The Los Angeles Times recently ran a series of editorials on the issue of homelessness in Los Angeles.
Excerpts:
Homelessness burst its traditional borders several years ago, spreading first to gloomy underpasses and dim side streets, and then to public parks and library reading rooms and subway platforms. No matter where you live in L.A. County, from Long Beach to Beverly Hills to Lancaster, you cannot credibly claim today to be unaware of the squalid tent cities, the sprawling encampments, or the despair and misery on display there.
[.....]
Today, we are paying the price: The economically homeless are now estimated to make up more than half of L.A.’s unhoused — and it is their rising numbers that are fueling the unprecedented growth in that population. More than half of the people surveyed by the Los Angeles Homeless Services Authority last year said they were homeless because of an eviction, foreclosure, unemployment or “financial reasons.”
[.....]
Until the mayor and the members of the City Council treat the building of these 10,000 units of housing with the kind of extraordinary urgency this crisis requires — the kind that the federal and state governments bestowed upon, for example, the rebuilding of the broken Santa Monica Freeway after the Northridge earthquake — they simply will not be built. And they must be built. Supportive housing in particular — which offers not just a place to live but also access to job counseling and mental health and substance abuse treatment, among other things — is the best long-term solution for the chronically homeless, whose cases are the most difficult to solve. A substantial number of these housing units must be located in every single council district. They cannot just be concentrated in poor areas or in neighborhoods with less political clout. Already, a new report shows that even more housing will be needed than was estimated at the time HHH was passed.
[.....]
The largest psychiatric institutions in the United States are the Los Angeles County jails, the Cook County Jail in Chicago and Rikers Island in New York. L.A. County incarcerates thousands of mentally ill people. The Sheriff’s Department reports that more than 70% of inmates who enter jail report a serious illness, either mental or physical. The county is moving forward with a $2-billion-plus plan to replace the aging Men’s Central Jail with a new facility specifically geared toward mental health treatment — but still a jail. We’re back where we started, but this time even more literally than before: Mentally ill people are prisoners. It’s not that jailers want the new business. It’s a population, L.A. County Sheriff Jim McDonnell recently told ABC7, “that I would argue should not be treated in a jail facility.”
[.....]
Across the city, drivers exiting freeways routinely encounter homeless people on the off-ramps shuffling from window to window requesting money. Libraries, train stations and public parks have become refuges for homeless people. In many residential neighborhoods and commercial districts, encampments have become a seemingly immutable fact of life. As homelessness spreads across Los Angeles County — the official tally shows a 46% increase from 2013 to 2017 — it is drawing two conflicting responses, at times from the same people. There’s sympathy and a desire to help, but there’s also a sense of being invaded and perhaps even endangered — in terms of both physical safety and public health
[.....]
Yet such a czar would only be as powerful as the mayor who appointed him or her. And in L.A., the mayor lacks legal authority to override City Council members, who can and do frequently say “no” to proposed housing and mental health facilities in their districts. And neither the mayor nor the czar would have control over the county, which supplies the services, or the region’s other 87 cities. Czar-like powers would be possible only if council members were to relinquish some land-use and budget authority through something like an emergency declaration. And remember, they never did that. They gathered together and said they were going to do it, and much of the world’s media mistook that cleverly phrased promise to do it as actually doing it. You’ll find news stories saying they did it. But they did not.
As an individual, there is little one can do against such massive needs. But we can be faithful to what we can do. Like most Angelinos, I voted for Measure H and HHH. I also donate to Union Rescue Mission and Salvation Army and Venice Family Clinic, three organizations that have been providing help for many years.
I'm a research scientist not a social worker. I'd have no idea how to help the people in these situations. Each person and family has a story and hats off to people who have the heart, knowledge, and skills to help them. And so I support the three organizations mentioned above. I'd encourage you to find a group or two to support. And maybe all of us together helping in some small way can begin to help turn the tide of this crisis.
Showing posts with label life. Show all posts
Showing posts with label life. Show all posts
Game 4 Grenfell - UK Guardian photos, BBC article and report from QPR
Some photos from the charity match at Loftus Road, home of Queens Park Rangers, one mile from the terrible Grenfell Tower fire.
To read about the BBC report on the event go here.
Text report and photos from the Queens Park Rangers site can be seen at this link.
Well done by all involved!
Game4Grenfell at QPR's Loftus Road – in pictures https://t.co/VcKXyrC28D— RF Chun (@a4theroad) September 5, 2017
To read about the BBC report on the event go here.
Text report and photos from the Queens Park Rangers site can be seen at this link.
Well done by all involved!
Game4Grefell - Hats off to QPR
While catching up on European soccer news, came across the charity match that will be televised in the UK to raise support for those who suffered so much loss as a result of the Grenfell Tower fire.
Hats off to QPR and all involved!
QPR, Queens Park Rangers, are the soccer club very closest to the site of the terrible fire. The club and its non-profit charitable foundation arm has teamed up with a number of other organizations and concerned individuals to host this event. If you follow the links, there is one that leads to an online donation page. I've made a small contribution and hope you will consider doing so as well. Thanks!💚 This lot have signed up for a #Game4Grenfell. Have you?— QPR FC (@QPRFC) August 30, 2017
Get your ticket from https://t.co/VDjHyW54SN! pic.twitter.com/XgE5M8WFEr
Hats off to QPR and all involved!
Health: My Story of Male Osteoporosis
The TV ads would suggest osteoporosis is a women's health issue.
However, men get osteoporosis also.
My diagnosis occurred by accident. Recently, had an episode of frozen shoulder. In order to be sure it wasn't something else, the orthopedic MD ordered an x-ray. It confirmed there was no overt structural problem in my shoulder. However, the radiologist commented on osteopenia.
The ball was thrown over to my primary care doctor (PCP) who then ordered a bone density scan.
The scan showed I had osteoporosis thus the PCP referred me over to the geriatrics department where I got blood tests for secondary osteoporosis. All of those tests came back negative and so the geriatrics MD recommended zoledronic acid by intravenous route. This medication is in the bisphosphonate class that is a very common approach to addressing osteoporosis.
Went to the infusion center on a Friday afternoon and got hooked up to an IV and the meds were delivered uneventfully. I was told that some percentage of patients experience flu-like symptoms. There is also a rare complication called osteonecrosis of the jaw.
Shortly after midnight, I felt some muscle aches. The pain grew more intense as Saturday wore on and eventually included a splitting headache. Could barely walk and with the splitting headache could not sleep. By midnight, the pain began to recede. All told the episode lasted about 24 hours.
I reported this to the geriatrics doctor and was told it seems to occur more often in male patients and the second dose is usually better tolerated. However, some patients switch to the oral form of the medication which can cause reflux and other GI distress so either way, there may be issues. I was told there are other medications but they are generally reserved for more serious cases and at this point there isn't warrant to go in that direction. My bone density scan is going to be repeated 2+ years after my first one and my situation will be re-assessed at that time. For now, the recommendation is to stick with zoledronic acid with a decision regarding route to be made later this year.
For more reading:
Data from HORIZON clinical trial of zoledronic acid shown to me by my geriatrics doctor. I was assured by the doctor that other studies show the medication works on men also. Here are some examples: study of the medication on male patients and a review item.
However, men get osteoporosis also.
My diagnosis occurred by accident. Recently, had an episode of frozen shoulder. In order to be sure it wasn't something else, the orthopedic MD ordered an x-ray. It confirmed there was no overt structural problem in my shoulder. However, the radiologist commented on osteopenia.
The ball was thrown over to my primary care doctor (PCP) who then ordered a bone density scan.
The scan showed I had osteoporosis thus the PCP referred me over to the geriatrics department where I got blood tests for secondary osteoporosis. All of those tests came back negative and so the geriatrics MD recommended zoledronic acid by intravenous route. This medication is in the bisphosphonate class that is a very common approach to addressing osteoporosis.
Went to the infusion center on a Friday afternoon and got hooked up to an IV and the meds were delivered uneventfully. I was told that some percentage of patients experience flu-like symptoms. There is also a rare complication called osteonecrosis of the jaw.
Shortly after midnight, I felt some muscle aches. The pain grew more intense as Saturday wore on and eventually included a splitting headache. Could barely walk and with the splitting headache could not sleep. By midnight, the pain began to recede. All told the episode lasted about 24 hours.
I reported this to the geriatrics doctor and was told it seems to occur more often in male patients and the second dose is usually better tolerated. However, some patients switch to the oral form of the medication which can cause reflux and other GI distress so either way, there may be issues. I was told there are other medications but they are generally reserved for more serious cases and at this point there isn't warrant to go in that direction. My bone density scan is going to be repeated 2+ years after my first one and my situation will be re-assessed at that time. For now, the recommendation is to stick with zoledronic acid with a decision regarding route to be made later this year.
For more reading:
Data from HORIZON clinical trial of zoledronic acid shown to me by my geriatrics doctor. I was assured by the doctor that other studies show the medication works on men also. Here are some examples: study of the medication on male patients and a review item.
Episode 7: The Bowels Awaken (albeit rather slowly)
Day 8 - Tuesday September 13
The overnight MD for 8-West is usually just one person for the unit but since the team showed up it must have been the transition to the morning shift that happens around 5AM.
The MD in charge asked a few questions and the order was given: nasal gastric tube insertion. In a matter of minutes, the tube was placed and in a matter of minutes hundreds of milliliters of fluid was collected in the vacuum trap. This would be the eighth time I've had this medical device utilized for my medical care - the second time during this hospitalization.
Eight days earlier .....
Day 1 - Tuesday September 6
On this day, I was scheduled for Laparoscopic Lysis of Abdominal Adhesions (video) (text explanation) at 1pm.
