Writing Poetry

 

You might surmise that someone whose education was in computer science and business and who spent his work career in those same fields would not have much writing or creative ability. But you’d be wrong. I’ve had the opportunity this week to write two different poems and would like to share them.

 

The first was due to a posting that was shared by a high school English teacher of several discarded first lines of potential poems that had never been written. This inspired me and I chose a first line that I thought would work well. You can see the result below. This took me only 20 minutes or so.

 

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Like a Bowl

 

I am a bowl, chipped at the rim,

Still to be used, but without the fine trim.

Some look at me and turn up their nose

But I'm useful still, and better than those.

 

A lot of people are just like that,

They're worn down from use, but handy to have,

Battered and scraped, and looking quite poor.

So love that old bowl, and use it some more.

 

 

This next one was from an English assignment from one of my grandsons. He freely admits that writing is not one of his skills. But he had to write a sonnet. So he provided the topic, and I gave him possible rhyming words. He then put his ideas down and I did the necessary wordsmithing to put it all into iambic pentameter as required. The below joint effort took about a half-hour.

 

 

Ode to a Choo-choo

 

I see them on the road through nearby town

It’s riding on a track that’s made of steel

It has more cars when going up than down

I love the way it roars and how it feels

 

The wheels on all the cars are set in pairs

The sound they make is always clicky-clack

When going fast they move a lot of air

The engine’s on the front but not the back

 

The ones between might be a box or tank

There’s no caboose, they’re all now very dead

Most cars are written on, and never blank

The final car has lights, it’s called a FRED

 

To know these things I need to use my brain

The thing I love the most is called a train.

 

 

So what do you think? Have I lost touch with my creative side? I freely admit that I’m better at structured writing, i.e. poems with rhyme and meter, than with the blank verse that’s more common these days. But this kind of writing is still quite fun to me.

 

All in the Numbers

 

When getting bloodwork the result is most often expressed as some sort of numeric value. I’ve decided to pull many of these number over time to give a summary for my primary care physician whom I’ll be meeting with in a few weeks. For the most part, the final number in each of these areas is fairly recent, i.e. in February, if not, I’ll indicate in the commentary. There are many more such numbers in my test results, but they are all pretty consistent and not an issue in the various medical issues I’ve been dealing with.

 

Weight: 234 >> 213 >> 203

I’ve started a habit of checking my weight once a week and recording it. The first in this series dates back to last April, i.e. 10 months ago. It was then that I started taking Mounjaro to help reduce/manage my blood sugars (which it has done a good job of doing). But a side effect of the GLP1 is to reduce your desire for food and thus impact your weight. The second number is a resultant reduction of my weight of roughly 20 lbs. The last 10 lbs is the result of my wife managing my diet because of my liver problems. I’m pretty satisfied with my current results, but wouldn’t mind another few lbs (I’ve had one of my grandsons make two new holes in the belt I most commonly use).

A1C: 8.9 >> 5.3 >> ??

The medications (Metformin and Lantus) I was taking to try to manage my diabetes needed some additional help, so last April I was prescribed Mounjaro as well. The goal of the endocrinologist was to get me under 7.0 into the “managed” diabetes range. However, by the time of my first episode of HE in November, I was down to 5.3, the more typical non-diabetic area. With the permission of my endocrinologist, we reduced my Lantus dose from 38 to 33. I monitor my blood sugars on a daily basis, but I’m still waiting to get my A1C checked again next month when I will see her and get a new rating to see if further adjustments are needed.

Ferritin: 11 >> 15 >> 51 >> 114 >> 138

Separately, it was noted two years ago that my iron levels were too low and I no longer qualified to give blood. I had a total of 3 IV infusions with a goal of getting my level over 100 – which you can see were successful. I was a little surprised in February that my reading had continued to rise, but this is still in the “normal” range. I was able to once again donate blood.

Triglycerides: 481 >> 312 >> 296

My triglycerides have always been too high, peaking at around 900 several years ago. I had brought them down into the 300-400 range with medication, but when that medication was no longer available my level started back up again. I am now taking a fairly expensive fish oil supplement and trying to be very consistent and my rate is coming back down to even less than it had before. Since the goal is to get my level closer to the “normal” range of <150, I still have a ways to go. This will be one of the discussion items with my PCP next month.

Bilirubin: 2.8 >> 2.3 >> 1.6

When my liver started having issues a few years ago, one of the few signs was my bilirubin. I peaked at a reading of 2.8 at the beginning of 2026. Now with a reduced diet that my wife is keeping me on, I have successfully brought it back to normal levels. This is a major factor in my MELD score, which I’ll discuss next.

MELD: 17 >> 12

I only got my first reading of this back at the beginning of the year. This score can range from a low of 6 to a high of 40. 10 or less is considered as normal with increasing concern as it gets higher. The only way to “fix” a liver permanently is a transplant, but not only am I considered too old, but with the number of livers available being rather small compared to the demand, anyone with a score of <25 is not eligible (and a score above 30 is indicative of being in a coma). But since the only symptom I have is my 3 episodes of HE (i.e. no jaundice, no ascites, etc.) taking it back down so quickly just through the use of two medications is a good sign. I’ll see the gastrointestinal doctor again at the end of June and also get a new MELD score at that time and see what she says.

