Next month, I will be 87, which suggests I will be a step closer to “A closer walk with thee.” (Song embeeded at end.)I like data, so I investigated, given my age and health situation, how much longer I have on God’s green earth, all else being equal.
In elderly patients on dialysis, especially with diabetes, average survival is meaningfully shorter than that of age-matched people without kidney failure. Studies of elderly dialysis patients often show mean survival from dialysis start on the order of 3–4 years, with diabetes and low albumin both associated with higher mortality. Since I have all three, dialysis, diabetes, and low albumin, the handwriting on the wall is for me. In most people, this can lead to fear of dying, which is the wrong approach.
The Best Cure for the Fear of Dying Is to Live
Most of us who spend hours on dialysis each week have had quiet moments staring at the ceiling, thinking about life — and yes, about death. It’s not a topic we choose, but the beeping machines and slow rhythm of treatment invite reflection. Over time, I’ve realized something that may sound simple yet carries immense freedom: the best cure for the fear of dying is to live.
Living doesn’t mean pretending everything is fine or ignoring the limitations that come with dialysis. It means choosing to be present — right here, right now — in the small, authentic moments that make life real. The laughter with a nurse. The comfort of warm sunlight after a treatment. The bite of your favorite meal, even if it comes on a day when your energy is low. These are the moments that define living.
Fear thrives in the future, in the what-ifs we can’t control. Life, though, happens in the now. When I finally started to embrace life as it is — and myself as I am — I began to feel lighter. My body might carry scars and limitations, but my spirit doesn’t have to. I remind myself daily: I am more than my condition. I am still learning, loving, creating, and sharing.
So, if the fear of dying visits you — as it sometimes visits all of us — answer it not with despair, but with life. See a sunrise. Call an old friend. Write down three things you’re grateful for. Every act of living pushes fear back a bit and fills the space with purpose.
Because in the end, the fear of dying fades when we remember how to live.
All told, there were 627 women assigned to Vietnam who were not recognized as combatants nor associated with any fighting group. They were not with the USO. As a Lieutenant assigned as Ordnance Advisor to the Brown Water Navy, I never ran across them in my travels in I-3 and I-4, but heard of them.
I submit that those of us in dialysis could profit from associating with our own “Donut Dollies” from time to time. We, too, need care, and our morale boosted from time to time. I’ve included below more information from Perplexity about this incentive, and at the end, a YouTube video about them.
Donut Dollies in Vietnam were American Red Cross women whose primary mission was to boost the morale of U.S. troops and give them a brief emotional break from the war. They were officially part of the Red Cross Supplemental Recreational Activities Overseas (SRAO) program and not combat personnel.redcross
Core purpose
The central purpose of the Donut Dollies was to bring “a touch of home” to service members by offering recreation, conversation, and sympathetic listening in an otherwise brutal and isolating environment. Their presence was meant to remind soldiers of normal life, family, and home, reducing feelings of loneliness and emotional strain.aarp+2
How they carried out the mission
These women ran and staffed recreation centers where troops could play games, listen to music, and relax, and they also created and led structured morale-building activities and programs. Because many units were in remote areas, they frequently traveled by jeep, truck, or helicopter to firebases and outposts to interact directly with soldiers who could not reach the centers.armyhistory+2
Emotional and psychological support
Beyond organized games and events, Donut Dollies provided informal counseling by listening to troops’ worries, fears, and stories without judgment. Veterans later described them as helping men feel less abandoned and “cut off” from what they held dear, giving many a temporary escape from the horrors of combat.wtvr+2
Name and distinction from earlier wars
The nickname “Donut Dollies” came from earlier Red Cross workers in World War II and Korea who actually served coffee and doughnuts from clubmobiles. Still, in Vietnam, the role had evolved to focus on recreation and morale rather than handing out food. In Vietnam, most accounts emphasize that they rarely, if ever, served donuts due to the climate and changed mission, even though the inherited nickname stuck.moaa+2
Risk and commitment
Although their role was noncombatant and recreational, Donut Dollies routinely operated in war zones, traveling into areas subject to rocket attacks, sniper fire, and other dangers, and a few were killed in the line of duty. Their purpose, however, remained consistent: voluntarily accept those risks to support the mental and emotional well-being of American service members in-country.wtvr+1
Over the past year or so, my dialysis team has constantly chided me on my “low” lab albumin, urging me to increase protein in my diet one way or another. What is lacking in this discussion is how, if at all, this situation relates to my peritoneal dialysis treatment. In an attempt ot clarify this situation, I turned to Perplexity with the following Prompt and results. In the findings that were directly applicable to me, I have inserted a bold and italic statement.