Briefly, I had surgery for small bowel obstruction in 2004. As a result, I was at risk for recurrent small bowel obstruction (SBO) due to adhesions from scar tissue formation resulting from the surgery. Most adhesions don't cause problems but some do and in my case, recurrent SBO episodes took place in 2005, 2009 (spring), 2009 (fall), 2014, and 2016 (spring) all resolved by non-surgical management using the nasal gastric tube and supportive IV.
After the episode in 2014, the surgeon in charge of my care said the number of recurrences is getting to be unusual high and elective surgical intervention might eventually need to be considered. After the episode in 2016, the surgeon in charge of my care (different MD), made a more insistent recommendation that elective surgical intervention should be very seriously considered. As a result of that recommendation, I was scheduled for elective surgery on this fine fall southern California day.
I checked into the procedure treatment unit (PTU). I changed into the surgical gown - a neat little thing that can be hooked up into a warm air blower! The nurse placed the IV catheter into my left hand. A member of the surgical team gave me a quick rundown of what to expect. For this type of surgery two hours would be typical if nothing unusual is found inside. The plan was to use four laparoscopic sites. However, if things got complicated, they would resort to a laparotomy. Blood transfusion is not anticipated but my blood type was determined should it be necessary.
I was informed that the surgery in the surgical suite I was scheduled for was running overtime and that there is a 45 minute sterilization procedure for the room before it would be ready for my surgery. I would know the surgery would be soon when the anesthesiologist checked in with me.
At 2pm, the anesthesiologist came by and explained what will happen. He and one of the medical students on the team walked with me as the medical bed threaded its way to the surgical suite. He asked about my research work and I asked him about his. Once in the surgical suite, I was transferred onto to the surgical stage. The anesthesiologist hooked me up to an IV and he explained he was beginning the process of putting me under. I was beginning to fade out. He placed an oxygen mask over me. I think the last thing I said was, "God bless you all." He said, "God bless you too."
I woke up in the post-anesthesia care unit (PACU). I was told by the surgeon that my case turned out to be more complicated that expected. Instead of just a few adhesions localized to one area there were dense matted adhesions in two areas. However, the team decided a laparotomy was not needed though it took nearly four hours to release all the adhesions.
With the anesthesia worked out of my system, I was moved into the transitional recovery unit (TRU). The regular surgical unit patient rooms on the eighth floor were full so I would be cared for in the TRU that is meant for recovery of out-patient procedures during the day. However, in a pinch they can be converted to regular recovery if somewhat cramped space for in-patients.
Day 2 - Wednesday September 7
A little after midnight, I hit the call button and reported feeling nausea. I was given some anti-nausea medication. I think it was around 2:30AM when I hit the call button again as the feeling came back and was much stronger. This time the overnight MD came in and explained nasal gastric tube insertion was necessary since I was suffering from post-operative ileus as my bowels were asleep as they don't like to be handled and four hours of handling had just taken place.
Day 3 - Thursday September 8
By nightfall, room 8331 opened up in 8-West. The IV fluids kept me hydrated. The NG tube suction kept the nausea and abdominal pains at bay.
Day 4 - Friday September 9
In the afternoon, the amount of fluid collected by the NG tube decreased enough that they removed the NG tube.
Day 5 - Saturday September 10
I began on some liquid diet with the plan of a discharge on Sunday. I felt the liquid food was still feeling a bit "heavy" but it wasn't too bad.
Day 6 - Sunday September 11
I was advanced to some solid food but it was was still feeling a bit "heavy" and it felt worse that on Saturday. The MD examined by abdomen and canceled the discharge order. One thing MDs try to avoid is sending people home only to have them come back into the ER with post-surgery complications. They thought that the post-operative ileus might still be hanging on.
Day 7 - Monday September 12
I went back to the liquid diet. It was still feeling a bit "heavy" and it was beginning to feel painful in my belly. I was given toradol since opioid (morphine and morphine-derivative) meds often slow down the digestive tract.
Day 8 - Tuesday September 13
Sometime after midnight, I can't remember when, I felt very bloated. There was so much air trapped in my belly that I belched repeatedly and it seemed to go on forever but it was probably just a couple of hours. Eventually, I hit the call button to report my situation to the nursing staff. They suggested that I get up and walk and see if it would clear up. I was able to walk around for a handful of minutes but I was starting to feel very weak and unstable and the nurse could see that I was at risk of falling so she brought me back to the room and had me sit in the chair. It seemed like a long time but was probably less than an hour when things started to go seriously sideways.
The nausea was welling up fiercely but vomit attempts come up dry after multiple attempts. The abdominal pain was off the charts; easily a 9 or 10 on the 0-10 pain scale the staff asks their patients to report their pain experience. I found sitting in the chair was getting very uncomfortable so I lowered by myself to the floor and put my face in the bucket in the hope vomiting would bring relief. But relief did not come.
I realized this was not going well and I hit the call button but was too weak to explain the reason for my call. The nurse came in and it was clear I was in distress and she was soon joined by several others. They tag teamed carried me off the floor and put me into bed and after a few questions and my weak attempts to describe what I was going through, the nursing staff paged the medical staff.
UPDATE: Was revisiting this post 1 year later and thought I'd add a few thoughts about morphine type pain medications. Clearly, there are occasions where receiving morphine and morphine-derivatives is entirely appropriate medically. For my SBO condition, I have generally declined the morphine because they can "slow down" the intestinal tract. You may have seen TV ads for the condition called OIC, opioid induced constipation. For people who have chronic pain and take opiod type medications, they often have constipation. Thus, in most of my hospital stays, I opted out of the morphine but did take it on a few occasions. So indeed, there were occasions when the pain was just too much and I would get the shot and the pain would dial down and one even feels a little euphoria as a result. However, at least for me, I would feel a miserable "brain haze" and overall "icky feeling" as it wore off.
The overnight MD for 8-West is usually just one person for the unit but since the team showed up it must have been the transition to the morning shift that happens around 5AM.
The MD in charge asked a few questions and the order was given: nasal gastric tube insertion. In a matter of minutes, the tube was placed and in a matter of minutes hundreds of milliliters of fluid was collected in the vacuum trap. This would be the eighth time I've had this medical device utilized for my medical care - the second time during this hospitalization.
The NG tube drew out liters of fluid through the day.
I found solace recalling the familiar Psalm written by David.
Day 9 - Wednesday September 14
Somewhere around mid-morning, I was wheeled down to the x-ray unit where contrast was delivered through the NG tube. The plan was to take a series of x-rays to monitor the flow of the contrast through my GI tract to see what was going on inside. Suffice to say I threw up some of the contrast but enough was inside me for the study to go forward. I can't recall how long I was down at the x-ray facility and at what intervals the x-rays were taken. Eventually, I was wheeled back up to 8-West where the portable x-ray unit would take additional pictures at designated intervals. By 3pm the nausea and pain from the fluid build up was too great and the NG tube suction was restarted. Additional x-rays were shot in the afternoon and early evening.
UPDATE: Revisiting this blog post almost a year later, I should note in regards to morphine (see notes on day 10), I did take some on this occasion in the late afternoon. Though the pain wasn't as intense as it was on day 8, it had just been so many hours of discomfort that I took the shot. Would also like to discuss, anti-nausea medication. The feeling of nausea is miserable. We know that feeling from sea-sickness (for those who have that problem - I do!) - that "I need to throw up and need to throw up now feeling." Of course, a lot of times, we don't actually throw up and it just feels icky. Anyway, I find nausea medicine takes the sensation back a couple of steps. It still doesn't feel great but it takes the edge off of it. And like the morphine, I did find myself getting a little foggy in the head as a result of taking it. So I did opt out of the nausea medicine when the nausea wasn't too bad. But I definitely did take that medication more frequently than the morphine.
Day 10 - Thursday September 15
The team ordered a CT scan with IV contrast for the morning. By the afternoon, the team told me that the contrast study from the previous day and from today showed that some of the contrast dye did make it into my colon but some was still trapped in the small bowels and that there were indications of looped bowels suggesting obstruction. It was likely I had some combination of small bowel obstruction and post-operative ileus. Whether one proceeded the other was not clear but the treatment for both was the same: NG tube and watch and wait. Surgical intervention would only be called upon if strangulation occurred.
Day 11 - Friday September 16
Up to this point, I had been given various saline solutions with dextrose to keep me hydrated and supplied with energy. However, this is not a complete nutritional profile. Since it was clear I would not be leaving anytime soon, provision needed to be made for me to receive total parenteral nutrition (TPN). Since this material cannot be delivered by the standard peripheral IV, a peripherally inserted central catheter (PICC) line needed to be installed.The specially trained technician swabbed my arm with disinfectant, laid out the sterile materials, visualized the vein in my arm with the ultrasound and threaded the catheter into the vein and eventually ending in my heart. Total time from beginning to end: 20 minutes. During this hospital stay, one song I learned in high school came to my mind during the many moments of discouragement. It is a simple song but it redirected my eyes toward God and sustained me.
Day 12 - Saturday September 17
The TPN bag was hung this evening. One bag had amino acids for my protein needs along with vitamins and minerals and a much higher percentage dextrose (sugar for calories) compared to the regular saline/dextrose IV bags. The other bag contained lipids and phospholipids.