Ammonia: 191 >> 181 >> 164

One of the goals of the two HE medications I’m taking is to change the ammonia (NH3) in your blood to ammonium (NH4) so it is not absorbable by the liver and leaves the body via your intestines. This measure is one indication that the medication is working and I am VERY faithful at taking my daily medications. The “normal” range for ammonia is 72 or less.

 

In general, I’m pretty pleased with the results above. I’d still like to see improvements in my triglycerides and ammonia. But if I can stay on the path I’m on, through diligent following of my medications and with the oversight of my diet with the assistance of my wife, I hope to continue to have a reasonably long life to enjoy with her and all my family and friends.

 

Liver Cirrhosis

I’ve made a number of postings related to Hepatic Encephalopathy. Now I’d like to delve a little deeper into the cause of HE where the term Hepatic refers to the liver, in particular cirrhosis of the liver. I originally thought I could do some research and post my findings, but, as I have discovered, the pathology of the liver and its relationship to other organs is a very complex subject. Thus, instead, I’m going to list a few links to research that others have done and then a little about how this relates to my own case.

Here are three good links which have a lot of information (don’t try to follow all the details in them unless you have a good science background):

·        https://my.clevelandclinic.org/health/diseases/15572-cirrhosis-of-the-liver

·        https://www.youtube.com/watch?v=junNUlypCwU

·        https://www.youtube.com/watch?v=kHB5e-4q7l8

So, how am I doing at managing my liver issues? Back in early January when I was going through my last bout of HE, my bilirubin peaked out at 2.8 (normal range is .2-1.4). That’s when I started on the appropriate medications (which manage the issues but cannot reverse them). My primary care physician commented at the time that I had brought that level down to 2.3. I had some additional bloodwork in early February and my bilirubin was down to just 1.6, only slightly elevated from the upper end of “normal”. So that’s a really good sign.

The other factor that I was watching was my ammonia level, something that I had only recently been tested for after my HE began. At the end of December I peaked at 191, where the “normal” range is 18-72. I was down slightly in early January to 181, and then in mid-February by nearly 10% more to just 164. I still have a long way to go in this measure, but a drop of 15% cannot be ignored.

Thus, while my overall MELD score is still a 14, I’ve made quite a bit of progress in the right direction. I remain a long way from having a high enough MELD score to qualify for a liver transplant, but as long as I can arrest the symptoms like the above ones (and thanks to my loving wife who is focusing a lot of her time on getting me on the appropriate diet), I’ll have a reasonable chance of living for several more years. But this is not a fun journey and not something that I would wish on anyone.

The End of an Era

This past Sunday (2/8/2026), at our church’s annual meeting, I was recognized for my retirement from the position of elder. While that took only a few minutes with a formal speech by the current chairman, my mind was racing through all the things I have been involved in for the past 40+ years. It’s going to take a lot longer to read this blog than that even took, and certainly it’s taking me a lot longer to capture in written words that event. But it’s important to me that I do so.

 

History

The organization of what is now the Bible Fellowship Church did not originally include a board of elders. Only the pastors were elders and they were overseen by a pair of District Superintendents. At the annual meeting, the Stationing Committee assigned pastors/elders to the various churches – effective immediately. So a church would say goodbye to their pastor when they were sent off to the annual meeting, not knowing if the same individual would return. In order that a church/pastor did not gain too much familiarity and the pastor have too much control of that church, the terms of service were limited to six years. The church had an “official board” comprised of individuals in leadership positions (Sunday school superintendent, teacher of each SS class, head of Women’s Missionary Society, worship leader, etc.)

In 1971 that arrangement changed to one where each church was controlled by a local Board of Elders. Thus in 1972, the “official board” was disbanded and the Board of Elders replaced it. The pastor of the Emmaus congregation, Harvey Fritz, who under the old structure would have been reassigned (he started at Emmaus in 1966) remained on. For the most part, except that women on the official board could not be elders, the new elders were simply the former members of the official board with new titles.

One of my God-given skills is the area of procedure and organization. My wife and I began attending Bethel in August 1976 and we became members the following year. One of the things that I noticed early on was that although the organization structure had changed, that was not reflected in any official documents. It had simply been easier to keep doing what they had before with Pastor Fritz leading the church and the Board of Elders following his lead. As a result the church had no bylaws or policy manual. I began writing down what those documents should have in them. I was not even invited to the elders meetings, so I was assigned to work with one of the other elders who would present my material and get it passed.

In the church elections in 1982, now having two children in our family, my name was placed on the ballot. (A side note – when we brought our children home from the hospital where they had been born, we stopped at the church on the way. Going up to the empty sanctuary, we brought our newborn to the altar and dedicated him/her to God in a private service of just the three of us. It has always been important that church play an important role in the lives of all our family members.) Probably because of my involvement in writing the new church bylaws and policy manual, I was elected to serve on the board. This began my 4+ decades of service. Although the Bible Fellowship Church also gave certain authority to a board of deacons, Bethel did not have one. Thus, in my first year as an elder I was given responsibility for baptisms and preparing the elements for communion. We finally created a board of Deacons in 1983, so I passed that responsibility over to them.