Prompt: I am on peritoneal dialysis and consistently have albumin in the 3.4 to 3.5 range regardless of how much protein is in my diet. Write a 500-word or so blog about all the factors in PD that are detrimental to protein.
Peritoneal dialysis (PD) is tough on protein balance in ways that go far beyond how much steak or whey you take in. Even with excellent intake, the therapy itself, plus inflammation and fluid shifts, can keep albumin stuck in the mid‑3s.pubmed.ncbi.nlm.nih+2
Protein lost into the dialysate.
Every exchange removes protein from the bloodstream into the PD fluid. Typical daily losses in PD are on the order of 5–10 g of total protein, with most of that being albumin, and the exact amount rises as membrane transport increases. Those grams do not sound huge, but over weeks and months, they represent a steady negative pull on your circulating albumin pool.pmc.ncbi.nlm.nih+2
High transport membranes or prescriptions with large volumes and long dwell times (My prescription contains both of these. I have four dwells of 2700 ML each lasting an hour and 45 minutes plus a manual fill of 2000 ML and about three hours in length.) tend to increase protein losses. Active or recent peritonitis can temporarily raise losses quite dramatically by making the membrane leakier, which can drag albumin down further even after the infection clears.pubmed.ncbi.nlm.nih+2
Inflammation and the acute‑phase response
Albumin is a “negative acute‑phase protein,” so inflammation actively suppresses its production in the liver. In PD cohorts, objective markers of low‑grade inflammation (CRP, IL‑6, and similar) are prevalent and inversely correlate with albumin levels and protein‑energy wasting. Prior peritonitis, chronic catheter‑related irritation, comorbid illnesses, and even fluid overload can all contribute to this background inflammatory load.pmc.ncbi.nlm.nih+6
Inflammatory signaling does not just reduce synthesis; it also increases muscle protein catabolism and blunts appetite. That combination means that the body is breaking down lean tissue while simultaneously making less albumin, so the lab number underestimates the effort you put into your diet.frontiersin+2
Glucose, appetite, and “hidden” malnutrition
Standard PD fluids deliver a sizable daily glucose load, sometimes approaching 300 grams, depending on the prescription and transport status. This absorbed glucose can dampen appetite and prompt patients to reduce overall food and protein intake, even if they do not feel classically “malnourished.” (While I am maintaining weight in the 143-146 range, undoubtedly this applies to my situation.) When intake slips below about 0.9–1.0 g/kg/day of protein, the body has trouble fully replacing ongoing dialysate losses.frontiersin+1
At the same time, high glucose exposure can promote central weight gain and muscle loss, so weight or BMI may appear stable while lean mass and functional protein stores erode. This disconnect between the mirror, the scale, and the chemistry panel is one reason clinicians now talk about “protein‑energy wasting” rather than simple malnutrition.onlinelibrary.wiley+2
Fluid status and “dilutional” effects
PD patients often battle subtle volume overload, especially when residual kidney function fades (My residual kidney function is considerably less than 100 ML/day) or ultrafiltration becomes less efficient. Extra extracellular fluid expands plasma volume so that the same absolute mass of albumin is distributed in a larger fluid space, lowering the measured concentration without a true parallel collapse in nutrition.tandfonline+3
This pseudo‑hypoalbuminemia can coexist with real protein‑energy wasting and inflammation, making the albumin number a composite of nutritional status, inflammatory state, and fluid balance. In practice, it means that improving ultrafiltration and decongestion can sometimes nudge albumin up, even if diet is unchanged. pubmed.ncbi.nlm.nih+3
Membrane characteristics and time on PD
Peritoneal transport status shapes both solute clearance and protein loss. High transporters tend to lose more protein into the dialysate, are more prone to fluid overload, and show lower albumin on average. Over the years, structural changes in the membrane and cumulative exposure to glucose and inflammation can accentuate this pattern.pmc.ncbi.nlm.nih+4 (As I recall, my transport is low, but I have been on PD for several years, so?)