UPDATE: Revisiting this blog post 1 year after this experience, I thought I'd mention a bit about the nutritional situation. The doctors went to TPN because they knew I would not be eating food anytime soon. The saline mix plus sugar IV that I had been receiving maintained my electrolyte balance which is absolutely essential as NG tube suction involves the loss of electrolytes that if not replenished would have potentially fatal consequences. At a nutritional level, by this point, the sugar in an IV is not enough nutrition. At this stage nearly 2 weeks into my hospitalization, my body had run down whatever stored sources of sugar I had, burning fat reserves to provide enough calories to keep various bodily functions going, and beginning to break down muscle to keep my supply of protein up for other higher priority functions. More nutrition was needed.
Day 13 - Sunday September 18
Rinse and repeat: the PICC line continued to give me TPN over a 24 hour period and the lipid bag was infused over 12 hours. NG tube output was measured during each shift and comparable replacement fluid was infused during that shift.
Day 14 - Monday September 19
Rinse and repeat: the PICC line gave me TPN over a 24 hour period and the lipid bag was infused over 12 hours. NG tube output was measured during each shift and comparable replacement fluid was infused during that shift.
Previously, the daily meds were: famotidine, lovenox, and atorvastatin. One new thing added was Reglan, three times a day via IV.
Today, I was issued "patio privileges" which meant I could tell the nurse that I was going to take a walk away from the 8th floor and could even go outside to the patios of the hospital. Since I was still dependent on the NG tube suction, the recommendation be away for a maximum of 30 minutes. I didn't have the energy to take advantage of it on this day but would in all the subsequent days.
Day 15 - Tuesday September 20
Rinse and repeat.
Day 16 - Wednesday September 21
The day started and seemed headed toward rinse and repeat. However, today, the team decided to test if I can go without the NG tube suction. The NG tube stayed in but I was unhooked from the suction starting in the late morning. If I felt nausea or pain, I was to report it to the nurses and they would examine me and reconnect me to the suction if needed. Interestingly and positively, no nausea or pain arrived after many hours "off leash!"
Liquid diet was started. Since my bowels had been asleep nearly 3 weeks, I was told take a sip every 10 minutes and don't push it. Just go slow.
Day 19 - Saturday September 24
More liquid diet. Take a bit every 10 minutes or so and don't push it. Just go slow.
Day 20 - Sunday September 25
Pureed food. Take a bit every 10 minutes or so and don't push it. Just go slow.
Day 21 - Monday September 26
Limited solid food. Take a bit every 10 minutes or so and don't push it. Just go slow.
The nutritionist came to check in on me in the morning. She anticipated I might be discharged on Tuesday. When I get home I was told to take it very slow. Wait a couple of weeks before adding raw fruits and vegetables.
The order was given to taper off the TPN. Because of the high dextrose content, they don't want to just stop the flow. The flow rate was cut in half for a couple of hours and then cut in half again for a couple of hours and then stopped all together.
By the afternoon, the PICC line was removed.
Day 22 - Tuesday September 27
Limited solid food. Take a bit every 10 minutes or so and don't push it. Just go slow.
Much appreciation goes to the staff of 8West, Team "L," the surgical group, and all the professionals at Ronald Reagan UCLA Medical Center for their efforts in my care. I am grateful we can find such people to do this kind of work - they are amazing.
Also, much thanks go to family and friends who visited and supported through prayer me and my wife through this health episode.
And most of all, God has shown me so much love and grace through Mrs. Rambler who was my heartbeat and rock to lean upon during this extended stay in the hospital.
Previous SBO hospitalizations:
2005
2016
Disclaimer: The material above is a description of my health experience. Though I have attempted to be accurate I am not a medical professional. If you are in need of actual medical advice, please contact your physician.
The overnight MD for 8-West is usually just one person for the unit but since the team showed up it must have been the transition to the morning shift that happens around 5AM.
The MD in charge asked a few questions and the order was given: nasal gastric tube insertion. In a matter of minutes, the tube was placed and in a matter of minutes hundreds of milliliters of fluid was collected in the vacuum trap. This would be the eighth time I've had this medical device utilized for my medical care - the second time during this hospitalization.
Eight days earlier .....
Day 1 - Tuesday September 6
On this day, I was scheduled for Laparoscopic Lysis of Abdominal Adhesions (video) (text explanation) at 1pm.
Briefly, I had surgery for small bowel obstruction in 2004. As a result, I was at risk for recurrent small bowel obstruction (SBO) due to adhesions from scar tissue formation resulting from the surgery. Most adhesions don't cause problems but some do and in my case, recurrent SBO episodes took place in 2005, 2009 (spring), 2009 (fall), 2014, and 2016 (spring) all resolved by non-surgical management using the nasal gastric tube and supportive IV.
After the episode in 2014, the surgeon in charge of my care said the number of recurrences is getting to be unusual high and elective surgical intervention might eventually need to be considered. After the episode in 2016, the surgeon in charge of my care (different MD), made a more insistent recommendation that elective surgical intervention should be very seriously considered. As a result of that recommendation, I was scheduled for elective surgery on this fine fall southern California day.
I checked into the procedure treatment unit (PTU). I changed into the surgical gown - a neat little thing that can be hooked up into a warm air blower! The nurse placed the IV catheter into my left hand. A member of the surgical team gave me a quick rundown of what to expect. For this type of surgery two hours would be typical if nothing unusual is found inside. The plan was to use four laparoscopic sites. However, if things got complicated, they would resort to a laparotomy. Blood transfusion is not anticipated but my blood type was determined should it be necessary.
I was informed that the surgery in the surgical suite I was scheduled for was running overtime and that there is a 45 minute sterilization procedure for the room before it would be ready for my surgery. I would know the surgery would be soon when the anesthesiologist checked in with me.
At 2pm, the anesthesiologist came by and explained what will happen. He and one of the medical students on the team walked with me as the medical bed threaded its way to the surgical suite. He asked about my research work and I asked him about his. Once in the surgical suite, I was transferred onto to the surgical stage. The anesthesiologist hooked me up to an IV and he explained he was beginning the process of putting me under. I was beginning to fade out. He placed an oxygen mask over me. I think the last thing I said was, "God bless you all." He said, "God bless you too."
I woke up in the post-anesthesia care unit (PACU). I was told by the surgeon that my case turned out to be more complicated that expected. Instead of just a few adhesions localized to one area there were dense matted adhesions in two areas. However, the team decided a laparotomy was not needed though it took nearly four hours to release all the adhesions.
With the anesthesia worked out of my system, I was moved into the transitional recovery unit (TRU). The regular surgical unit patient rooms on the eighth floor were full so I would be cared for in the TRU that is meant for recovery of out-patient procedures during the day. However, in a pinch they can be converted to regular recovery if somewhat cramped space for in-patients.
Day 2 - Wednesday September 7
A little after midnight, I hit the call button and reported feeling nausea. I was given some anti-nausea medication. I think it was around 2:30AM when I hit the call button again as the feeling came back and was much stronger. This time the overnight MD came in and explained nasal gastric tube insertion was necessary since I was suffering from post-operative ileus as my bowels were asleep as they don't like to be handled and four hours of handling had just taken place.
Day 3 - Thursday September 8
By nightfall, room 8331 opened up in 8-West. The IV fluids kept me hydrated. The NG tube suction kept the nausea and abdominal pains at bay.
Day 4 - Friday September 9
In the afternoon, the amount of fluid collected by the NG tube decreased enough that they removed the NG tube.
Day 5 - Saturday September 10
I began on some liquid diet with the plan of a discharge on Sunday. I felt the liquid food was still feeling a bit "heavy" but it wasn't too bad.
Day 6 - Sunday September 11
I was advanced to some solid food but it was was still feeling a bit "heavy" and it felt worse that on Saturday. The MD examined by abdomen and canceled the discharge order. One thing MDs try to avoid is sending people home only to have them come back into the ER with post-surgery complications. They thought that the post-operative ileus might still be hanging on.
Day 7 - Monday September 12
I went back to the liquid diet. It was still feeling a bit "heavy" and it was beginning to feel painful in my belly. I was given toradol since opioid (morphine and morphine-derivative) meds often slow down the digestive tract.
Day 8 - Tuesday September 13
Sometime after midnight, I can't remember when, I felt very bloated. There was so much air trapped in my belly that I belched repeatedly and it seemed to go on forever but it was probably just a couple of hours. Eventually, I hit the call button to report my situation to the nursing staff. They suggested that I get up and walk and see if it would clear up. I was able to walk around for a handful of minutes but I was starting to feel very weak and unstable and the nurse could see that I was at risk of falling so she brought me back to the room and had me sit in the chair. It seemed like a long time but was probably less than an hour when things started to go seriously sideways.
The nausea was welling up fiercely but vomit attempts come up dry after multiple attempts. The abdominal pain was off the charts; easily a 9 or 10 on the 0-10 pain scale the staff asks their patients to report their pain experience. I found sitting in the chair was getting very uncomfortable so I lowered by myself to the floor and put my face in the bucket in the hope vomiting would bring relief. But relief did not come.
I realized this was not going well and I hit the call button but was too weak to explain the reason for my call. The nurse came in and it was clear I was in distress and she was soon joined by several others. They tag teamed carried me off the floor and put me into bed and after a few questions and my weak attempts to describe what I was going through, the nursing staff paged the medical staff.
UPDATE: Was revisiting this post 1 year later and thought I'd add a few thoughts about morphine type pain medications. Clearly, there are occasions where receiving morphine and morphine-derivatives is entirely appropriate medically. For my SBO condition, I have generally declined the morphine because they can "slow down" the intestinal tract. You may have seen TV ads for the condition called OIC, opioid induced constipation. For people who have chronic pain and take opiod type medications, they often have constipation. Thus, in most of my hospital stays, I opted out of the morphine but did take it on a few occasions. So indeed, there were occasions when the pain was just too much and I would get the shot and the pain would dial down and one even feels a little euphoria as a result. However, at least for me, I would feel a miserable "brain haze" and overall "icky feeling" as it wore off.