 

Service on the Board of Elders

            Over the 43 years from 1982 to 2025, I served in a number of positions. I was the chair, the secretary, and the treasurer. Besides my oversight based on the BFC and church policies, I also served on a number of different committees from time to time. I had my largest impact while serving in a finance position. I’d like to mention some of the incidents I was involved in.

            In 1988, as we were completing the church addition that includes the gallery and the offices below them, both the church treasurer and the financial secretary chose to resign. As the person on the board with the most interest in that area, I took over those positions. I was also one of the few people in the church who owned a computer and knew how to put together spreadsheets to help with my calculations. As I began pulling in all the information from the 8.5x14 papers which they had been using, I quickly discovered that the annual reports to the congregation, the annual summary to the denomination, and the amount of money in the bank were three different figures. So, while I trusted the individuals who had been making all the entries, I needed to find the cause of the discrepancies. To help me, I had all the giving envelopes for several years (enough to fill several large boxes), as well as all the financial statements.

            Working back through the years, I was able to identify several simple mistakes. Just one example: One of the annual expenses was $100 to the church’s delegate to annual conference. That happened to be Gerald Schlonecker. But instead of cashing the check, he gave it back to the church, saying “I don’t need it.” But the financial secretary did not have a way of taking as income a check that the church had written but never cashed. Instead he entered it incorrectly and there was thus a $100 discrepancy. There were a number of such easy mistakes over the years. At the end of this reconciliation process, the annual reports were within a few dollars of each other. However, that amount was considerably different than what we had in the bank. Since we had just completed the construction of the addition, I separately recorded all the withdrawals from the construction loan.

            Emmaus has a policy that when a project such as this is undertaken, that they require a hold of the cost of replacing the torn-up sidewalk in the event that the organization does not do it, then the borough will have the funds to do so themselves. That holdback was done, but the church did the work to install the new sidewalk. However, the bank still had a hold on the loan for the amount of the work. Thus, they closed out the construction loan and rolled the entire amount over into the mortgage even they had never given the church the full amount of the loan. Using my figures, I scheduled a meeting with the bank officials. They agreed with my analysis and transferred the amount of the holdback into our account. This final correction put all three figures into agreement within about $100. Thus, the annual report to the congregation merely showed a reconciliation to properly “balance the books.” Problem solved. And I could then have an envelope burning celebration in our fireplace of the several years worth of giving envelopes. No stealing of funds had taken place, but evidently the effort of managing a construction loan as well as the regular giving was what encouraged the treasurer and financial secretary to throw up their hands and resign their position. And my having access to a computer made it all fairly easy.

 

Non-church Activities

With my God-given skills and interests, I was also able to use them in denominational projects. There were four such projects over the years.

One: the church in Newark, DE, was started with Bill Schlonecker as pastor. Since our annual conference delegate was Gerald, Bill’s father, he had a conflict of interest in serving as a temporary elder there and I was chosen instead. Myself and one other individual made a day-long trip to Newark where we interviewed all the leadership, including those who had been nominated to be elder, deacon, etc. They met our criteria and we recommended to the BFC that Newark be admitted as a “particular church” instead of being a church extension work

Two: the denomination became aware that the pastor of one church extension work was acting inappropriately, specifically that he was having a sexual relationship with a lady from another church. Again, as surrogate elders, we met with that pastor, confirmed the improper relationship and recommended that his pastorate be terminated.

Three: the denomination became aware that a conflict at a small church had caused both of their elders and their deacon to resign because they could not support the position of the pastor who wanted to close their building and move to a facility elsewhere in the county. According to the laws in that state, that made the pastor the sole decision maker so he could have done so. Again, myself and another individual, were appointed as surrogate elders by the board of church health. Moving quickly, we interviewed all the parties involved. The pastor, who had come into the BFC from another denomination, was determined to have his own way – a way that would have ended up destroying the church by ignoring the wishes of the elders there. We ended the day by voting to terminate his pastorate, gave him one day to clean his personal items out of the church office (with someone to oversee him and prevent any improper action) and then to turn in his key to the building. We then began the process of calling for a meeting of the church (with appropriate notice). On the designated day, the executive director of the BFC gave the message and then we held a vote to appoint the recently resigned men back to their former role. Having gotten a unanimous vote, I and the other surrogate elder resigned, as our services were no longer needed.

Four: When the recent issue of transgender individuals was gaining momentum, the BFC felt a need to act relatively quickly to examine our Faith and Order to see what changes might be needed. Having recently written a 5-part blog based on my research into this topic (see https://ramblinrussells.blogspot.com/2016/05/gender-and-sex-part-1-conception-to.html), I volunteered to serve on this committee. We met monthly and had a resolution to present to the BFC by the following year.

 

People are Important

            Being an elder is not just meetings and committees. A key component is getting to know the people in the congregation, praying for them, bringing them to Christ, and being open to answering their questions. Being retired and being the oldest on the board gives me a number of opportunities to focus on this area. Here are a few examples:

            I became aware of a new attendee who had lived in the south for most of her adult life. When she was quite young, her mother had passed away and her father had given her away to be raised by a couple in the next county. She had now returned to the area and had been able to locate her father’s grave, but wished to know more. Using my genealogy skills, I was able to find her father’s obituary in the newspaper and show her that her name appeared there, i.e. that she had not been forgotten. But even better, I was able to find that she was a distant cousin of myself. So now, when we meet in church (which she continues to attend), I greet her with a “hello cousin” and she feels that she belongs here. Amazing what a little bit of research and those few words of greeting have changed her outlook.