Despite all of these detrimental forces, many studies suggest that modestly low but stable albumin in a clinically well, eating‑adequately PD patient may reflect the “new normal” of life with the therapy rather than a simple failure of dietary effort. The key is to view that 3.4–3.5 not in isolation, but against the backdrop of dialysate protein losses, inflammation markers, fluid status, body composition, and how you actually feel and function day to day.pmc.ncbi.nlm.nih+4 (I hope my team reads this!!)
As per our schedule, we traveled to Texas Oncology for me to start immunotherapy. In military terms, the infusion was a Piece of Cake (POC). Took about 50 minutes total, and was painless except for the insertion of a feed into my forearm. Felt nothing concerning the infusion itself, so perhaps all of the input about all the possible side effects was lawyer talk.
The picture is the actual view from my chair during the infusion. Up the green line is a smaller bag in which the immo-mix was hanging. The lower bag in view is the saline solution, which is used at the end of the procedure to flush the lines and my internal passages. Again, other than the initial “pain” of sticking a needle in my arm for access, the procedure itself was painless. At the completion, I got a “See you in three weeks,” and off we went.
Yesterday, I provided a first cut at a Comprehensive Guide to Peritoneal Dialysis. It is a first draft, and I plan to add several topics and photos. Examples are a section on the Fresenius-sponsored Patient Hub, pictures of our setup, including storage, and anecdotal stories along the way. Stay tuned.
Throughout the several years I have been on Peritoneal Dialysis, I have neither found nor been presented with a Comprehensive Guide that addresses most, if not all, of the many questions that arise when informed that you, too, will be subject to the procedure(s). This blog is my first attempt to address this issue. Using Perplexity and experience, I have constructed a Comprehensive Guide, embedded below in PDF format. Feel free to download it and use it as you see fit. To my knowledge, it is accurate as of this date (12/07/2025). There is no trademark nor Copyright. Hank 12/07/2025. The lead picture was made using Nano-Banana.
First, yesterday I attended the school call at Texas Oncology, where my immunotherapy is scheduled to start for real on Monday, at 1315. The head nurse went over the schedule, what to expect, but spent most of the session on possible side effects, I assume per their law team, and what to do about them, basically notify them. Interestingly, if I am going to experience side effects, they are often immediate—obviously, more on this as we get into it.
Secondly, my labs are in. While my Albumin is still low, it did rise to 3.5 from 3.4, a big wow from the 5.0 goal. On a good note, my adequacy test came in at 1.99, up from 1.87 a quarter ago. This indicates I am getting enough dialysis. The remaining measurements, like phosphorus, were all within spec, which should make my team happy.
Lastly, I’m really enjoying playing around with a new AI music tool for me, Suno.com. You should check it out. Meanwhile, while on YouTube for something else, I ran into this song for your entertainment, which maps quite well to my current situation.
Consider the statement “AI presents an immense reduction in the reenactment costs of acquiring knowledge.” Write an intellectual blog entry expanding on this topic.
That’s an intriguing and sophisticated topic that fits well with your analytical writing style. Here’s a well-developed blog entry expanding on that statement with depth and clarity.
AI and the Diminished Cost of Knowledge Reenactment
The assertion that “AI presents an immense reduction in the reenactment costs of acquiring knowledge” captures one of the most transformative elements of our era. Knowledge, in economic terms, has long been constrained by the cost of reenactment—the time, labor, and resources required to rediscover, replicate, or internalize previously established understanding. Artificial intelligence disrupts this paradigm by decoupling the effort of human inquiry from the act of knowledge reproduction.
Historically, learning and mastery demanded iterative human reenactment. Apprentices watched, practiced, erred, and refined skills across years. Scholars sifted through archives to retrieve fragments of insight. Entire institutions arose to make the acquisition of knowledge more systematic, but inefficiency persisted. Each learner repeated a portion of the same journey their predecessors had already completed.