The overnight MD for 8-West is usually just one person for the unit but since the team showed up it must have been the transition to the morning shift that happens around 5AM.
The MD in charge asked a few questions and the order was given: nasal gastric tube insertion. In a matter of minutes, the tube was placed and in a matter of minutes hundreds of milliliters of fluid was collected in the vacuum trap. This would be the eighth time I've had this medical device utilized for my medical care - the second time during this hospitalization.
The NG tube drew out liters of fluid through the day.
I found solace recalling the familiar Psalm written by David.
Psalm 23
The Lord is my shepherd,
I shall not want
He makes me lie down in green pastures
He leads me beside quiet waters
He restores my soul
He guides me in the paths of righteousness
For His name’s sake.
Even though I walk through the valley of the shadow of death
I fear no evil, for You are with me
Your rod and Your staff, they comfort me.
You prepare a table before me in the presence of my enemies
You have anointed my head with oil
My cup overflows
Surely goodness and lovingkindness will follow me all the days of my life
And I will dwell in the house of the Lord forever
Day 9 - Wednesday September 14
Somewhere around mid-morning, I was wheeled down to the x-ray unit where contrast was delivered through the NG tube. The plan was to take a series of x-rays to monitor the flow of the contrast through my GI tract to see what was going on inside. Suffice to say I threw up some of the contrast but enough was inside me for the study to go forward. I can't recall how long I was down at the x-ray facility and at what intervals the x-rays were taken. Eventually, I was wheeled back up to 8-West where the portable x-ray unit would take additional pictures at designated intervals. By 3pm the nausea and pain from the fluid build up was too great and the NG tube suction was restarted. Additional x-rays were shot in the afternoon and early evening.
UPDATE: Revisiting this blog post almost a year later, I should note in regards to morphine (see notes on day 10), I did take some on this occasion in the late afternoon. Though the pain wasn't as intense as it was on day 8, it had just been so many hours of discomfort that I took the shot. Would also like to discuss, anti-nausea medication. The feeling of nausea is miserable. We know that feeling from sea-sickness (for those who have that problem - I do!) - that "I need to throw up and need to throw up now feeling." Of course, a lot of times, we don't actually throw up and it just feels icky. Anyway, I find nausea medicine takes the sensation back a couple of steps. It still doesn't feel great but it takes the edge off of it. And like the morphine, I did find myself getting a little foggy in the head as a result of taking it. So I did opt out of the nausea medicine when the nausea wasn't too bad. But I definitely did take that medication more frequently than the morphine.
Day 10 - Thursday September 15
The team ordered a CT scan with IV contrast for the morning. By the afternoon, the team told me that the contrast study from the previous day and from today showed that some of the contrast dye did make it into my colon but some was still trapped in the small bowels and that there were indications of looped bowels suggesting obstruction. It was likely I had some combination of small bowel obstruction and post-operative ileus. Whether one proceeded the other was not clear but the treatment for both was the same: NG tube and watch and wait. Surgical intervention would only be called upon if strangulation occurred.
Day 11 - Friday September 16
Up to this point, I had been given various saline solutions with dextrose to keep me hydrated and supplied with energy. However, this is not a complete nutritional profile. Since it was clear I would not be leaving anytime soon, provision needed to be made for me to receive total parenteral nutrition (TPN). Since this material cannot be delivered by the standard peripheral IV, a peripherally inserted central catheter (PICC) line needed to be installed.The specially trained technician swabbed my arm with disinfectant, laid out the sterile materials, visualized the vein in my arm with the ultrasound and threaded the catheter into the vein and eventually ending in my heart. Total time from beginning to end: 20 minutes. During this hospital stay, one song I learned in high school came to my mind during the many moments of discouragement. It is a simple song but it redirected my eyes toward God and sustained me.
Weary and heavy laden
Gentle am I, humble in heart
And you shall find rest for your soul.
All things are given unto those who believe
Princes and lowly ones His blessings receive
And just when I think that means everyone but me
Jesus comes beckoning to me
Enter the holy gates just as you are
No need for a happy face, just come with your heart
And Jesus will bring us a joyful melody
If only His calling we heed
We are His little ones, children of God
Children and fellow heirs of His kingdome come
And we share the greatest love the world has ever seen
Here in the Lord's family
The TPN bag was hung this evening. One bag had amino acids for my protein needs along with vitamins and minerals and a much higher percentage dextrose (sugar for calories) compared to the regular saline/dextrose IV bags. The other bag contained lipids and phospholipids.
UPDATE: Revisiting this blog post 1 year after this experience, I thought I'd mention a bit about the nutritional situation. The doctors went to TPN because they knew I would not be eating food anytime soon. The saline mix plus sugar IV that I had been receiving maintained my electrolyte balance which is absolutely essential as NG tube suction involves the loss of electrolytes that if not replenished would have potentially fatal consequences. At a nutritional level, by this point, the sugar in an IV is not enough nutrition. At this stage nearly 2 weeks into my hospitalization, my body had run down whatever stored sources of sugar I had, burning fat reserves to provide enough calories to keep various bodily functions going, and beginning to break down muscle to keep my supply of protein up for other higher priority functions. More nutrition was needed.
Day 13 - Sunday September 18
Rinse and repeat: the PICC line continued to give me TPN over a 24 hour period and the lipid bag was infused over 12 hours. NG tube output was measured during each shift and comparable replacement fluid was infused during that shift.
Day 14 - Monday September 19
Rinse and repeat: the PICC line gave me TPN over a 24 hour period and the lipid bag was infused over 12 hours. NG tube output was measured during each shift and comparable replacement fluid was infused during that shift.
Previously, the daily meds were: famotidine, lovenox, and atorvastatin. One new thing added was Reglan, three times a day via IV.
Today, I was issued "patio privileges" which meant I could tell the nurse that I was going to take a walk away from the 8th floor and could even go outside to the patios of the hospital. Since I was still dependent on the NG tube suction, the recommendation be away for a maximum of 30 minutes. I didn't have the energy to take advantage of it on this day but would in all the subsequent days.
Day 15 - Tuesday September 20
Rinse and repeat.
Day 16 - Wednesday September 21
The day started and seemed headed toward rinse and repeat. However, today, the team decided to test if I can go without the NG tube suction. The NG tube stayed in but I was unhooked from the suction starting in the late morning. If I felt nausea or pain, I was to report it to the nurses and they would examine me and reconnect me to the suction if needed. Interestingly and positively, no nausea or pain arrived after many hours "off leash!"
Day 17 - Thursday September 22
By the afternoon, I had been off suction for over 24 hours so the team decided it was time to remove the NG tube!
Day 18 - Friday September 23
Day 18 - Friday September 23
Liquid diet was started. Since my bowels had been asleep nearly 3 weeks, I was told take a sip every 10 minutes and don't push it. Just go slow.
Day 19 - Saturday September 24
More liquid diet. Take a bit every 10 minutes or so and don't push it. Just go slow.
Day 20 - Sunday September 25
Pureed food. Take a bit every 10 minutes or so and don't push it. Just go slow.
Day 21 - Monday September 26
Limited solid food. Take a bit every 10 minutes or so and don't push it. Just go slow.
The nutritionist came to check in on me in the morning. She anticipated I might be discharged on Tuesday. When I get home I was told to take it very slow. Wait a couple of weeks before adding raw fruits and vegetables.
The order was given to taper off the TPN. Because of the high dextrose content, they don't want to just stop the flow. The flow rate was cut in half for a couple of hours and then cut in half again for a couple of hours and then stopped all together.
By the afternoon, the PICC line was removed.
Day 22 - Tuesday September 27
Limited solid food. Take a bit every 10 minutes or so and don't push it. Just go slow.
By 1pm I was officially discharged!
Another song that gave me comfort and strength during my three-week stay was this old classic hymn.
Another song that gave me comfort and strength during my three-week stay was this old classic hymn.
Great is thy Faithfulness (Thomas Chisholm)
Great is thy faithfulness, O God my Father
there is no shadow of turning with thee
thou changest not, thy compassions, they fail not
as thou hast been thou forever will be.
Great is thy faithfulness! Great is thy faithfulness!
Morning by morning new mercies I see
all I have needed thy hand hath provided
great is thy faithfulness, Lord, unto me!
Also, much thanks go to family and friends who visited and supported through prayer me and my wife through this health episode.
And most of all, God has shown me so much love and grace through Mrs. Rambler who was my heartbeat and rock to lean upon during this extended stay in the hospital.
Previous SBO hospitalizations:
2005
2016
Disclaimer: The material above is a description of my health experience. Though I have attempted to be accurate I am not a medical professional. If you are in need of actual medical advice, please contact your physician.
Harsanyi - How Obama Divides America
Hard hitting stuff over at Reason.com posting an op-ed from David Harsanyi.
Excerpts:
Seemingly every political battle waged by the modern Democratic Party—gay rights, immigration, climate change, inequality—is imbued with a kind of spiritual certitude that justifies circumventing debate. If a person who opposes the Obama administration's transgender bathroom policy is just like a Klansman, why even discuss the matter? In this context, the histrionics of Democrats in Congress over guns or the media's melodramas make all the sense in the world. [.......]
If you continually claim that every problem in America is driven by hate, people may start believing you. According to a new Pew Research Center poll, Americans' perception of race relations is more negative today than it has been in 20 years. About 48 percent of those polled claim that "race relations are generally bad." And 36 percent of adults say that "too much attention" is paid to race and racial issues today. Are things really worse today than they were 30 years ago? Fifty years?