            My wife and I had been part of one of the small groups of the church. We were led by another of the church elders. But when he began having some significant health issues and stepped aside as an elder, I took on the role of leading that group. In the past this would have been out of my comfort zone, but as an elder it is something that I needed to do. (Note, I received a phone call from this individual when he saw my being recognized in the church’s livestream. He asked about how the group was going, so he still has a heart for this group.)

People whom you work with includes your own family as well as others. The highlight of my career was when I had the opportunity to lead two of my grandsons to the Lord and then to baptize all four of them (the only non-pastor that I am aware of at our church who performed such a service. See https://ramblinrussells.blogspot.com/2020/09/baptizing-grandsons.html).

Witnessing to others is not just an elder responsibility, it is something that all Christians should do. I make a habit of using the time before/after church services to talk to and encourage others. Even though I now use a cane for mobility, I go up/down the stairs to the gallery as needed. Last week someone told me that he and his wife really appreciated my ministry when she was suffering from “long COVID” for several years. Even my time in rehab following my foot amputation did not stop me from sending my prayers to others. You never know how your words or your actions might be observed by someone else and encourage them in their walk with Christ.

 

Conclusion

            There have been other men in our church who have had long terms of service as an elder. The longest for many years was Gerald Schlonecker at 39 years. But with my years of service finally ending at 43, I have set a new high watermark. And since the highest on our current board is just shy of 25 years, my record may stand for a long time. I never thought when I was first affirmed as an elder back in 1982, that that was just the beginning of such a term of service. And I don’t know how many years I have left on this earth because of the various physical infirmities I am dealing with. But for as many years as God chooses to give me, I will continue to share my faith and use my skills to honor Him.

Bloodwork and diagnoses

            The human body is amazingly complex. One of those complexities is blood. Not only is this blood composed of a number of types of cells, but these cells are responsible for carrying elements throughout the body and back again. In their final stage some of these waste elements are transferred to other items such as urine, so when I say “blood” in the below paragraphs, be mindful that I am also using these other items. After some discussion of bloodwork and diagnoses, I will also mention some other related topics that are currently impacting me in this same area.

 

Bloodwork

Hospitals are busy places. There are some activities that impact their patients that I’d like to discuss. First, in order to monitor their patients there is a constant stream of testing. Our primary hospital here has a tech who goes around and “checks the vitals” at least once a shift. Even overnight, this same activity takes place at every shift change, i.e. including at 3am. In addition, anyone who is classified as diabetic gets a finger stick and their blood sugar checked before and after each meal. And all this of course is in addition to any testing for the reason the patient is there (MRI, CT scan, EEG, ECG, etc.), and these go on 24 hours a day. So not only does one feel like a pin cushion, but you don’t get much sleep either.

            And things don’t stop when you finally check out and go home. There is required bloodwork that may be scheduled so the doctors can continue to see if you’re recovering properly, and other bloodwork that is needed for a later follow-up meeting – perhaps 6 months or a year later.

            We’re fortunate here in the Lehigh Valley that not only is our primary care physician (PCP) a member of a group that is “owned” by the local hospital, but that the local testing service is also a subsidiary of the hospital. And not only do they all share the same computer system, but that system, containing all the test results, is accessible to the patient online whenever needed. The below charts all come from that computer system.

 

Diagnoses

            All doctors go through increasingly complex and focused education so they can be experts in their specialty. But education does not mean that the doctor is also experienced. And in less metropolitan settings where doctors may have to be the local expert in several areas, that may make the job even more complicated. Thus, experts who work at large research hospitals or university settings often put together relatively easy to understand/use diagnosis tools that can substitute for this lack of experience. In this section I’d like to show one such diagnostic tool that I’ve recently been exposed to because of my liver (hepatic) problems.

            This tool is called the “Child-Pugh”, not because it has anything to do with children, but because it’s named after the two researchers who developed it, one of whom has the last name of “Child” (see https://www.mdcalc.com/calc/340/child-pugh-score-cirrhosis-mortality#evidence).  This tool looks at five of the many items from this bloodwork, rates each item on a 1-3 scale, and asks that you add them. The resulting total score gives an estimate of the severity of liver cirrhosis without requiring the doctor to do a liver biopsy with its accompanying risks. Here are the five items measured for this tool, the scale of each, and my own personal results:

Bilirubin (<2, 2-3, >3)

[Bilirubin, bilirubin-2]

As you can see, my bilirubin was higher during my recent incidents of hospitalization, with my latest reading being 2.3. Looking back over the past 10 years, except for a few times of hospitalization, my readings have been in line, i.e. <2. I’ll have more to say about this below under the section on diet.

Albumin (>3.5, 2.8-3.5, <2.8)

[Albumin]

Aways firmly in range, i.e. 4-5

Prothrombin (<1.7, 1.7-2.3, >2.3)

[Prothrombin]

Although there is a recent spike to 1.4, this is still within the desired limit.

