble things,
  but you surpass them all.”
30 Charm is deceptive, and beauty is fleeting;
  but a woman who fears the LORD is to be praised.
31 Honor her for all that her hands have done,
  and let her works bring her praise at the city gate.

Proverbs 31:10-31

A psalm of David

1 Blessed are those who have regard for the weak;
  the LORD delivers them in times of trouble.
2 The LORD protects and preserves them—
  they are counted among the blessed in the land—
  he does not give them over to the desire of their foes.
3 The LORD sustains them on their sickbed
  and restores them from their bed of illness.

Psalm 41:1-3

8 p.m.

Thanks for checking in…!!!

Irene did well with the revised fistula at dialysis today.  This is a HUGE development!

We’re very grateful for UCSF and Dr. Charles Eichler’s surgical expertise. 

She’s still experiencing NUMBNESS in the fingertips of her right hand but we obviously hope that this diminishes over time.

She’s recovering this evening from a very rigorous week. 

Thanks for caring…and rejoice with us…!!!
Dave

6.30 p.m.

Thanks for checking in…!!!

Irene was discharged from UCSF late this morning and is now resting at home.  She’s still using heavy pain meds and the numbing continues in the fingertips of her right hand.  We’re obviously hoping this awkwardness goes away quickly…!!!

Dr. Eichler said that the fistula revision can contempate use tomorrow at dialysis.  Hopefully the colossal pain she was feeling will now be minimized…only time will tell. 

She’s scheduled to be re-examined by Dr. Eichler at UCSF on August 18th.

Thanks for your continued care and prayer,
Dave

9.30 p.m.

Irene’s body doesn’t know if it’s coming or going…

Yesterday’s very invasive angiogram procedure @ UCSF went well and she was up for the challenge of today’s early morning dialysis followed by the 2.5 hour surgery relative re-engineering her fistula. 

Her dialysis treatment at UCSF this morning was only 2 hours because the pain and discomfort was too much to continue.  They were able to get her to “dry weight” but were unable to remove all of the toxins that would have been removed in the last hour.

UCSF decided this evening that they needed to keep her one more night for observation since she’s still trying to come out of the anesthesia (my uneducated guess is that it’s tied to the dialysis and lack of her body’s ability to clear it through normal kidney function).  She’s also battling nausea and right arm pain this evening.  Her entire right hand is numb but the medical team said that is normal following the procedure today and should dissipate over time.

Dr. Eichler performed the surgery today and remains hopeful that progress has been made.  He wants to see Irene in his UCSF office within the next 2 weeks for a post-op exam.

The Primary Amyloidosis still remains in remission but it’s damage lingers on…

Hopefully she’s discharged in the morning!!!

The entire team @ UCSF ROCKS...!!!

Thanks for caring,
Dave

1 p.m.

Irene made it successfully through dialysis this morning! YAY!

She's resting and recovering through a typical post-dialysis day, knowing that she needs to muscle it through Monday's 3 1/2 hour session...then admitted to UCSF on Tuesday.

Thanks for caring,
Dave

12.30 p.m.

Thanks for checking in.

Irene had a massive needle infiltration today, which has pre-empted her from completing dialysis treatment. She's home icing the significant swelling. She returns tomorrow morning where they will endeavor to get her through a complete session.

http://www.mcrh.org/Hemodialysis/35759.htm

Thanks for caring,
Dave

9 p.m.

Irene’s circulation in her hand is worsening and she’s counting down the days to the UCSF procedure (although it’s not as if she is looking forward to the upcoming skirmish). 

This evening she commented that after two hours on the dialysis machine today the pain escalated to an 11 on a 1-10 scale.  Not good.  She endured colossal pain and discomfort but was determined to finish the session so she that didn’t have to return tomorrow.  She’s using hand warmers to promote circulation; her arms even have burn marks on them.

The nausea is raging this evening; the emotions are raw…but she remains faithful.

Irene deeply appreciates the expressions of care and intercessory prayer.

When It Pours, He Reigns,
Dave

Thanks for checking in…!!!

Here’s the latest development.

On Tuesday, July 26, 2011, Irene is scheduled @ UCSF for an Angiogram, http://en.wikipedia.org/wiki/Iodinated_contrast, using CO2 rather than DYE in order to minimize what remaining kidney function she currently enjoys.

Following the Angiogram she will be admitted at UCSF.

Wednesday, July 27, 2011, Irene will have an Angioplasty procedure, http://www.radiologyinfo.org/en/info.cfm?pg=angioplasty, in order to expand the vein diameter in her right arm. This is her FISTULA arm and where the dialysis needles penetrate. Following the procedure UCSF Irene will be dialyzed. We hope that she can be discharged late Wednesday.

Certainly this is not a process that Irene wants to go through but the arm pain has become excruciating after about 2 hours on the machine. She’ll endure 4 more days of dialysis before the procedure is done on July 26.

Angioplasty is the best mitigation measure available with the most amazing medical team on the planet…!!!

Stay tuned and thanks for caring,
Dave

8 p.m.

Thanks for checking in!

Irene’s local vascular specialist believes that the dialysis discomfort is primarily due to poor circulation in her arm. He will consult with her nephrology team in the coming days. If his observation is validated he is recommending an angiogram http://www.vascularweb.org/vascularhealth/Pages/angiogram.aspx to increase the size of the vein in her arm.

Irene has a 3.5 hour dialysis session scheduled for tomorrow to make up for lost time on Monday. Hopefully she can complete the entire session!