Artificial intelligence fundamentally alters this cost structure. Through large-scale model training and algorithmic generalization, AI systems can internalize patterns across massive informational domains—mathematics, language, biology, engineering—and instantly reenact those insights in new contexts. This compression transforms learning from an act of rediscovery to an act of retrieval. The friction that once defined intellectual progress now yields to automation.
Moreover, this compression scales. Where a human researcher might require months to synthesize prior literature before forming a hypothesis, an AI agent can parse thousands of papers in minutes, identifying conceptual linkages invisible to human cognition. Where artisans once internalized tacit knowledge through direct mentorship, generative models can simulate the procedural reasoning behind those skills, opening pathways for global access to expertise once confined to physical proximity.
This reduction in reenactment costs also reconfigures the economics of creativity. The artist, engineer, or scientist now operates within an augmented partnership rather than in isolation. By allowing AI to recall, recombine, and emulate learned knowledge instantaneously, humans are liberated to focus on contextual judgment, ethical discernment, and conceptual innovation—the domains where mechanistic reenactment still falters.
Yet this shift introduces philosophical tension. The lowered barrier to reenactment invites superficial engagement: instantaneous knowledge without experiential depth. A generation that can summon understanding without labor risks losing appreciation for the process that once cultivated intellectual resilience. The challenge, therefore, lies not in restraining the technology but in redefining the purpose of human learning itself—emphasizing not accumulation but interpretation, not recall but synthesis.
AI, in this sense, does not merely make knowledge more accessible. It collapses the traditional machinery of replication and opens a new frontier where the marginal cost of insight tends toward zero. The question ahead is not whether humanity will learn faster, but what it will choose to do when reenactment is no longer a prerequisite for understanding.
Is a phrase used by military to indicate potentially about to engage the enemy. That’s how my day went today. Started off with Fresenios labs which stretched to an hour or so. Across the street to CVS where my wife got a flue and COVID shot and I received the latter. The to a big box store, then to a dig rescue where we donated 88 lbs of dog food. To lunch then to IGA thence home fir very short stay, then walk Dickens then back home where shortly it was shower and dialysis time.
Yesterday, as scheduled, I went to Texas Oncology and met with Dr David D’Spain. Turns out he is very personable, but also direct and to the point, which I like and respect in a doctor. The waiting room was crowded, as it often is in my experience, since skin cancers are prevalent here due to months of sun beating down.
Six vials of blood were drawn. We have an education appointment for about an hour on Thursday, and tentatively, my actual treatment, called Cemiplimab-rslc Q21D, starts Monday. It is tentative because our health insurance provider must approve it before we can begin. It is scheduled to take place every three weeks for up to two years. The doc stated there is a distinct possibility that when I go off the treatment, there will be no remaining cancerous cells.
Since this is ME being treated, I turned to Perplexity to learn more about Cemiplimab-rslc Q21D with the following results:
For my blog at www.feeser.me tell me all about Cemiplimab-rslc Q21D.