Ascites (absent, slight, moderate)

[Ascites]

Not a numeric value, but testing in this area indicates none found.

Encephalopathy (none, grade 1 (restless, sleep-disturbed, irritable/agitated, tremor, impaired handwriting)-2 (lethargic, time-disoriented, inappropriate), grade 3 (somnolent, stuporous, place-disoriented, hyperactive reflexes)-4 (unrousable coma, no personality/behavior))

I have no chart to go with this, but the reason I was taken to the ER and hospitalized was due to my exhibiting all the issues in grade 1. I’ll have more to say about this in the next paragraph.

 

Adding the results in these areas (2,1,1,1,2) give me a composite score of 7. 5-6 is considered “normal”, 7-9 is considered “moderate”, and 10-15 is considered "severe”. Thus, of the five areas, only the first and last are anything but “normal”. But Encephalopathy is not a measured item that can change based on any subsequent bloodwork, it is observational and will never disappear from my record. I could go several years without any other occurrences of this, but having it once in my record would seem to mean that I can never get back to grade 0 in this measure and thus the lowest score for me in the future would be a 6 instead of a 5. Something about this seems a little unfair.

 

Diagnosis and Diet

            Many articles on the subject of disease use language such as “diet and exercise” as at least a partial solution to various diseases. While I had eliminated non-sugar soda several years ago, I had replaced it with diet Mt. Dew which tasted about the same. I also often had a box of snacks in my room. I tended to have only one bowel movement every few days and was often “stuffed up”. But the nutritionist who met with us on my last ER visit who made a few comments and provided me with the hospital furnished meds indicated that “poops are your friend” and they would ideally like me at 3-4 per day. She also recommended the “Mediterranean diet” (https://my.clevelandclinic.org/health/articles/16037-mediterranean-diet) which emphasizes plant-based foods and healthy fats, saying that you eat mostly veggies, fruits and whole grains. My wife has taken charge of this area. She is also trying to create a sodium-limited diet.

            Not known for any conservative leanings, Prevention magazine published an article a few years ago (3/1/2023) entitled “31 Foods that boost liver function, according to research and dietitians.” As they address what they term as NAFLD (Non-alcoholic Fatty Liver Disease) about 2/3 of their list of 31 foods are exotic seeds/grains from other parts of the world. But of those remaining, nearly all of them are now a part of my diet. It remains to be seen what their ultimate impact will be, but if all I do is drop my bilirubin from the 2.3 on my last bloodwork down to below 2 like it was until recently, I’ll be happy. [Note that I put little trust in this source. For example, one of the food suggestions was based on a sample of only 25 people, no control group, no peer reviews, and only noting that 52%, i.e. 13 of the 25 people had a positive reaction. Not a very scientific review!]

            I’ve also been working on the exercise aspect. I had planned to start doing some limited walking (with the assistance of my cane) – just daily trips to the mailbox or down the street. With my lowered weight this year I thought I could handle that. But the cold single-digits are upon us and there is a lot of snow and ice outside so that’s not wise. Instead until the spring season begins I have purchased a low-cost exercise machine that I can use on a regular basis (it folds up so takes minimal room). Just got it yesterday and I’m slowly getting adapted to using it, despite my half-foot amputation.

 

Cost Implications

            The cost of medications is a moving target. It used to be that pharmacy companies (generally based in the US), spent a lot of money on drug development, clinical trials, and getting FDA approval.  These companies would recover this cost through the cost of the drug, and the federal government was forbidden from negotiating prices. This began changing in 2022 as part of the Inflation Recovery Act under then President Biden when they announced that they would be choosing just 10 drugs where price negotiation would begin. They were cognizant of the fact that many families had to make tough choice – like do I get the drugs I need or do I put food on the table. It took a while for this to get worked out, but the number of drugs or drug families is now 15/year. Here is an announcement from a few months ago on just one drug family (https://www.whitehouse.gov/fact-sheets/2025/11/fact-sheet-president-donald-j-trump-announces-major-developments-in-bringing-most-favored-nation-pricing-to-american-patients/).

            (Note – Mounjaro, which I use to treat my diabetes also has a side effect of weight reduction. One of its ingredients is a GLP-1 (glucagon-like peptide) much like Wegovy which you may have seen advertised by some Hollywood A-listers. But it also contains a GIP (glucose-dependent insulinotropic polypeptide) that encourages fat reduction by reducing how much fat is stored and stops the amount of fat in the body from increasing.)

            By putting these drugs on the plan and requiring that the drug companies sell them in the US for the same MFN (Most Favored Nation) price as they offer to other countries, this will reduce the pricing, in the case of Mounjaro, from over $1000/month to only $350.

            For their part, as a representative of the many older retired folks such as myself, AARP had eliminated the complicated “donut hole” coverage scheme and gone to a concept called OOP (out of pocket) maximums. For 2026, OOP is $2100, after which all your drugs are paid for by your Part D insurance of Medicare (assuming that you enrolled in that Part D plan).