On Thursday she is seeing Dr. Charles M. Eichler @ UCSF, the specialist who performed original the FISTULA surgery, http://en.wikipedia.org/wiki/Hemodialysis#AV_fistula, in 2008.

Thanks for caring,
Dave

3 p.m.

Thanks for checking in.

Irene's had growing challenges at dialysis related to the fistula function.

On several occasions over the last few weeks she was sent home early without completing the sessions. She had dialysis 4 days last week because the challenge is escalating. She came home early again today with an incomplete session.

She has an appointment tomorrow with a vascular surgeon.

Stay tuned and thanks for caring,
Dave

6.30 p.m.

Irene's recovering from 2.5 hours of dialysis treatment today. The medical team iced the region throughout the treatment because the pain was intense. It's a typical evening...raging nausea and chronic fatique.

She gets to return tomorrow for more of the same...

Thanks for caring,
Dave

3 p.m.

Thanks for checking in.

Irene was sent home early today from dialysis treatment because of needle complications and pain. She returns tomorrow so it's another 4 day dialysis week.

Irene is cancelling the plans that she had made for tomorrow...an off day for dialysis. It's certainly emotionally challenging...........

Thanks for caring,
Dave

Happy 4th of July...!!!

I hope you appreciate this article as much as I do......

Author: Paul G. Kengor
I encourage you to set aside the burgers and dogs and soda and beer for a moment this Fourth of July and contemplate something decidedly different, maybe even as you gaze upward at the flash of fireworks. Here it is: Confirm thy soul in self-control.

What do I mean by that? Let me explain.

The founders of this remarkable republic often thought and wrote about the practice of virtue generally and self-control specifically, two things long lost in this modern American culture of self. Thomas Jefferson couldn’t avoid a reference to one of the cardinal virtues—prudence—in our nation’s founding document, the Declaration of Independence, which, incidentally, ought to be a must-read for every American every Fourth of July (it’s only 1,800 words). Our first president and ultimate Founding Father, George Washington, knew the necessity of governing one’s self before a nation’s people were capable of self-governance. As Washington stated in his classic Farewell Address, “’Tis substantially true, that virtue or morality is a necessary spring of popular government.”

A forgotten philosopher who had an important influence on the American Founders was the Frenchman, Charles Montesquieu, whose work included the seminal book, The Spirit of the Laws (1748). Montesquieu considered various forms of government. In a tyrannical system, people are prompted not by freedom of choice or any expression of public virtue but, instead, by the sheer coercive power of the state, whether by decree of an individual despot or an unaccountable rogue regime. That’s no way for human beings to live. There’s life under such a system, yes, but not much liberty or pursuit of happiness; even life itself is threatened.

Montesquieu concluded that the best form of government is a self-governing one, and yet it is also the most difficult to maintain because it demands a virtuous populace. As noted by John Howard—the outstanding senior fellow at the Howard Center for Family, Religion, & Society—Montesquieu noted that each citizen in a self-governing state must voluntarily abide by certain essential standards of conduct: lawfulness, truthfulness, honesty, fairness, respect for the rights and well-being of others, obligation to one’s spouse and children, to name a few.

“Each new generation must be trained to be responsible citizens … to be virtuous and conscientious,” writes Howard in The St. Croix Review. “Once the free society is well-established, the daily life of the family and the society is such that becoming virtuous is not a monstrous chore for the young people.”

Sadly, becoming virtuous has indeed become a monstrous chore in a society not only lacking virtue but eschewing virtue—fleeing virtue like a vampire fleeing a cross. Living life in a good way—what Benedict Groeschel calls The Virtue Driven Life—becomes so alien that the people prefer darkness over light. When virtues are not taught—whether at home, at school, or by America’s educator-in-chief, the TV set—they become unknown and ignored and unfulfilled, desiccated and dead upon the national landscape.

And perhaps saddest of all, as John Howard notes, virtue is something that can be acquired, like learning to speak a culture’s language. Once inculcated, however, it needs to be continuously reinforced by the cultural elements of the society. Virtue needs nourished, like fruitful plants need water and sunlight. Says Howard emphatically: “I want to repeat…. Virtue must be continuously reinforced by the culture.”

We Americans might not think about this much, but we actually sing it fairly often, even if the words don’t sink in. Consider this line from one of our sacred political hymns, America, the Beautiful:

America, America,
God mend thine ev’ry flaw,
Confirm thy soul in self-control,
Thy liberty in law.

That’s the ticket: Confirm thy soul in self-control. Our liberty is enshrined in our laws, but liberty should not be license for opportunities for the flesh. Our liberties, protected and permitted as they are, should not be exploited to do anything and everything we want, including things harmful to oneself, to one’s family, to one’s neighbors, to one’s culture, to one’s country. That misunderstanding and abuse of freedom is what Pope Benedict XVI calls a “confused ideology of freedom,” one that can engender “the self-destruction of freedom” for others.

In truth, a genuine freedom requires responsibility. As the song says—and as Washington and Montesquieu intimated—we must successfully govern ourselves in order to successfully govern our nation.

It’s a timeless concept worth remembering this Fourth of July and every day going forward.

Dr. Paul Kengor is professor of political science at Grove City College, executive director of The Center for Vision & Values, and author of the newly released Dupes: How America’s Adversaries Have Manipulated Progressives for a Century. His other books include The Crusader: Ronald Reagan and the Fall of Communism and God and Ronald Reagan.