When Obama calls for unity (you'll recall this was a big part of his first campaign), he's not talking about a nation that maximizes its freedom so that there is space for an array of cultural outlooks and ideas. He means a nation of diverse people who can all agree that progressivism is right for the nation.
Reading my Facebook newsfeed each day is a window into the divide --
Friends who are gun owners defending gun rights and other friends demanding more gun control ...
Friends who think the UK is crazy to do Brexit and others posting articles explaining it isn't such a bad idea ...
Friends who support Hillary and friends who don't ...
Friends who support Trump and friends who don't ...
Friends who think there is no room for objections to LGBT at any level and those who have reservations for religious reasons ...
Friends who think groups and people that are skeptical of global warming are criminal or crazy and those who link to articles that question climate change ...
Friends who support more immigration and others who thinks maybe it is time to slow down ...
Friends who are atheists who think theists are stupid and theists who think atheists are stupid ...
Friends who hate the 1% and businesses and there are those who question government over-regulation ...
And on and on ... and both sides blast the other side ...
People have always had differing opinions but now in the world of social media, it is available for everyone to see. On one hand, maybe it can open up real conversation? On the other hand, it may feed into polarization?
Excerpts:
Seemingly every political battle waged by the modern Democratic Party—gay rights, immigration, climate change, inequality—is imbued with a kind of spiritual certitude that justifies circumventing debate. If a person who opposes the Obama administration's transgender bathroom policy is just like a Klansman, why even discuss the matter? In this context, the histrionics of Democrats in Congress over guns or the media's melodramas make all the sense in the world. [.......]
If you continually claim that every problem in America is driven by hate, people may start believing you. According to a new Pew Research Center poll, Americans' perception of race relations is more negative today than it has been in 20 years. About 48 percent of those polled claim that "race relations are generally bad." And 36 percent of adults say that "too much attention" is paid to race and racial issues today. Are things really worse today than they were 30 years ago? Fifty years?
When Obama calls for unity (you'll recall this was a big part of his first campaign), he's not talking about a nation that maximizes its freedom so that there is space for an array of cultural outlooks and ideas. He means a nation of diverse people who can all agree that progressivism is right for the nation.
Reading my Facebook newsfeed each day is a window into the divide --
Friends who are gun owners defending gun rights and other friends demanding more gun control ...
Friends who think the UK is crazy to do Brexit and others posting articles explaining it isn't such a bad idea ...
Friends who support Hillary and friends who don't ...
Friends who support Trump and friends who don't ...
Friends who think there is no room for objections to LGBT at any level and those who have reservations for religious reasons ...
Friends who think groups and people that are skeptical of global warming are criminal or crazy and those who link to articles that question climate change ...
Friends who support more immigration and others who thinks maybe it is time to slow down ...
Friends who are atheists who think theists are stupid and theists who think atheists are stupid ...
Friends who hate the 1% and businesses and there are those who question government over-regulation ...
And on and on ... and both sides blast the other side ...
People have always had differing opinions but now in the world of social media, it is available for everyone to see. On one hand, maybe it can open up real conversation? On the other hand, it may feed into polarization?
Recurrent Small Bowel Obstruction and 24 Inches of Plastic Tubing
image source: http://www.oxfordmedicaleducation.com/clinical-skills/procedures/nasogastric-ng-tube/
24 inches of plastic tubing. Doesn't seem like much but it is one of the major pieces of technology in the non-surgical management of small bowel obstruction. The ER nurse knew my medical history so she knew I knew what was about to happen thus her explanation was relatively brief. In 2004, twelve years earlier, the descriptions and assurances were quite extensive as it was the first time I underwent the procedure. But on this afternoon, it was all done in short order. She coated the tubing with anesthetic gel and skillfully placed the nasal gastric tube.
24 hours earlier ........
April 22 Friday
I was at work having a mostly normal day. But inside, in my small intestines, things were not normal. Around 5PM, I began to experience abdominal pain. It was a familiar sensation. Over the years, sometimes the pain would go away after a few hours as the obstruction would resolve on its own in short order. On some occasions, the pain would remain at a low level for more than a few hours and then go away. On some occasions, the pain would escalate and the decision would be made to head to the emergency room. By midnight, the pain was present for seven hours and was increasing. We made the decision to head to the Ronald Reagan University Medical Center.
April 23 Saturday
Emergency department (ED) waiting rooms are somber places. The patient waiting is in some kind of distress. The family member or friend bringing them in is concerned.
The first point of contact with the ED is the triage nurse who asks some questions, gets medical history and takes vital signs. Some cases get moved right into the emergency room itself. Others are sent to the waiting area. Small bowel obstruction (SBO) in the early stages don't get moved to the front of the line so my wife and I waited quietly with about a dozen other people.
After an hour or so, I was called in. There are examination rooms with various equipment and there are designated areas in the hallway with a number on the wall where gurneys are parked. As would be typical for a big city ED there were many patients parked in the hallway and I was parked.
ED's are like Las Vegas casinos in a couple of ways: there is a pretty constant beehive of activity and you have no sense of the passage of time unless you have a watch or someone to tell you what time it is. When you are in pain time seems to pass very slowly. I was eventually examined by a doctor. I can't remember how long it was I was parked in the hallway. But during the passing time, I could see and hear the stories of other patients and what pain has brought them to the ED. Some are in good humor despite the suffering and others wail in pain. I tip my hat to the medical professionals who live and work in this world!
I have been told UCLA tries very hard to encourage good doctor-patient communication experiences. The doctor came he asked me to describe (without any interruption) what I was experiencing. He then did a physical exam. He said given my medical history and current physical state, an SBO was quite likely and a CT scan was ordered. Pain (morphine) and anti-nausea medication was administered and I began the process of drinking the liquid contrast for the CT scan.
Time passed and my drinking of the contrast liquid was slow. First, it tastes terrible and second, with a SBO (i.e. backed up plumbing in your gut), adding more fluid is very uncomfortable. The pain and nausea came back fiercely and I was given another dose of both meds. I eventually gulped down enough of the contrast liquid. However, the call to go to the CT didn't come. We asked about it and the nurse found out that one of the CT units had broken down so the backlog was causing the delay.
Eventually, I was rolled to the CT suite and a set of images were taken with the contrast liquid. Then another set was taken using IV contrast that gives an indication of blood flow to the area being imaged. I was rolled back to my spot in the hallway.
The MDs (two this time) came back and said, yup, the CT showed a SBO so we are going to admit you into the hospital but the problem right now is that the hospital is completely full. However, a bed should open up in a few hours.
At some point, I was moved into an examination room where the nasal gastric tube was installed and hooked up to the house vacuum system. By mid-afternoon, I was moved into Eighth Floor East Wing. The ED portion of the story was a least 14 hours.
The NG tube was gurgling and the IV was keeping my electrolytes in balance and giving me sugar for energy and I slept in short bits through the night.
April 24 Sunday
Psalm 27:1 The Lord is my light and my salvation - whom shall I fear? The Lord is the stronghold of my life - of whom shall I be afraid?
I was in 8-East so the window faced the morning dawn which roused me from my fitful slumber. I reached for the phone and snapped the picture you see above.
The surgical team made their visit and said it was pretty much wait and see.
SBO is a fairly common reason people are hospitalized. If a patient comes into the ED and determined to have SBO and they have NEVER had abdominal surgery, the recommendation is surgery. Tumors of the small intestine can cause SBO and they would not be detected by imaging. However, if a patient has SBO and they have had prior surgery, non-surgical management is recommended since the case may resolve on its own. In the case of recurrent SBO due to prior surgery, the reality is that even the best of surgical techniques can leave scar tissue adhesions on the intestines which raises the risk of SBO. In my case, the surgery was in 2004 and this was my fifth recurrent SBO.
Non-surgical management is not without risk. The main concerns are complications of the SBO. Strangulation of the bowel (blood flow being cut off) will lead to death of intestinal tissue and requires immediate surgical intervention. The other concern is perforation of the bowel that also demands immediate surgical intervention. Either can be fatal if surgical intervention is delayed. Thus, monitoring of the patient by direct observation, blood work up, and vital signs help the doctors know if things are going in a bad direction.
But if the patient appears stable, it is watch and wait and hope the SBO resolves on its own. One clue is the how much material is being collected via the NG tube. When the SBO resolves, fluid once again begins moving forward in the intestinal tract and less material is extracted by the NG tube suction.
April 25 Monday
Psalm 142:5 I cry to you, Lord; I say, “You are my refuge, my portion in the land of the living.”
With an NG tube placed and being in hospital (even if without an NG tube) is not conducive to high quality sleep and there is diminished quantity of sleep. Besides reduced sleep, physical weakness due to one's condition, and the uncertainty takes its toll on even the most positive of personalities. For me, I took to reading the Psalms on the Bible on my iPhone. I jotted down some phrases on the iPhone notepad that resonated with me. I've put some of them underneath the photos I took.
Check out this wonderful video of a conversation between U2 front man Bono and Bible scholar Eugene Peterson about the Psalms.
In the afternoon, the surgical team dropped by to check in on me. Based on the NG tube output and the x-ray they took in the morning, they decided to turn off the NG tube suction and installed a bag to collect fluid by gravity. The plan was to check back the next morning to see how much fluid would be collected.
April 26 Tuesday
Psalm 18:2 The Lord is my rock, my fortress and my deliverer; my God is my rock, in whom I take refuge, my shield and the horn of my salvation, my stronghold.
The surgical team came in and took a look at the NG tube collection bag and noted the volume and color. The volume was modest and the color consistent with gastric fluid. They decided it was time to take the NG tube out! The next test would be to have some liquid diet food for lunch and monitor my reactions.