            One of the other 15 drugs for 2027 is called Zifaxan (also sometimes known as Rifaximin), which helps treat hepatic encephalopathy. This is being offered through the hospital pharmacy at about $1200/month (for just 60 pills) or $14,400/year – pretty pricy! The GI coordinator has also passed me information on getting the drug through a Canadian pharmacy for much less, or getting me connected with a company who will sell me income-limited credit cards to reduce the cost.

            Two weeks ago, AARP took the next step in the process and added Xifaxan to their official formulary list. But with me already using enough other medications to take me past the OOP, the net additional cost will be zero, even before the MFN pricing is determined and put in place for 2017. This is one more instance where it appears I made the right choice in enrolling in the AARP Part D plan back when I turned 65.

 

Diagnoses and Follow-ups

I’d like to finish this long blog by detailing all the various medical areas I have dealt with over the last 25 years, and where they fit in the above picture.

 

PCP – The job of the PCP is to monitor what’s going on in your life and make medical recommendations. They schedule an “annual wellness check” for all Medicare patients and use several of the comprehensive bloodwork tests to look for trends that they can pass along to you. They also monitor your vaccinations (preventing a disease is a lot cheaper than having to deal with you getting it. I’ve had to delay this meeting twice in the past few months because of dealing with my current liver issues. But I’ve taken the necessary bloodwork tests and will be meeting with her in a few weeks.

 

Urology – in 2001 I had my [only] encounter with a kidney stone. It was very painful. During the treatment and removal process, the urologist noted it was a uric acid stone. This is the same material that can cause gout if it settles in the ankles. After about 5 years of follow-up, he indicated that we did not need to meet again. The job of refilling the low-cost medicine (Allopurinol) used to keep the urine from getting too acidic was turned over to my PCP at the time.

 

Dermatology – on two occasions I noticed some small bumps forming on the skin of my forearms. Fearing it might be caused by skin cancer, I scheduled an appointment with a dermatologist. Both times he cut off the growthe and sent it for biopsy, and both times it came back negative. He gave me a prescription (betamethasone) to be used in the future. I recently started using it again on a new round of these bumps, but I now operate independently of the doctor.

 

Neurology – Since my current set of issues had a mental component, neurology got involved. As the testing needed is quite involved, they operate under the principle of “Diagnosis by Exclusion” i.e. finding all the things it's not. Getting no positive responses from the other medical areas, they needed to do their own testing and see if the remaining cause (mini-stoke or TIA) was indicated. After 24 hours of testing, I received the following message from them: “Your EEG did not show seizures or findings that indicate you are at an increased risk of seizure. We will discuss this further at your next visit.” So I’ll simply look for a follow-up visit perhaps a year from now.

 

Hematology – about a year ago, I found I was constantly being rejected when going to give blood because my iron level was too low. The hematologist said that it was like my body had a slow leak in it and recommended getting IV iron transfusions periodically. At that point my bloodwork showed a level of only 10. His recommendation was to shoot for a level of over 100. My readings since then have been 11, 15 [feeling like it wasn’t working well yet], then 51, 114, and recently 138. I have one more test and then a follow-up visit with him later this spring, so we’ll see what his recommendation is then.

 

Cardiology – the most significant medical event of my life, a “widow maker” heart attack happened in early 2005 (21 years ago). Because of my quick response, I am a survivor. I have no long-term issues, but I continue to have twice-yearly follow-up meetings to ensure it remains that way.

 

Endocrinology – diabetes is a messy and wide-spread disease. In type 2 diabetes the body doesn’t make enough insulin or doesn’t use it properly. This chronic condition is managed with lifestyle changes like diet and exercise, and sometimes medication. So medication has been my fallback position. I currently take pills (twice daily), an injection of insulin (twice daily), and another injection (once a week). This last injection seems to have done the trick with my body weight down nearly 30 pounds over 9 months. When I began having my current problems, there was a concern by the medical team that I may have overdone my routine and with the endocrinologist’s permission, we reduced my daily Lantus dosage. But now with my weight even further down and my wife’s focus on my diet, we’ll have to look at that again. I have two follow-up bloodwork tests and a scheduled meeting with my endocrinologist in two months to make those decisions.

 

Foot Surgery – in January 2024 I went to the ER feeling pretty lousy. While the staff was looking for the cause, one of the blood tests that they ran was on kidney function. The bottom line, i.e. the diagnostic, in this test is called an eGFR (estimated glomerular filtration rate). My eGFR was pretty horrible with a score of 10, indicating that my kidneys were close to failure. However, that was actually not the case. What I had was an infection around the area on my right foot where I had been working on correcting for several years. But now I had developed sepsis. One definition I have found for sepsis is “a life-threatening medical emergency where the body’s overwhelming response to an infection triggers a chain reaction …” In this case, the infection in my foot was being picked up by my blood which carried it to my kidneys to help clean that “dirty” blood. This automated diagnosis of my eGFR is like blaming your vacuum cleaner for the dirt on the floor, when all the vacuum cleaner is trying to do its job.