Cemiplimab-rwlc (brand name Libtayo) is an intravenous PD‑1 immune checkpoint inhibitor used every 3 weeks (Q21D) to treat several cancers, most notably advanced cutaneous squamous cell carcinoma (CSCC), basal cell carcinoma (BCC), and some non–small cell lung cancers (NSCLC). It is a “3‑weekly anti–PD‑1 immunotherapy that reactivates T‑cells to attack cancer cells.”[1][2][3][4][5][6][7][8]
What Cemiplimab-rwlc Is
Cemiplimab-rwlc is a laboratory-made monoclonal antibody, in the same general family as pembrolizumab and nivolumab, but developed specifically as Libtayo by Regeneron/Sanofi. It targets the PD‑1 receptor on T‑cells and is supplied as a 350 mg/7 mL single‑dose IV formulation.[2][3][9][6][10]
“Q21D” Dosing Explained
“Q21D” means “every 21 days,” which corresponds to the standard 3‑weekly (Q3W) Libtayo schedule. The approved fixed dose for adults is 350 mg IV, infused over about 30 minutes, every 3 weeks until disease progression, unacceptable toxicity, or a defined maximum duration in some adjuvant settings.[11][12][3][13][6][1]
Typical regimen: 350 mg IV over 30 minutes, Q21D/Q3W.[3][6][11][1]
In adjuvant CSCC, one option is 350 mg every 3 weeks for 12 weeks, followed by 700 mg every 6 weeks, up to 48 weeks total.[14][3]
How It Works
Under normal conditions, PD‑1 on T‑cells acts like a “brake,” helping prevent excessive immune responses when it binds to its ligands, PD‑L1 or PD‑L2. Many tumors exploit this by expressing PD‑L1/PD‑L2, effectively turning T‑cells off at the tumor site.[5][7][8][2]
Cemiplimab binds to PD‑1 and blocks its interaction with PD‑L1/PD‑L2, releasing this brake. That disinhibition boosts T‑cell proliferation, cytokine production, and cytotoxic activity against cancer cells, which can result in tumor shrinkage or durable disease control.[9][7][8][2][5]
Main Approved Uses
Regulatory approvals (US and other regions) have expanded over time as data accumulated. Key adult indications include:[15][4][10][14]
Metastatic or locally advanced CSCC not amenable to curative surgery or radiation (the original landmark approval).[4][10][1][15]
Locally advanced or metastatic BCC after hedgehog inhibitor therapy or when such therapy is inappropriate.[3][4]
First‑line monotherapy for NSCLC with high PD‑L1 expression and no EGFR/ALK/ROS1 aberrations, in selected patients.[4][3]
Adjuvant treatment of CSCC at high risk of recurrence after surgery and radiation, as of an October 2025 FDA decision.[14][3]
Efficacy Highlights
In pivotal CSCC trials, cemiplimab produced objective response rates around the mid‑40% range, with a majority of responders maintaining benefit for at least 6 months. Extended or alternative schedules (such as 600 mg every 4 weeks) have shown pharmacokinetic and clinical activity consistent with standard Q3W, although 350 mg Q21D remains the core labeled regimen.[13][6][1][15][9][4]
Safety and Side Effects
Cemiplimab shares the class-immune-related toxicity profile of PD‑1 inhibitors, reflecting an overactivated immune system. Common issues include fatigue, rash, pruritus, diarrhea, and endocrine abnormalities such as thyroid dysfunction.[16][1][3]
More serious immune‑mediated events can involve the lungs (pneumonitis), liver (hepatitis), colon (colitis), kidneys (nephritis), and other organs, requiring treatment interruption, steroids, and occasionally permanent discontinuation. No formal dose-reduction scheme is recommended; instead, dosing is held or discontinued based on severity.[6][1][16][3]
Practical Q21D Points
For my readers, it may help to frame Q21D cemiplimab as:
A brief outpatient IV infusion every 3 weeks, usually without complicated premedication in most patients.[11][6][3]
A long‑term treatment: often continued for many months, or up to 1–2 years in adjuvant or certain advanced settings, if tolerated and effective.[1][13][3][14]
A systemic immune therapy: side effects can appear weeks to months after starting and sometimes after stopping, so ongoing monitoring is essential.[16][1][3]
Quick Comparison For Readers
This is how cemiplimab Q21D is positioned alongside other PD‑1 inhibitors using a simple comparison table:
This framing keeps the focus on what matters for patients and non‑specialist clinicians who might read your blog, while staying accurate to the Q21D cemiplimab‑rwlc data.
This past Friday, I blogged about the phrase “I’m Not Disabled, I’m enhanced” and how I related to it. I thought it would be instructive to use this blog to write a song, which I did, and it is embedded below.
How it was put together. I turned to the AI engine Poe and used a plugin named Music Generator by @CoolBotMakerGuy, into which I wrote a header prompt and pasted in input from Friday’s blog to base the song’s lyrics on. I then copied the generated lyrics and pasted them into the appropriate place in Suno to create the song below. I told Suno to use the blues genre, in the style of Jimmy Reed, from 1955. I downloaded the finished product as an MP4 file. Cool beans! Keep in mind that three AI engines were used to make the song! This is not a one and done process.