Although I was already walking around (if at all possible patients are encouraged to get out of bed) the previous days, it is a bit easier with no NG tube. I did many laps around 8-East and ventured out to other parts of the 8th floor. I noticed the art work and below are pictures of some of my favorites.
Just love the humor of a picture of people looking at a picture!
Modern art can be hit or miss. At least this was kind of pretty and interesting!
Of course, you got to get an obligatory picture of a work by a famous artist like Worhol!
Hospitals and healing go together. In addition to the medical procedures and drugs, the other part of the equation is helping the patient's emotional state. I suppose that is part of the art collection to make the place seem more alive than just sterile walls. As I took my walks around the corridors, I came across many other patients doing the same thing. Some had an IV pole like myself. Others had many other things attached to them. But we all tried to give a smile to each other as we walked the hallways. I'm told also that there are more and larger windows in newer hospital design to bring more light in and allow the patients to see the outside world. In the rooms are couches and recliner chairs so that visitors can if they wish stay the night.
Visiting a patient in the hospital is not an easy thing to do for most people. It is a reminder of our mortality which is something most of us struggle with. Also, unless you have a special gift, knowing what to say or not to say is an issue. As someone laying in the hospital bed, I can only say that company is welcome. However, conversation readiness is highly variable from a patient perspective. Sometimes I felt filled with words that longed for someone to hear. But at other times, the medications or the lack of sleep or the aches and pains, the words were few and conversation was an energy drain and the silent company was needed and welcome. Thus, take your cues from the patient you are visiting.
Psalm 63:6 On my bed I remember you; I think of you through the watches of the night.
April 27 Wednesday
Psalm 19:1 The heavens declare the glory of God; the skies proclaim the work of his hands.
Good morning! Lunch and dinner (liquid meals) were tolerated from the day before. This morning was pureed food. By late morning, the word was given ... they were cutting me loose! The paperwork worked its way through the system and finally by early afternoon, my last tie to medical procedures was cut with the removal of the IV needle in my left forearm. Below is the IV pole on which hung the bags that fed me a saline solution with dextrose sugar and potassium for five days. The rectangular shaped boxes are the IV pumps. In my case, only one of them was active. I suppose some other patients might have multiple bags of things to be infused as there were three IV pumps on this pole.
Thanks to the doctors and nurses and staff of RRUMC. Thanks to friends and family who visited. And a huge thank you to Mrs. Rambler for love and support through this episode of "in sickness and in health" of our married life.
Previous SBO hospitalizations:
Disclaimer: The material above is a description of my health experience. Though I have attempted to be accurate I am not a medical professional. If you are in need of actual medical advice, please contact your physician.
Philemon - a small story of the big difference Jesus makes in life
What do Christians believe?
How do we see and describe how God is at work in the lives of human beings?
At one level, we can go to the theologically rich descriptions that can be found in St. Paul's writings in Romans and Galatians and other places. And there is definitely a place for that.
However, sometimes, it is just as powerful and perhaps even more so when we look at the "small" stories that reveal the big impact of what God means to people's lives.
In the New Testament, I think of the one chapter book of Philemon. It is the story of three men: Paul, Onesimus, and Philemon. These three me all want to follow Jesus. In 25 verses, we read their story in all its humanity and their wrestling with what it truly means to follow the Christ!
In the video below, noted Bible scholar NT Wright offers some of his reflections of the grandeur of what God was doing in Christ in the lives of these three believers. Their example of Jesus' reconciling work 21 centuries ago is just as relevant today.
How do we see and describe how God is at work in the lives of human beings?
At one level, we can go to the theologically rich descriptions that can be found in St. Paul's writings in Romans and Galatians and other places. And there is definitely a place for that.
However, sometimes, it is just as powerful and perhaps even more so when we look at the "small" stories that reveal the big impact of what God means to people's lives.
In the New Testament, I think of the one chapter book of Philemon. It is the story of three men: Paul, Onesimus, and Philemon. These three me all want to follow Jesus. In 25 verses, we read their story in all its humanity and their wrestling with what it truly means to follow the Christ!
In the video below, noted Bible scholar NT Wright offers some of his reflections of the grandeur of what God was doing in Christ in the lives of these three believers. Their example of Jesus' reconciling work 21 centuries ago is just as relevant today.
Association and separation?
In life, we rarely find ourselves in 100% agreement with people. We may share similar faith perspectives but disagree on some political matters. We might side with one political party in most issues but not all issues. We might hold certain doctrines of the Christian faith with greater firmness and less on others. On lighter concerns, like sporting matters, a Dodger fan probably could not root for the SF Giants with the possible exception of the Giants vs. NY Yankees!
We face the social dimensions of this question on the bigger issues: when do we associate even if we might disagree? When do we separate because the issue of disagreement is too large.
How do we provide a framework of choosing?
In USA political life, there are two major parties and though one can be a member of the myriad of small parties, realistically, the only candidates getting elected come from the two major parties. Thus, one chooses a party based on which is most inline with one's views. No party matches us 100% so we live with this association but separate on particular issues.
The same would be true for aspects of the Christian community.
A simple example is the divide over infant vs. adult baptism. Some Christians feel very strongly on this point and would use that as one factor in selecting a church to be a part of. While others don't feel so strongly and it isn't a consideration in the choice of a church to associate with.
I am still working out frames to analyze the issue trying to balance ideals and practical realities.
Here is where I am at right now.....
On issues of broad social interest I think the net of association should be pretty broad. As an example, the battle against human traffic draws people from many points-of-view. On this issue, Christians, Jews, atheists, agnostics, secularists, feminists, liberals, and conservatives can all work together to fight this.
When it comes to the overall peace and prosperity of our city and nation, I would support the capable candidate regardless of their individual faith/non-faith. Thus, I'd rather vote for a capable atheist than a sincere but in-over-their-head Christian to be mayor of my town or whatever the post might be.
If the audience and concern is a bit more narrow then I would cast a narrower net. For example, a group of Christians are gathering together to have a conference on how to communicate the value of faith to youth. On this matter, my filter for association might be as broad as does the group and individuals in the group subscribe to the Nicene Creed or the Apostle's Creed. I might add that I would want participants to hold that the Scriptures are a trustworthy and authoritative guide to doctrine and practice. Beyond that we might have differences in points-of-view on other more specific areas of Christian faith and practice.
Where I am beginning to see some clouds in this analysis in that there are Christians who would probably affirm the Nicene/Apostle's Creed but demure on the high view of the Scriptures. Additionally, there are a number of "denominationally distinctive" issues. In some cases, disagreement on one issue might be discomforting to me personally but not a cause to break association. As an example, I think adult baptism makes the most Scriptural sense but I would not separate from a church that practices infant baptism over that issue. But what happens when there are a multitude of issues? At what point is there too many disagreements leading to a need for separation?
We face the social dimensions of this question on the bigger issues: when do we associate even if we might disagree? When do we separate because the issue of disagreement is too large.
How do we provide a framework of choosing?
In USA political life, there are two major parties and though one can be a member of the myriad of small parties, realistically, the only candidates getting elected come from the two major parties. Thus, one chooses a party based on which is most inline with one's views. No party matches us 100% so we live with this association but separate on particular issues.
The same would be true for aspects of the Christian community.
A simple example is the divide over infant vs. adult baptism. Some Christians feel very strongly on this point and would use that as one factor in selecting a church to be a part of. While others don't feel so strongly and it isn't a consideration in the choice of a church to associate with.
I am still working out frames to analyze the issue trying to balance ideals and practical realities.
Here is where I am at right now.....
On issues of broad social interest I think the net of association should be pretty broad. As an example, the battle against human traffic draws people from many points-of-view. On this issue, Christians, Jews, atheists, agnostics, secularists, feminists, liberals, and conservatives can all work together to fight this.
When it comes to the overall peace and prosperity of our city and nation, I would support the capable candidate regardless of their individual faith/non-faith. Thus, I'd rather vote for a capable atheist than a sincere but in-over-their-head Christian to be mayor of my town or whatever the post might be.
If the audience and concern is a bit more narrow then I would cast a narrower net. For example, a group of Christians are gathering together to have a conference on how to communicate the value of faith to youth. On this matter, my filter for association might be as broad as does the group and individuals in the group subscribe to the Nicene Creed or the Apostle's Creed. I might add that I would want participants to hold that the Scriptures are a trustworthy and authoritative guide to doctrine and practice. Beyond that we might have differences in points-of-view on other more specific areas of Christian faith and practice.
Where I am beginning to see some clouds in this analysis in that there are Christians who would probably affirm the Nicene/Apostle's Creed but demure on the high view of the Scriptures. Additionally, there are a number of "denominationally distinctive" issues. In some cases, disagreement on one issue might be discomforting to me personally but not a cause to break association. As an example, I think adult baptism makes the most Scriptural sense but I would not separate from a church that practices infant baptism over that issue. But what happens when there are a multitude of issues? At what point is there too many disagreements leading to a need for separation?
Life: Episode V, SBO Strikes Back
For followers of this blog, you know I have been hospitalized for small bowel obstruction in 2004, 2005 and earlier in 2009 and later in 2009.
In 2004, there was a surgical intervention. One side-effect of a surgical intervention is the formation of scar tissue and possible adhesions. These raise the risk of future bowel obstruction episodes.
Think of the intestines as ribbons in a bowl (abdominal cavity). Normally, they slip and slide past each other without incident. But if one has scar tissue so they aren't so smooth in certain patches and they are sticky (adhesions), the ribbons will not always slip and slide past each other as smoothly and every once in a while they get stuck. At that point, the plumbing analog gives you the best picture - things get backed up!