[eGFR]

Over the next several days while the surgeon was doing his job of giving me a TMA (trans-metatarsal amputation), the rest of staff were doing daily checking of my kidney function, watching it climb a few points each day. By the time I transferred to a rehab facility, my eGFR was back up to over 50 – not quite normal. As I write this, my last kidney function test shows that my score is 61, i.e. on the low end of normal. But alas, computers do not forget. So while my kidney function is now normal and there are not any ongoing issues with them, my medical record will continue to show that I have CKD (chronic kidney disease)! Our automated systems do have their limitations. I no longer need any follow-ups with my surgeon, but will continue to need to adapt to my amputation.

 

Gastro-Internist – this is the topic I started with in this blog. We’ve looked at all my bloodwork and a number of related items. But there are still areas that need to be addressed such as: how badly has my liver been damaged; how has my life expectancy been reduced; am I a candidate for a liver transplant (and does that answer change if I have a relative who is willing to be a donor)? I’ve gotten my meeting with the head of the GI team scheduled for next Wednesday where I’ll bring up all these issues, then we’ll see where it goes from there.

 

Conclusion

            This has been an intense few days of research and recounting my various medical issues. What does your story look like?

 

 

 

 

Christmas 2025

 

Christmas 2025

We thought that 2024 would be our last year together for our annual family vacation at Pinebrook, but then in addition to Tiernan getting a job there Aryon had trouble finding a job the Pinebrook asked Tiernan if his brother was available. But next year Aryon will be doing his military service and Tiernan has already let Pinebrook he will not be there so we’ll be down to just 5 grandchildren. So we’ve already decided that 2026 will be the last Russell summer at Pinebrook after being there nearly every year since 1977 – a run of nearly 50 consecutive years! Prices are also increasing regularly, so now is a good time to stop.

 

Family Updates

            I thought it might be interesting to give a quick synopsis of each family member.

·       Chris – was just named an associate at Lockheed – no increase in pay, just in responsibility

·       Pam – lots of responsibilities at their church

·       Aryon – in his junior year at Taylor. May be leaving college for the time being and getting a job.

·       Tiernan – in his freshman year at Taylor

·       Ilyanna – planning on going into the trades (not sure which one)

·       Matthew – still working for gun parts company (receiving, repackaging, shipping). Lives part-time with his parents and helps give medical aid to them.

·       Kim – Lost her job this summer and currently unemployed – actively looking for new job

·       Ethan – in an 11^th grade dual-enrollment program at Liberty University Online Academy. If all goes well will be graduating with an associates degree in 2028, then would like to get a job in railroading

·       Isaiah – 10^th grader at LUOA, thinking of getting a job in the trades – probably as an auto mechanic

·       Caleb – 10^th grader at LUOA, will likely go into their dual enrollment program

·       Asher – 8th grader at LUOA, probably will go into military

·       Donna – doing yard work (since I can’t), takes care of pets (4 cats, dog, 2 birds). Recently taking care of me (see next item)

Medical Update

Until about two months ago things were going well. Then started having physical issues and ended up in the hospital with a case of cirrhosis of the liver (sound familiar?) Still working through the issues involved, but a lot depends on a change of diet. However during the process I reached a milestone with a total weight loss of just over 200 (down nearly 30 pounds in the last year.) One more thing to track.

As always, we are finding that HE is in control and we need follow his leading.

 

 

Health Connections

 

There was a recent article posted on Fox News with the title “Why most people fall off a ‘health cliff’ at 75 — and 5 ways to avoid the drop” (https://www.foxnews.com/health/why-most-people-fall-off-health-cliff-75-ways-avoid-drop). This article was based on an episode of “60 Minutes.” Some of the key quotes were: “most people experience a steep decline in their 70s,” and “At 75, both men and women fall off a cliff.” Being on the far side of 75 myself, I can confirm that the number of medical issues increases at that time.

But I’ve also noted another phenomenon – that the issues we experience are not just individual and unrelated to each other. We tend to talk about them as separate issues – things like “I had a knee replacement”, or “I have diabetes.” But things are not that simple. I’d like to use this posting to relate three pairs of issues that I’m having, then concluding with a very involved situation I just went through.

 

Foot Amputation and Diabetes

I had been battling an issue with my feet for several years. The underlying cause was a malformation at the base of the big toe on my right foot. The pressure from walking on this resulted in the formation of a large callous. This eventually broke off, leaving a hole in my foot. After what seemed like continual issues, including getting neuropathy in the front part of both feet, I had multiple rounds of skin grafts, etc. But nothing seemed to work. I eventually got diabetes as well which added to the overall problem. It’s difficult to label things as “cause” or “effect”, but the chief take-away is that it often doesn’t matter.

In January, 2024, I went to the hospital with an apparent case of Covid – contracted by our son-in-law at his place of work and “shared” with the entire family. But as the on-call surgeon examined the wound on my foot, he made the determination that the extra level of infection in that part of my foot would be best “fixed” by removing first the offending toe, then on further examination that they amputate the front part of my foot as well.

 

Iron Levels and Gastrointestinal Issues

Since I post links to my blog on my Facebook page, that’s the source of most of my readers. Thus, it’s unusual that I get a response from someone outside that group of people. It’s even more unusual that I get a response from an organization. But that was the case not long ago when I got a response from just such a source. The following was posted in response to my blog on my medical conditions from last December

DCC Health ServicesOctober 23, 2025 at 1:07 PM

It’s really inspiring how you stay proactive about your health and keep such detailed notes. When you mentioned your liver specialist, it made me wonder about the difference between a hepatologist vs gastroenterologist — it’s something many people might overlook.