And so it was at 2AM Thursday January 30. Sometimes, the pain goes away in an hour or so and I return to regular life. But by 8AM, the pain had not receded and I was concerned and phoned my primary care physician. He was booked for the day but slotted me in with one of the younger doctors in the office. J drove me to the office for the 10AM appointment.
The doctor had my medical history so she knew to ask about how the pain compared to previous episodes. She then listened for "bowel sounds" and then did a physical exam feeling different parts of my belly and asking where it hurt when she would press. My regular PCP swung by and they talked about my situation with me and agreed I should be sent to the ER at Santa Monica UCLA Orthopaedic Hospital.
ER's in big cities are busy places and the physical space of the ER often shows the signs of the wear and tear of lots of patients coming through. It took an hour or so before I was assigned an exam room. As I walked in, I could see patients in the hallways.
An IV line was put in, blood was drawn and I was given the "pink liquid" to drink for the CT scan. The pink liquid has bound iodine which allows the radiologist to see how well things are flowing/not flowing in my intestinal tract. One drinks the liquid a bit at a time and eventually when I drank enough of it and it had some time to work its way through my system, I was wheeled into the CT scanner for pictures. This was followed by another set of pictures with iodine introduced through the IV. The sensation of the iodine coursing throughout the body is unmistakeable hence the radiology technician always tells you in advance what you will experience so it won't be so alarming.
With the two sets of pictures completed, I was wheeled back to the ER exam room.
As I mentioned, the ER exam area is crowded with mere curtains separating the exam beds. The two patients nearest me were clearly elderly patients. I didn't actually see them but I could hear the doctors asking them questions. Since they could not hear well, the doctors and nurses were asking them questions quite loudly! And indeed, from the questions, their conditions were quite serious.
Eventually, the ER doc on my case came in and said, you got a partial small bowel obstruction and we are going to put a nasal gastric tube into you and admit you into the hospital.
The nurses came to put in the NG tube and explained what they would do. Having been through the procedure four times before, I knew the drill. Nonetheless, the sensation of having a plastic tube threaded into your nose and down your throat into your stomach is not something you ever get used to.
I was moved into a room in 4NW - fourth floor north wing. The low steady suction was turned on. I was given a shot for the nausea which would eventually recede as the NG tube took out backed up fluid in my stomach. The IV kept me hydrated, my potassium levels at the proper level, and provided calories. When evening rolled around they gave me a stomach acid blocker through the IV and a shot to stave of blot clots. The shot was into my belly fat!
Friday morning brought the morning blood draw, x-ray and visit by the surgical team. Later I was visited by the hospitalist. The hospitalist is like the primary care doctor but she/he works in the hospital. Both the surgeon and hospitalist seemed upbeat about my situation. SBO is not an uncommon reason for hospitalization and their plan was to let the NG tube work and avoid surgery if at all possible. They encouraged me to get up and walk around.
By Friday afternoon, they pulled out the NG tube and would observe me on Saturday. Saturday morning x-ray. They said it looked good so Saturday lunch, I had my first meal - the liquid diet. Saturday night I had my first regular meal. Sunday morning, I had a light breakfast and they cut me loose!
A huge thank you to the nurses and staff of 4NW! You guys/gals are terrific. And thanks to the docs - PCPs, ER, radiologists (never actual met them!), surgical consult team and hospitalists!
Disclaimer: The material above is a description of my health experience. Though I have attempted to be accurate I am not a medical professional. If you are in need of actual medical advice, please contact your physician.
In 2004, there was a surgical intervention. One side-effect of a surgical intervention is the formation of scar tissue and possible adhesions. These raise the risk of future bowel obstruction episodes.
Think of the intestines as ribbons in a bowl (abdominal cavity). Normally, they slip and slide past each other without incident. But if one has scar tissue so they aren't so smooth in certain patches and they are sticky (adhesions), the ribbons will not always slip and slide past each other as smoothly and every once in a while they get stuck. At that point, the plumbing analog gives you the best picture - things get backed up!
And so it was at 2AM Thursday January 30. Sometimes, the pain goes away in an hour or so and I return to regular life. But by 8AM, the pain had not receded and I was concerned and phoned my primary care physician. He was booked for the day but slotted me in with one of the younger doctors in the office. J drove me to the office for the 10AM appointment.
The doctor had my medical history so she knew to ask about how the pain compared to previous episodes. She then listened for "bowel sounds" and then did a physical exam feeling different parts of my belly and asking where it hurt when she would press. My regular PCP swung by and they talked about my situation with me and agreed I should be sent to the ER at Santa Monica UCLA Orthopaedic Hospital.
view of north wing (photo using paper artist app)
ER's in big cities are busy places and the physical space of the ER often shows the signs of the wear and tear of lots of patients coming through. It took an hour or so before I was assigned an exam room. As I walked in, I could see patients in the hallways.
An IV line was put in, blood was drawn and I was given the "pink liquid" to drink for the CT scan. The pink liquid has bound iodine which allows the radiologist to see how well things are flowing/not flowing in my intestinal tract. One drinks the liquid a bit at a time and eventually when I drank enough of it and it had some time to work its way through my system, I was wheeled into the CT scanner for pictures. This was followed by another set of pictures with iodine introduced through the IV. The sensation of the iodine coursing throughout the body is unmistakeable hence the radiology technician always tells you in advance what you will experience so it won't be so alarming.
With the two sets of pictures completed, I was wheeled back to the ER exam room.
As I mentioned, the ER exam area is crowded with mere curtains separating the exam beds. The two patients nearest me were clearly elderly patients. I didn't actually see them but I could hear the doctors asking them questions. Since they could not hear well, the doctors and nurses were asking them questions quite loudly! And indeed, from the questions, their conditions were quite serious.
Eventually, the ER doc on my case came in and said, you got a partial small bowel obstruction and we are going to put a nasal gastric tube into you and admit you into the hospital.
The nurses came to put in the NG tube and explained what they would do. Having been through the procedure four times before, I knew the drill. Nonetheless, the sensation of having a plastic tube threaded into your nose and down your throat into your stomach is not something you ever get used to.
I was moved into a room in 4NW - fourth floor north wing. The low steady suction was turned on. I was given a shot for the nausea which would eventually recede as the NG tube took out backed up fluid in my stomach. The IV kept me hydrated, my potassium levels at the proper level, and provided calories. When evening rolled around they gave me a stomach acid blocker through the IV and a shot to stave of blot clots. The shot was into my belly fat!
Friday morning brought the morning blood draw, x-ray and visit by the surgical team. Later I was visited by the hospitalist. The hospitalist is like the primary care doctor but she/he works in the hospital. Both the surgeon and hospitalist seemed upbeat about my situation. SBO is not an uncommon reason for hospitalization and their plan was to let the NG tube work and avoid surgery if at all possible. They encouraged me to get up and walk around.
north facing window while walking the 4th floor (photo using paper artist app)
A huge thank you to the nurses and staff of 4NW! You guys/gals are terrific. And thanks to the docs - PCPs, ER, radiologists (never actual met them!), surgical consult team and hospitalists!
Disclaimer: The material above is a description of my health experience. Though I have attempted to be accurate I am not a medical professional. If you are in need of actual medical advice, please contact your physician.
New template
Turned 50 this year!
This blog has been left someone underused these days. But I've decided to recognize leaving the 40-something life with a new template and color scheme.
Hope to write here occasionally!
This blog has been left someone underused these days. But I've decided to recognize leaving the 40-something life with a new template and color scheme.
Hope to write here occasionally!
In memoriam: Kuan-Teh Jeang, 1958-2013
Before I start today’s seminar, I would like to offer some brief remarks in memory of Kuan-Teh Jeang who died last Sunday, January 27 at age 54. I was a post-doctoral fellow in his lab at the NIH from 1993 to 1997 working on the molecular biology of HIV.Remarks by Michael Gottesman at Retrovirology.
This photograph (shown above) is from 2012 when he gave the George Khoury lecture in October. This named lecture was started at the NIH in 1994 to recognize the highest levels of scientific research and to remember Dr. Khoury who was one of the bright stars of the NIH who died much too soon. It should be noted that Teh started his scientific career as a post-doctoral fellow in George Khoury’s lab about 25 years ago. And so giving the lecture was both a tremendous scientific and personal occasion for Teh. Who could have known that three months later another one of NIH’s leading lights would pass away much too soon. Suffice to say, Teh’s scientific accomplishments in the field of the molecular biology of human retroviruses were numerous and are best detailed in official remembrances of his life.
I’ll simply say, it was a tremendous honor to work at the NIH for those four years. Teh was the energetic and tireless leader of our research group dedicated to peeling back what was unknown about HTLV and HIV. On a personal level, since our group was composed of post-docs who came from far and wide from Washington DC, he generously gave personal attention and practical help to us, his incoming post-docs. Those simple kindnesses helped us settle into our lives in and around Bethesda.
May God rest his soul and comfort his wife and three children who remain.
Post at BioMedCentral.
Comment from Journal of the International AIDS Society.
Statement at Cell and Bioscience.
Notice at the NIAID/NIH web site.
As part of the network of lab alumni, I've received notice that two longer recollections will be published at Cell and Bioscience and Journal of Biomedical Sciences. I will link to them when they go live.
UPDATES:
Obituary at Journal of Biomedical Sciences.
In memoriam at Cell and Bioscience.
Editorial item at Cell and Bioscience.
Life: A Day of Loss at Sandy Hook Elementary School
Despair we fight to keep at bay
As we cry for those lost today
May arms enfold those who sorrow
And love be present when they awake tomorrow
To those near give strength for the sad to borrow
To have hope renewed in the days after tomorrow
As we cry for those lost today
May arms enfold those who sorrow
And love be present when they awake tomorrow
To those near give strength for the sad to borrow
To have hope renewed in the days after tomorrow
Politics: Election Day In America
Got to my polling place 10 minutes before opening at 7AM. By the time, the poll worker announced, "The polls are open," there were 20 in line. I got in and marked my ballot with the ink-a-vote pen and feed it into the reader. My ballot was the second one cast.
All across America, this civic ritual is taking place in fire stations, homes, schools, church gyms and condo/apartment recreation rooms.
As one born in the USA, I've known this opportunity since I was 18. This morning, I think about those new citizens and the excitement they feel the first time they cast a ballot. For some in this world, casting a vote is a charade for dictators to say they have 99% of the support of their people. For some in this world, the possibility doesn't even exist.
Let us take on this responsibility with gratitude and sober mind. And let us offer up a prayer for those elected to govern whether we voted for them or not.
All across America, this civic ritual is taking place in fire stations, homes, schools, church gyms and condo/apartment recreation rooms.
As one born in the USA, I've known this opportunity since I was 18. This morning, I think about those new citizens and the excitement they feel the first time they cast a ballot. For some in this world, casting a vote is a charade for dictators to say they have 99% of the support of their people. For some in this world, the possibility doesn't even exist.
Let us take on this responsibility with gratitude and sober mind. And let us offer up a prayer for those elected to govern whether we voted for them or not.
Life: First Time Home Buyer Experience, Part II
Our bid process was relatively uneventful.
We made an offer. The seller made a counter offer. We accepted.
The train began running down the tracks!
The loan process
It is a lot of paper work so get on that right-away.
Multiple Steps
After the loan paperwork gets started, you will be working with inspectors. Our realtor recommended Advanced Group Property Inspections. You can inspect as much as you like but the cost is on the buyer as part of the due-diligence.
The inspector checks the place out for problems big and small.
Indeed, if they find a big problem of deal breaker proportions, it is part of the purchase contract that you can bail out and recover your deposit (in our case 3% of the agreed upon price).
For smaller problems, you can ask the seller to fix something or offer some cash credit to fix the problem later. If your requests aren't a deal breaker for them, they often will meet you part of the way on the request to keep the deal moving forward.
In our case, there were a few things here and there so we requested some cash credit and the seller agreed to meet us half-way on that.
We made an offer. The seller made a counter offer. We accepted.
The train began running down the tracks!
The loan process
It is a lot of paper work so get on that right-away.
We got the feeling the industry is pretty competitive as the rates and fees cited by three mega-banks (Chase, Wells Fargo and Bank of America) was pretty much the same.
Since we have a lot of our financial services handled by Bank of America, we went with them.
Everyone has a horror story about bank mix-ups in the loan processing.
On one hand, I'm surprised given how many loans are processed over the decades you would think the process is well worked out. But on the other hand, so many hands touch the documents that something inevitably gets fouled up.
I won't name names at Bank of America but, on the whole, our customer service experience from them would not get an "A" rating; maybe a "B-" and more likely a "C."
Maybe my expectations were too high. Alas, we were told that the boo-boos on the paperwork, missed deadlines and general air of low communication we experienced were not unusual.
So my only advice would be to read everything as careful as you can. At various points we found the city of the property wrong, birthday listed incorrectly, conflicting instructions on how to fill out various forms, phone numbers mistaken, etc.
Also, keep track of the timelines and be sure to call to check that things were on track. Even with our consistent contacts with the lender and our agent's contacting the lender, deadlines were missed by a couple of days on two occasions (conditional approval and final approval).
Everyone will have advice for you and you just have to weigh it for yourself. Certainly, if you got a good realtor, and we did, that helps. He or she will know about local conditions in the area you are buying into. He or she will also know about what kind of issues are cropping up from lenders.
Get input from web pages and others who have purchased recently. We also leaned on Home Buying for Dummies.
Multiple Steps
After the loan paperwork gets started, you will be working with inspectors. Our realtor recommended Advanced Group Property Inspections. You can inspect as much as you like but the cost is on the buyer as part of the due-diligence.
The inspector checks the place out for problems big and small.
Indeed, if they find a big problem of deal breaker proportions, it is part of the purchase contract that you can bail out and recover your deposit (in our case 3% of the agreed upon price).
For smaller problems, you can ask the seller to fix something or offer some cash credit to fix the problem later. If your requests aren't a deal breaker for them, they often will meet you part of the way on the request to keep the deal moving forward.
In our case, there were a few things here and there so we requested some cash credit and the seller agreed to meet us half-way on that.
You will also work with an escrow company that serves as the neutral third party between buyer and seller handling funds and documents. The seller selected Peninsula Escrow. The mountain of paperwork is quite daunting. In end, we didn't read every line of every page but we did look closely at pages that were obviously specific to our situation and we did find one document that belonged to another file that was being worked on in their office. Peninsula Escrow staff communication skills were much better than Bank of America! And that is all I'm going to say about that!!
So after the initial flurry of activity with loan applications, inspections and escrow forms, things become quiet as the various entities beaver away at the paper work ...
So after the initial flurry of activity with loan applications, inspections and escrow forms, things become quiet as the various entities beaver away at the paper work ...
Life: First time home buyer experience, part I
We have moved in to our new place!
Don't plan to write a whole novel on the experience but would like to process the experience by sharing a few observations on the process in some blog posts.
Step one: look over your finances.
Given the amount of time, effort and funds, purchasing a home is quite a process since most of us aren't swimming in dollars! Most banks have first-time home buying educational web pages that help you figure out key financial questions: What will be your monthly expenses will be? What kind of downpayment you will need?
Identify a lender you will likely get a mortgage from and get pre-approved. That letter helps the seller take you more seriously.
Step two: figure out where you would like to live given the financial constraints you identify from step one and start looking at places and neighborhoods.
Here is where a realtor could be helpful.
We worked with Glenda Lousignont. She knows the part of Los Angeles County we were interested in.
Mrs. Rambler and I give a big thumbs up to Glenda for her efforts in showing us places and answering our many questions!
Life: An animal watcher's psalm
As the deer pants for water
May my soul long for Thee.
As the pup yearns and reaches
May my heart feel Your touch.
As the cattle graze on hills
May my being enjoy Your care.
As the kitten sleeps in serenity
May my spirit rest in trust.
As the pelican plunges into sea
May my mind hunger for truth.
As the shorebird advance and retreat
May my will move with Thee.
As the sheep live in pasture
May my soul be at peace.
May my soul long for Thee.
As the pup yearns and reaches
May my heart feel Your touch.
As the cattle graze on hills
May my being enjoy Your care.
As the kitten sleeps in serenity
May my spirit rest in trust.
As the pelican plunges into sea
May my mind hunger for truth.
As the shorebird advance and retreat
May my will move with Thee.
As the sheep live in pasture
May my soul be at peace.
Life: Probiotics and my digestive system
Okay, this post might cross into that Too Much Information category but I'll go ahead anyway!
Like many people, I have somewhat common and frequent digestive system discomforts. As such, the probiotics industry is growing by providing various tablets, liquids and foods with probiotic additives.
I have attempted a simple semi-scientific test. For 28 consecutive days, I had one serving at breakfast of probiotic yogurt or kefir from Green Valley Organics. I kept a log of my digestive discomforts. I would note a score of "1" for any symptoms. If they are more notable, I would log a "3" for that day. I also kept a log of 28 consecutive days when I did not take any probiotic product for breakfast.
With the yogurt and kefir, I logged a score of 22 compared to 24 without. Not much of a difference so far. One can imagine many other factors impact digestive discomforts. Obvious is ordinary ups and downs of life stress. Another is the occasional meal this might have been a little too exotic. But hopefully, over a 28 day survey period all those even out.
Anyway, I am starting another 28-day cycle with the product and will keep the log again and see how the numbers stand.
As for the yogurt and kefir itself, I do enjoy them and if they help the tummy feel better that would be a bonus.
Like many people, I have somewhat common and frequent digestive system discomforts. As such, the probiotics industry is growing by providing various tablets, liquids and foods with probiotic additives.
I have attempted a simple semi-scientific test. For 28 consecutive days, I had one serving at breakfast of probiotic yogurt or kefir from Green Valley Organics. I kept a log of my digestive discomforts. I would note a score of "1" for any symptoms. If they are more notable, I would log a "3" for that day. I also kept a log of 28 consecutive days when I did not take any probiotic product for breakfast.
With the yogurt and kefir, I logged a score of 22 compared to 24 without. Not much of a difference so far. One can imagine many other factors impact digestive discomforts. Obvious is ordinary ups and downs of life stress. Another is the occasional meal this might have been a little too exotic. But hopefully, over a 28 day survey period all those even out.
Anyway, I am starting another 28-day cycle with the product and will keep the log again and see how the numbers stand.
As for the yogurt and kefir itself, I do enjoy them and if they help the tummy feel better that would be a bonus.
Life: Thoughts by the Shore
The constant crash of sea to shore
How small we on this earthly place
Enamored with our thoughts that roar
Drowning out God's whispers of grace.
You are constant as sea to sand.
Water gently caressing my feet
Sand settling around where I stand
Embedding grace - God and I meet.
How small we on this earthly place
Enamored with our thoughts that roar
Drowning out God's whispers of grace.
You are constant as sea to sand.
Water gently caressing my feet
Sand settling around where I stand
Embedding grace - God and I meet.
Life: Remembering the I have a Dream Speech
Simply wonderful!
Students recite portions of MLK's famous speech at the Lincoln Memorial.
Students recite portions of MLK's famous speech at the Lincoln Memorial.
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