I’ve been seeing a gastroenterologist for the past few years.  This began when I had my first bout of a UTI (Urinary Tract Infection) and they detected the cause of that infection due to cirrhosis of my liver as well as a potential issue with my pancreas. The latter turned out to not be a major issue as the potential cancerous spot upon further examination turned out to not be cancerous. Instead I got put on a program of getting a CT scan every 6 months just to ensure that things did not progress in a “bad” way.

 

Diabetes and Cataracts

Sometimes the connection leads to positive results. One example from my life is that under Medicare, they will pay for an annual eye exam for anyone who is diabetic. Thus, when my annual exam detected the formation of cataracts, I quickly found myself at the office of an ophthalmologist and going through a few hours of intense testing. They quickly scheduled me for the removal of cataracts in both eyes, to be followed by monitoring for healing and then getting a new set of glasses.

Thus, in this case the connection had a positive outcome and resulted in fairly quick changes that may have taken much longer otherwise.

 

A “Perfect Storm”

Earlier this week I encountered a whole bunch of otherwise unrelated issues (primarily ones with medical implications) While earlier these may not have caused any problem, the body is not able to deal with so many of them as one ages. Here is list of all the issues I was dealing with (and all at the same time):

·       Vision restrictions – as I noted above, I was going through cataract surgery. After the second eye was done I was in a situation where my distance vision was severely compromised (this was probably the biggest issue listed here).After the first eye was done, I could still wear my prescription glasses and my eyes automatically adjusted to not using them for reading/middle distance, but continuing to rely on them for long distance. But after having surgery on the second eye that strategy did not work, so I had to get around with my compromised eyes. Once I get fitted for new lenses (next week!) this issue will be resolved.

·       Impact of diabetes medication – I began taking Mounjaro about six months ago. It takes a while to have an impact, but when I started my sugar levels were above 8 (the equivalent of 200+) – well into the “diabetic” range. But, true to expectations, they had been coming down and as of this hospital visit my sugar level was only 5.3 (the equivalent of 105) and below not only the “pre-diabetic” or “controlled” levels into the “non-diabetic” range. While this would be viewed as great news, it was also putting a strain on my body.

·       Iron levels – Just a week ago I had the third of my visits to the infusion center for additional iron (just think of a bag of fluid that looks like soy sauce). Again, preliminary results are positive, but another form of stress on my aging body.

·       Break in sternum – I never mentioned this to the hospital staff, but last week I cracked my sternum when trying to realign my water mug and pulling it toward me. While this is again not a serious issue, it adds to the overall stress as I try to avoid any additional movement that would either irritate it more or cause additional pain.

In addition to all these medical issues, I was having other stresses on my life. The Collegiate Outreach Board where I have served for about 20 years has shrunk and I am now the board chair, the secretary AND the treasurer. We had a meeting this past weekend where due to a number of circumstances I had to quickly put together an agenda as well as put together a couple of quarters of financial statements. I was aware that doing this while dealing with the above medical issues was a strain that I was not used to.

Finally, because of the changes introduced by the sale of our old house and moving in with our daughter and family there were a number of personal issues that impacted me.

On Sunday afternoon, the above set of issues pushed me “over the edge” – first becoming evident in the personal areas, then relatively quickly in the medical area. My interactions with my wife became increasingly improper as I found myself yelling and swearing at her (something that’s totally out of the norm for me and for which I later needed to apologize deeply. But then I began having medical complications as well where I could think but I couldn’t get the end of a sentence out and I was stumbling in my speech. Eventually my wife, to her credit, ended up calling an ambulance to take me to the ER as she couldn’t get me to agree that it was necessary.

The hospital staff, for whom I have the utmost respect, tried to find what was causing my condition. But they kept coming up negative on all their testing. (As my grandchildren later joked, they scanned my brain (an MRI) and couldn’t find anything!) I had a brain MRI, an EKG, an echo cardiogram, and innumerable personal tests – but everything was coming up normal! In the end they made a series of recommendation (which I have followed through on) – have my cardiologist look at the possibility of having me wear a cardiac monitor for a few weeks (which he declined as not being needed), making a slight reduction in the amount of insulin I take just so it doesn’t get too low (which my endocrinologist has agreed to), and having a follow-up visit with a neurologist in 4 weeks (which I already have scheduled). They also found evidence of a recent/newly started UTI, so they prescribed an antibiotic for a week. They also discontinued one of my medications since my results of the A1C show I no longer need it.

The bottom line is that while I did have some negative symptoms initially, there is no single cause evident, rather it’s the combination of all the little factors that pushed my body “over the edge”. Thus, there is no identifiable medical cause to be found – the solution is in the combination of factors. So, in the coming days I’ll focus on managing my body’s reaction to my need for new glasses, I’ll make the series of small changes that the doctors have recommended, and I’ll be grateful for a medical community that has expressed so much concern. But mostly I’ll try to find ways to repair the damage that I’ve done to the relationship with my wife who has had to  experience my inappropriate actions/words. Honey, I love you and appreciate all that you do!